Morpho Review Complete

7/28/2019 Morpho Review Complete

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Onlypathologiesaretreatedinthissummary,notumorsarewri5en:

theywillbesummarizedinasingletable

1

Insanegraphicreviewforthe2semesterexam

AlessandroMo5a,UVVG,3rdyear

COMPLETEVersion


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CardiacPathologiesRheuma;c

IschemicHeart

Disease

Ischemicheartdiseaseiscausedbytheinterrup;on,par;alorcomplete,ofarterialbloodflowtothe

myocardium.Diseasebeginstomanifestwhencoronarybloodsupplynolongersa;sfytheoxygen

demandmyocardium.Themaincausethatgeneratescardiacischemiaiscoronaryatherosclerosis

(narrowingoftheofarteriallumenbyplaque),some;mesaggravatedbyarterialspasmoraprocess

ofsuperimposedthrombosis.Cardiacischemiamaybesilentormaymanifestclinicallyinseveral

forms:anginapectoris,myocardialinfarc;on,chronicischemicheartdisease.

Cardiac

Pathology 1Pericardium

Myocardium

Endocardium

Anginapectoris:transientpainfulcriseslocalizedpredominantlyprecordial,threetypes

ofangina:

Stableanginaisusuallyunder15minutes,

triggeredbyfactorsthatoverloadheart

(emo;ons,exercise)andresolvesatrestand

administra;onofcoronaryvasodilators

(nitroglycerin)Instableangina(premyocardial

infarc;on,aggravatedangina)iscausedbythe

forma;onofanon-obstruc;velythrombussuperimposedtoaplaque.Prinzmetalanginais

anunusualformofanginathatoccursatrest,

oenduringsleep,causedbyarterialspasm

superimposedtoaatherosclerosislesions.

Myocardialinfarc6onisthemostimportantcauseofmorbidityandmortalityinmodernsociety.Isanexpressionofbrutal,completeand

persistentinterrup;onofbloodflowthroughacoronaryarterybranch,

whichtranslatesmorphologicallybynecrosisofmyocardialterritoryserved

bythatartery.ComeswithAtherosclerosis+superimposedthrombosis,

hemorrhageintoplaque,persistentarterialspasm,arteri;s,congenital

coronaryanomaliesetc.Labfindings:raisedLDH,CPK.Types:transmural

subendocardial.Chronologicalmorphologychanges:

1. First12hours:nomacroscopicalchanges2. In1-2days:swollen,paleyellowcentralarea,raisedneutrophilsac;on3. In3-7days:necrosisareabecomeyellowish,macrophagesreplace

neutrophils,granula;on;ssueforma;on

4. In2-3weeks:depressedareawithsotexture5. In4-5weeks:hardscarearea,retracted,palegray

Chronicischemicheartdiseasedefinesslowinstalla;onofconges;veheartfailureduetomyocardialaltera;onsbychronicischemia.

Mostofthesepa;entshaveahistoryofepisodesofanginapectorisormyocardialinfarc;on.

Thehearthasvariabledimensions,myocardiumhasabrowncolorandcansome;mesbeiden;fiedareaofinfarc;onwithdifferentseniority.Thereisalwaysadvancedlesionsofatherosclerosisofthecoronaryarteries.

Valves

2


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3

Rheuma;cHeartDisease

Cardiac

Pathology 1

Isasystemicinflammatorydiseaseofconnec;ve;ssue,affectschildrenfrom5to15yearsold,symptomsstartsaer1-4weeksfroma

tonsilli;scontrac;on,usuallycomeswithstreptococcalinfec;ons.TheAcuteform(rheuma6cfever)hassomeextra-cardiac

manifesta;onssuchas:largejointsimpairments,tegumentaryimpairmentsandneurologicaldamage.Cardiacmanifesta;ons(rheuma;c

pancardi;s)hasrheuma;cinvolvementssuchaspericardi;s,myocardi;s(withAschoffgranulomas)andendocardi;s.TheChronicphase

isasequeloftheacuteoneandtriggersvalvulardeforma;ons,CHF,endocardi;sandthromboembolism.

