Cellinjuryanddeath lecture-i-090515081023-phpapp01
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Transcript of Cellinjuryanddeath lecture-i-090515081023-phpapp01
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PATHOLOGICAL CALCIFICATION PATHOLOGICAL CALCIFICATION
Definition:-
Abnormal deposition of calcium salts together with smaller amount of Mg++ ,Fe++ & other minerals in tissues other than osteoid or enamel
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• Dystrophic calcificationDystrophic calcification
• Metastatic calcificationMetastatic calcification
Pathologic calcificationPathologic calcification
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• Dystrophic calcification
refers to local deposition of calcium salts in necrotic or degenerate tissues, whatever the type of necrosis, in spite of normal serum Ca++
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Pathologic CalcificationPathologic Calcification
Dystrophic CalcificationDystrophic Calcification
- Area of tissue necrosis- Area of tissue necrosis
- Aging or damage heart valve- Aging or damage heart valve
- Atherosclerosis- Atherosclerosis
- Single necrotic cell- Single necrotic cell
“ “psammoma body”psammoma body”
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Aortic valve , gross , (calcified aortic stenosis).
55
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Metastatic calcification reflects deranged calcium metabolism in contrast to dystrophic calcification and is associated with increase serum calcium level & systemic deposition of Ca++salts in interstitial tissue of gastric mucosa, kidney,lungs,systemic arteries& pulmonary veins.
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• Increased secretion of parathyroid hormone Increased secretion of parathyroid hormone • Destruction of bone tissue 2ndry to primary tumor of Destruction of bone tissue 2ndry to primary tumor of bone marrow ( multiple myeloma, leukemia), or diffuse bone marrow ( multiple myeloma, leukemia), or diffuse skeletal metastasis.skeletal metastasis.• Vitamin D-related intoxicationVitamin D-related intoxication• Renal failureRenal failure•Excessive intake of calcium & absorbable antacids as Excessive intake of calcium & absorbable antacids as milk or calcium carbonate.milk or calcium carbonate.
Metastatic calcificationMetastatic calcificationHypercalcimiaHypercalcimia
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This is dystrophic calcification in the wall of the stomach. At the far left is an artery with calcification in its wall
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“Metastatic calcification" in the lung of a patient with a very high serum calcium level (hypercalcemia).
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PIGMENTSPIGMENTSEX-ogenous--- (tattoo, Anthracosis)
END-ogenous--- they all look the same, (e.g., hemosiderin, melanin, lipofucsin, bile), in that hey are all golden yellowish brown on “routine” Hematoxylin & Eosin (H&E) stains
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Accumulation of PigmentsAccumulation of Pigments
• Exogenous pigments Carbon ( anthracosis) Coal dust ( pneumoconiosis) Lung: pick up by alveolar macrophages
regional lymph nods
blackening the tissues of the lungs (anthracosis)
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TATTOO, MICROSCOPICTATTOO, MICROSCOPIC
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ANTHRACOSISANTHRACOSIS
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Pulmonary anathracosis (deposition of carbon particles)
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Carbon- laden macrophages (black exogenous pigment)
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• Endogenous pigment
:Lipofuscin – aging pigment(fucus=brown)
lipid, phospholipid-protein complex (lipid peroxidation) ,brown-yellow pigment accumulated as the atrophic and dying cells undergo autophagocytosis. Harmless,Sign of free radical injury & lipid perioxidation, seen in aging patients severe malnutrition & cancer cachexia.
Accumulation of PigmentsAccumulation of Pigments
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Lipofuscin granules in a cardiac myocyte as shown by A, light microscope (deposits indicated by arrows) , and B,Electron microscopy (perinuclear ,intralysosomal location).
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Lipofuscin (wear & tear) pigments in cardiac myocytes
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MelaninMelanin
• Melanin – melas= black
• In melanocytes formed by oxidation of tyrosine to dihydroxyphenylalanine by tyyrosinase enzyme
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Nevus ( melanin pigmentation)
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:Hemosiderin – aggregates of ferritin micelles (iron + apoferritin = ferritin) Hemosiderosis:- Excess of hemosiderin granules in mononuclear phagocytes without organ dysfunction Causes:- Local (bruise) Systemic as Hemolytic anemia, Increased absorption of dietary iron Repeated blood transfusion
Hemochromatosis:- Excess of hemosiderin granules in mononuclear phagocystic system & paranchymal cells causing organ dysfunction ( liver fibrosis, DM, heart failure).
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Hemosiderin granules in liver cells A, H&E section showing golden-brown,finely granular pigment. B, Prussian blue reaction, specific for iron.
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Alveolar (hemosiderin-laden) macrophages in patient with heart failure (heart failure cells)
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Heart failure cells (hemosiderin-laden macrophages ),Prussian blue reaction
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Jaundice
Yellowish discoloration of skin & sclera due to deposition of bilirubin pigment.
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Bile pluges in liver of patient with obstructive jaundice
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HemosiderinHemosiderin
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The brown coarsely granular material in macrophages in this alveolus is hemosiderin
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These renal tubules contain large amounts of hemosiderin, as demonstrated by the Prussian blue iron stain
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• Fig 1-20
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Ageing:Ageing:
“Progressive time related loss of structural and functional
capacity of cells leading to death”
• Senescence, Senility, Senile changes.
• Ageing of a person is intimately related to cellular ageing.
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Factors affecting Ageing:Factors affecting Ageing:
• Genetic – Clock genes, (fibroblasts)
• Diet – malnutrition, obesity etc.
• Social conditions -
• Diseases – Atherosclerosis, diabetes etc.
• Werner’s syndrome.
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Cellular mechanisms of Cellular mechanisms of ageingageing
• Cross linking proteins & DNA.
• Accumulation of toxic by-products.
• Ageing genes.• Loss of repair
mechanism.• Free radicle injury• Telomerase shortening.
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Telomerase in ageing:Telomerase in ageing:
GermCells
SomaticCells
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Ageing Ageing ––changes:changes:
• Gradual atrophy of tissues and organs.
• Dementia
• Loss of skin elasticity
• Greying and Loss of hair
• BV damage – atherosclerosis/bruising.
• Loss of Lens elasticity opacity vision
• Lipofuscin pigment deposition – Brown atrophy in vital organs.
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Pathology Pathology of elderlyof elderly
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Factors affecting ageing:Factors affecting ageing:
• Stress• Infections• Diseases• Malnutrition• Accidents
• Diminished stress response.
• Diminished immune response.
• Good health.
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Conclusions:Conclusions:
• Cellular Injury - Various causes• Reversible Injury Adaptations
– Hypertrophy, Hyperplasia, Atrophy– Accumulations - Hydropic, hyaline, fat..
• Irreversible Injury - Necrosis– Coagulative, Liquifactive, Caseous
• Ageing - Causes, Changes, Factors
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THE END