Pericardi;sInflammatory

Non-

inflammatory

Calledeffusions,triggershydropericardium,haemopericardiumandchilleffusion

(lymph).Theaccumula;oncanbefrom50to2000mlwithorwithoutclinical

manifesta;ons

Acute:bybiologicalfactors,canbeinformof:serous,fibrinous,suppura;veor

hemorragic.inChroniconewefindathickperitoneum,constric;ve,fibroustriggered

byTBC,staphylococcalsep;cemiaandradioteraphy

Cardiomyopathies

dis;nctgroupofprimi;vediseaseoftheheartmusclethatdid

notcauseinflamma;onandarenotassociatedwith

hypertension,congenitalheartdisease,valvularorcoronary

arterydisease.Itischaracterizedbyheartfailure,ventricular

volumeandincreasedventriculararrhythmias.

Conges6ve/dilata6ve:isthemostcommon,triggeredbyalcohol/

drugs,dilata;onoccursinbothventricles,HFin5years

Hypertrophy:inyoungpa;ents,forlong;measymptoma;c,

gene;ccausesarestudied,decreasestheintraventricularvolume

Restric;ve:limi;ngdiastolicfilling,generateatrialdilata;onand

retrogradevenousstasis,bringtoaglobalHF

Myocardi;s

Definedasgeneralizedinflamma;onofthemyocardium.Areclassifiedintotwobroadcategories,

rheuma;c(discussedbefore)andnon-rheuma;csuchas:

1. Viral(toxic):byHIV,influenzavirus,generallyreversible,worseinchildrenandpregnancystatus2. Non-Viral:dividedinbacterial,drivenbyhypersensivitytomedicamentsandararegiantcells

myocardi;s


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Cardiac

Pathology 1 Endocardi;s

Non-infec6ousmayalsobeofseveraltypes:

Non-bacterial,associatedwithmetasta;ccancer Libman-Sacks,associatedwithSLEandvalvularvegeta;on

progress

FromCarcinoidSyndrome

,genera;ngendocardialplaquesatRHValves

Infec6ouscausedbybacterialcoloniza;on,rarelyfungal,of

endocardium,withasevereimpairmentofvalvularapparatus.

AcuteBacterial,orulcera;veisdrivenbyStaphylococcusAureusanddetroysthevalvesun;ltheHF

Sub-AcuteBacterial,orpolypousiscausedbystreptococcusViridiansandtriggersapolypoidvegeta;onthatgenerate

embolism

ValvulopathiesMitralStenosisiscaused

usuallybyrheuma;c

diseases,thebloodflowfromLAtoLVdiminishes,

ini;allytriggersanatrial

dila;on,in;me

hypertrophyand

pulmunarystasiswithrisk

ofpulmunaryedema.

MitralInsufficiencyaverycommonvalvedisease,

generatedbyamitral

prolapseorpapillarmuscle

rupture,bloodregurgita;on

insystoletriggersLV

hypertrophyandLAhyp.

Aor6cStenosisiscausedusuallybycalcifica;onsorcongenital

condi;onssuchasbicuspidvalve.

BloodflowdiminishesfromLVto

Aorta,triggersamarkesLV

hypertrophyandbovineheart

inradiologyfindings

Aor6cInsufficiency

maybecongenitalor

aerasyphili;c

aor;;s,blood

regurgitatesfrom

AortatoLV

Tricuspidorpulmonaryonesareveryrare,associatedwithmitral

problems.PulmonarycanbeaffectedincongenitalorinFallots

tetralogy

Congenital

HeartDiseases

Abnormali;esofembryonicdevelopmentbygene;ccausesorviralinfec;onsorteratogensubstances.WithBloodShuntsfromLtoRsidewefindventricularseptaldefects,interatrialseptaldefects,fetalductus

arteriosusthattriggeralatecyanosis.FromLtoRbutwithearlycyanosis=Fallotstetralogy:pulmonary

stenosis,v.septaldefect,Dxposi;onoftheAorta,rightventricularhypertrophy.Withoutbloodshuntsthere

aretransposi;onsofgreatvessels,coarcta;onoftheAortaandSitusInversus(dextrocardia)

HeartFailure

Definedastheinabilityofthehearttodealwiththebody'sdemands,ontheLEFTsideistriggeredby:

ischemicheartdisease,MI,arterialhypertension,valvulopathies,myocardiopathies.Generatesdispnea,

pulmonaryedema,hydrothorax,lowrenalperfusion,cerebralanoxia.OntheRIGHTsidecanbetriggeredby

apreviousleheartfailure,apulmunaryvascularhypertension,valvulopathies,cardiomyopathies.Triggersperipheraledema,ascitesandhepatomegaly 4


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Vascular

System 2 Arteriosclerosis

Arteriolo-sclerosiscanbedividedin:

Hyaline,inchronicischemia,benignnephroangiosclerosis

Hyperplas;c,aconcentricthickeningofarterioleswalls,reducedlumenand

malignantnephroangiosclerosis

Atherosclerosisoratheromatosis,hasamixedandnotfullyelucidatedpathogenesis,

hasvariousriskfactors(hypercholesterolemia,highLDLconcentra;ons,hypertension,

diabetes,aging,sex=male,smoking).Lesionsarefoundedinthein;mallayerof

arteries(atheromas)andarefibrino-lipidicplaques(withalipidiccenterandafiibrous

capsule).Evolu;ons:calcifica;on,ulcera;on,superimposedthrombosis(occlusionof

thearteria),hemorrage,aneurysm.Clinicalmanifesta;on:MI,chronicischemia,

aneurysm,emboliza;on

Arteri;s

Inflamma;onmaybegininin;ma,mediaoradven;;a(atthelevelof

vasavasorum)ofthearteries.In

termsoftheseloca;onscan

dis;nguish:endarteri;s,mesarteri;s

orperiarteri;s.Arteri6stypes:

Thromboangi;sobliterans,namedBuergersDisease

Polyarteri;sNodosa Syphili;cArteri;s Raynaudsdisease

Aneurysms

Abnormaldilata;ons,

localized,permanent

ofthebloodvessels

Atherosclero;c Celebral Dissec;ng(aorta) Arteromatous

Fistula(post-

trauma;c) Syphili;c

VenousThrombosis

Forma;onofthrombi,oeninthedeepveinsofthelower

limbs.Theprocessisfavoredbythestasisatthislevelcaused

byimpedingofvenousreturnasaresultofheartfailure,

pregnancy,prolongedbedreposeorvaricoseveins.

Thrombophlebi6s,comeswithinflamma;onandcanbe

dividedinto:bacterial,intravenouschemicalirrita;onand

post-trauma;c.Phlebothrombosis,inturn,comeswithout

inflamma;on,itcanbepost-opera;ve,obstetrical,medical-

associatedandmigratory

VaricoseVeinsAreabnormallydilatedveins,withatortuouscourse,mainlyarefoundedinlowerlimbs,but

wecanalsofindtheminformofesophagealvarices(portalhypertension),hemorrhoidsand

varicocele

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Respiratory

System 3

RespiratorySystemPathologies

Rhini6sareinflamma;onofthenasalmucosa.Canbeacuteandchronic.Acuterhini;s,inturn,canbe:

Acuteviralrhini6s(commoncold)iscausedmainlybyadenoviruses.Itmanifestsclinicallywithincreasednasalsecre;on,nasal

conges;on,sneezing.Morphologicalsubstrateisrepresentedbyanacutecatarrhalinflamma;onofthenasalmucosa

Allergicrhini;siscausedbyatypeIhypersensi;vityreac;ons(IgE),followingexposuretovariousan;gens:pollen,dust,flouretc.

Ismanifestedbyabundantwaterynasalsecre;on,sneezingcrisis.Specifically,istheappearanceofinflammatoryinfiltraterichin

eosinophilsinthenasalmucosaBacterialrhini;susuallyoccursasacomplica;onofformsdescribedabove,characteris;cisthe

transforma;onofinflammatoryexudatefromawateryintoapurulentone.Chronicrhini6s,canalsobeoftwotypes:Hyperplasicchronicrhini;soccursduetorepeatednasalinflamma;on.Itis

characterizedbyhyperplasiaofmucousglandssome;mesrealizingrealadenomatouspolypsthatcanextenduptothethroat.

Theyappearasmul;ple,so,pedicledforma;ons,withbunchofgrapes-looking.Chronicatrophicrhini;s(ozena)isalsoa

possibleconsequenceofrepeatedacuteinflamma;on.Ismanifestedbydiminishingsenseofsmellduetopavimentosase

metaplasia,fibrosisandreducingofthemucousglands.

6

Bronchi

Pulmonary

Parenchyma

Pleural

Laryngi6sareinflamma;onofthelarynx.Maybeacuteorchronic.Ofacutelaryngi;s,themostimportantformsare:

Catarrhallaryngi;sisinmostcasescausedbyaviralinfec;on(influenzavirus).Manifestedclinicallybydrythroatandhoarseness.

Morphologicallyischaracterizedbyedemaandhyperemiaofthelaryngealmucosa,mucousexudatewhich,duetomicrobial

superinfec;ons,becomesmucosal-purulentLaryngealdiphtheriaisnowrare.Itisanacutepseudomembranousinflamma;onof

thelarynx,hasapar;cularseverityduetopossiblemechanicalasphyxia;onthroughmembranesofthepa;ent.Chroniclaryngi;s

maycon;nueacuteforms,ormayhavechronicitycharactersfromthebeginning,becauselocalac;onofchronicirrita;vefactors

(smoking,pollu;on).Ismanifestedbyhoarsenessandirrita;onspas;ccough.Morphologicalcanbedescribedtwoforms:

Hyperplasiclaryngi;swiththickeningofthepharyngealmucosa.Some;mesmayoccurlocalizedhypertrophy,pseudotumoral

(singersnodules)Atrophic,drylaryngi;s.

UpperResp.Tract


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BronchialDiseasesRespiratory

System 3

Bronchi6sareinflamma;onofthelargeandmediumbronchi.Maybeaffectedconcomitantandtrachea,inwhichcasewespeakofa

tracheobronchi;s.Canbeacuteandchronic.

Acutebronchi;sareini;atedbymicrobes(pneumococcus,streptococcus,etc.),viruses(influenza),ormayhavecausebyirrita;on

(pollu;on).Dependingonthequalityofinflammatoryexudate,aredescribedseveraltypesofacutebronchi;s:catarrhalbronchi;s,

ini;allymanifestedbyconges;on,edemaandhypersecre;onofmucus,whileinadvancedstagesoccurandserousexudate.Soontherewillbeamicrobialsuperinfec;on,exudatebecomingpurulentduetotheinfluxofgranulocytesulcera;vebronchi;sisamoresevere

form,characterizedbytheoccurrenceofulcersofvariabledepthinbronchialmucosa,atwhicharesome;mesassociatedprocessesof

necrosisandhemorrhagepseudomembranousbronchi;s(diphtheria)

gangrenousbronchi;sisrare,occursconsecu;velytomalignanttumors,infec;onswithanaerobicstreptococcietc.Bronchialmucosa

showsextensivenecrosiswithdepositoffibrin,necro;cmaterial,microbialcolonies.

Chronicbronchi6sischaracterizedclinicallybytheappearanceofmorethan2yearsconsecu;velyofepisodesofproduc;vecoughfor

atleast3months.Itispar;cularlycommoninsmokersandthosewholiveinpollutedurbanenvironments.

Thediseaseismanifestedwithhypersecre;onofmucus,andasaresultofmicrobialsuperinfec;on,thereisamucosal-purulent

exudate.Themaincomplica;onsofchronicbronchi;sinclude:pulmonaryhypertensionwithcorpulmonaleoccurrencesquamousmetaplasiaofciliatedbronchialepithelium,withpossibilityofdevelopingmalignancies.

Asthmaisclinicallymanifestedbydyspneacrisisandexpiratorywheezing.Frome;opathogenicpointofviewcanbedescribedtwotypes:

extrinsicasthma,isbasedonatypeIhypersensi;vityreac;on,beginsinchildhoodandusuallythereisanallergicfamilyhistory

intrinsicasthmaoccursinadults,cannotbeiden;fiedanallergicfactorandusuallycomplicatesachronicbronchi;s.Morphologically,is

characterizedbyhypersecre;onofmucus,bybronchialglandhyperplasia,inflammatoryinfiltraterichineosinophils,basementmembrane

thickeningandbronchialmusclehypertrophy.Sputumofthepa;entscontainsCharcot-Leydencrystal,producedbythedisintegra;onof

eosinophils.

Bronchiectasisimpliestheexistenceofabnormal,persistentdilata;onofbronchi.Canbecausedbyseveralfactors:sequelaeofsome

suppura;vepneumonia,influenza,whoopingcoughmechanicalbronchialobstruc;oncausedbytumors,foreignbodiesetc.

congenitaldiseases:muciviscidosis,Kartagenersyndrome(sinusi;s,situsinversusandcongenitalbronchiectasisbyimmobilityciliaof

bronchialepithelium).Bronchialdila;oniscalledbronchiectasiscavity.Theycanhavediffuseorlocalizedcharacter,canbesingleor

mul;pleandmayhavedifferentshapes:cylindrical,saccularormoniliforme(dilatedpor;onsalterna;ngwithunaffectedpor;ons).

Bronchiectasiscavityisini;allydry,smooth,andaerwardstofillwithstagna;ngmucus.Thismucuscausesobstruc;onoftheterminal

bronchiandpromotemicrobialsuperinfec;on,withtheappearanceofpurulentsecre;ons.Epitheliumborderingthecavityisconverted

tometaplasia,andfinallytoatrophy.Bronchialwallistheseatofchronicinflamma;on,withatrophyoftheelas;cfibers,muscleand

mucousglands.Inadvancedstagesoccursgranula;on;ssueprolifera;onwithreplacementfibrosis. 7


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8

Respiratory

System 3 PulmonaryParenchyma

Representsinflammatorydiseasesofpulmonaryparenchyma.Arecausedbymicrobialorviralgerms.Morphopathologicalsubtypes:

Lobarpneumoniarepresentstheclassicformofbacterialpneumonia,andismainlycausedbypneumococcus(Streptococcus

pneumoniae).Currentlycompleteevolu;onofthediseaseisrare,duetoan;bio;ctherapy.Clinicallymanifestswithfever,chestpain

andcoughwithsanguinolentsputum.Thediseaseislimi;ngtoasinglepulmonarylobe(lobarpneumonia),oeninferior,rarelymore

lobes.Thestar;ngpointofthediseaseispulmonaryalveoli.Untreated,intermsofmorphology,evolvingintofourphases:acuteconges;on,redhepariza;on,greyhepariza;on,resolu;on.Lobularpneumonia(bronchopneumonia) usuallyoccursindebilitated

persons,childrenandold,asaresultofinfec;onwithpyogenicstreptococci,Staphylococcusaureus,Klebsiellapneumoniae,etc.Unlike

lobarpneumonia,thestar;ngpointofinfec;onisbronchioles,withsecondaryextendinginalveoli.

Areaffectedmorepulmonarylobules,whichappearasoutbreaksofcondensa;on.Microscopically,bronchopneumoniaoutbreak

appearcenteredbyabronchioluswithpurulentbronchioli;slesions.Itissurroundedbyalveoliwithvarioustypesofpulmonary

alveoli;s,whichseveritydiminishesfromthecentertotheperiphery.Inters66alpneumoniaiscommonlycausedbyviralinfec;on

(influenzavirus,adenoviruses,etc.)orMycoplasmapneumoniae.Pulmonarymorphologicalchangesoccurringcanbesystema;zedas

follows:inters;;allesions,thickenedalveolarsepta,withdilatedvesselsandmonocyteinflammatoryinfiltrate,withoutgranulocytes

necro;zingbronchioli;slesions,some;meswiththeappearanceofmul;nucleatedgiantcellsalveolicontainedemafluid,redblood

cells,fibrin.Pulmonaryemphysemaispermanentdila;onofterminalrespiratorybronchiolesandalveoliofthelungs.Disease

pathogenesisisnotfullyelucidated.Itisassumedthataltera;onofalveolarwallsmaybecausedbytheac;onofproteoly;cenzymes

suchaselastase,whichdestroystheelas;cfibersatthislevel.

Pneumonia

Primarytuberculosisintermsofmorphologyischaracterizedbytheappearanceofprimarytuberculosiscomplex(Ranke),consis;ngofthreeelements:primaryaffect(Ghon)consistsofanareaofcaseousnecrosiswithperipheraltuberculousfollicles,mostcommonly

localisedsubpleuralthemiddlepor;onoftherightlungconnec;nglymphangi;s:tuberculousfolliclesalongtheefferentlympha;csof

primaryaffec;onhilaradenopathy,withthepresenceofprolifera;v-altera;velesionsinthelymphnodes,tributarytothedamaged

lympha;cs.Secondarytuberculosis(postprimary)developsmostoenindebilitatedpersons,immunizedbypriorinfec;on.Sourceof

bacillimaybeendogenous(reac;va;onoflatentlesionsfromprimarydisease)orcantalkingaboutexogenouscontamina;onby

inhala;onofbacilli.Thelesionsbeginsinthebestaeratedpulmonaryareas(apicalposteriorpart),intheformofaggregatesof

tuberculousfollicles(Simonoutbreak).Folliclesconfluenceandsoonoccurstheircaseousnecrosis.

PulmonaryTBC


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9

Respiratory

System 3

Pleuri;s

InflammatoryTypes:Sero-fibrinouspleurisycanoccurin

rheuma;sm,uremia,tuberculosis,ormaybeacomplica;onof

pneumonia.Itischaracterizedbytheappearanceofan

intracavitaryserousexudate,withfibrinousinflamma;onof

pleuralserous.Hemorrhagicpleurisy,withexudaterichin

erythrocytes,canoccurintuberculosis,mesothelioma,

pulmonaryinfarc;on

Purulentpleurisy(pleuralempyemaorpiotorax)appearsin

pleuro-pulmonaryinfec;onwithpyogenicgerms.

Non-inflammatorypleuraleffusion:Hydrothoraxis

characterizedbytheaccumula;onoftransudateinpleuralcavity.

Hemothoraxrepresentaccumula;onofbloodinpleura,usually

asaresultofthoracictraumaorruptureofaaor;caneurysm

Chylothoraxconsistsinaccumula;onofoflymphinpleuradueto

anobstruc;onofthethoracicduct

Pneumothoraxisrepresentedbythepresenceofairinthe

pleuralcavity.Dependingonthemechanismcanbedescribed

severaltypes:spontaneous,trauma;cortherapeu;c.

Pneumoconiosisareprofessionalpulmonarydiseasecausedbyinhala;onofvariousanorganic

powders.Severityoflesionsisvariable,dependingonthetypeofdust,theirconcentra;on,dura;on

ofexposureandthecoexistenceofotherpulmonarylesions.Types:Silicosis,Anthracosis,Asbestosis

Pneumoconiosis


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Gastri;sAcute

Chronic gastricmucosalerosions smallfocaldefectsof

substanceinthegastric

mucosa

Usuallysuperficial,mayextendtotheserous

Idiopathic:SuperficialgastriHsisamildform,characterizedbyachronicinflammatoryinfiltrateinthelaminapropriae.Glandsarenotaffected.

AtrophicgastriHs,advancedstage.Itischaracterizedbyextensiveinflammatorychangesinthedeepergastricmucosa.

Autoimmune:(TypeA)occursduetothepresenceofan;bodiesagainstparietalcells,andwillbecomplicatedwithachlorhydriaandperniciousanemia.Lesionsarelocatedonthegastricfundiclevel,

beingsimilartothoseseeninidiopathicgastri;s.

Infec6ous:(typeB)isproducedbyHelicobacterpylori,presentlesionsofchronicsuperficialgastri;slocatedintheantrumandgastricbody.Germscanbeiden;fiedingastricmucusand,inac;veforms,

appeargranulocytesintheneckofglands.

Hyperplas6c:(Menetrier)ischaracterizedbyahighlyexpressedthickeningofthegastricmucosa,thepresenceofgiantfoldsthatgivethegastricareaacerebroidaspect.Itisconsideredaprecancerous

condi;on.

Gastric

Pathology

Pep;c

Ulcer

Duodenal

Gastric

Isusuallylocalizedonthelowcurvature,inantralandpre-pyloricregion.Appearsasasolu;onof

con;nuity(crater),usuallysingle,rounded,withadiameterof2-3cm,withnet,prominentmargins.

Gastricmucosafoldsconvergetowardsulcer.Gastricwallpenetra;onisvariable,ulcerscanhave

differentdepths.Some;mesthereareovercomingallthestructuresofstomach,thebasisofulcer

beingcomposedofaroughfibrous;ssueblock(callosulcer).Microscopically,thebasisofgastric

ulcerconsistsoffourlayers.Theyare,fromsurfacetodepth:Superficial,anareawithfibrino-

leukocyteexudate,areaoffibrinoidnecrosis,areaofgranula;on;ssue,areaoffibrous;ssuewithinflammatoryinfiltrate.

Causedbyincreasedacidifyingofduodenal

environment.Frequently,itislocalizedonthe

anteriororposteriorwalloftheduodenum,in

thepost-pyloricarea.Usuallyunique,but

therearealsodoubleduodenalulcers,

situatedoppositeontheanteriorand

posteriorwall(ulcersinthemirror).

Complica;ons:

Haemorrhages:fromoccultbleedingsto

massivebloodloss(haematemesisor

melaena)Perfora6on:morecommonin

duodenalulcers(peritoni;s)

Penetra6on->(liver,pancreas).

Pyloricstenosis,duetoulcerhealing,with

occurrenceofaretrac;lefibrousscars. 10

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Crohn'sdisease

Chronicinflammatorydiseaseofunknowne;ologythatcanaffecttheen;regastrointes;naltract,butespeciallytheterminalileumand

colon.Thediseasehastwospecificfeatures:theinflammatoryprocessaffec;ngalllayersoftheintes;neandsegmentalnatureofthe

lesions(impairedsegmentsofintes;nesalterna;ngwithunaffectedareas).

Macroscopicinterestedsegments:appearthickened,swollenwithnarrowedlumen,onmucosalsurfaceoccurslinearulcera;onthat

graduallybecamedeeper,andcanbetransformedintofistulas.Canoccurmesentericlymphadenopathy.Microscopically,itisfound:

thepresenceofapolymorphousinflammatoryinfiltrate,afibrosisprocessthatinterestsallintes;nalstructures,oencanbeobserved

non-caseousgranulomasCrohn'sdiseasecanrarelydevelopintoacancerofthesmallintes;neorcolon.

Intes6nal

Pathology

Ulcera6veColi6s

Chronicinflammatorydiseaseofthecolonofunknowne;ologythataffectsyoungadults.3specificmorphologicalfeaturesthatallow

differen;aldiagnosiscomparedtoCrohn'sdisease:impairmentlimitedtothecolon,fromileo-cecalvalveuptoanus,therectumisthe

mostseverelyaffected,andthesmallintes;neisnotinterestedlesionshavediffusecharacterandnotsegmentalcharacterlesionsinterestcolonmucosaandsubmucosa,extendingindepthisexcep;onal.Macroscopically,affectedthemucosaisfirstred,granularand

bleedseasilyattouch.Thenappearsuperficialulcersthatextendintothesurface,surroundedbythickened,hyperplasicintes;nal

mucosa,whichprotrudesintotheintes;nallumen(inflammatorypseudo-polyps).Microscopicallythereisacongestedmucosa,swollen

withpar;allydestroyedepitheliumareiden;fiedhemorrhagicsuffusionsandlympho-plasmacellsinflammatoryinfiltrate.Specificis

glandularcryptsimpairment,withappearanceofgranulocytsinflammatoryinfiltratewithlargeareasofnecrosis(cryp;cabscesses).In

advancedstagescolonbecomesatrophied,withthepersistenceofachronicinflammatoryinfiltrateinthemucosaandsubmucosa.

AcuteAppendici6s

Exuda;veinflamma;onoftheileo-cecalappendix.Frequentlyoccursconsecu;velytotheappendicularorificeobstruc;onthroughfecal

(solidifiedfaecalmaterial),hyperplasiaoflymphoidstructuresfromappendicularwall,etc.Thisprocesspromotesstagna;onof

secre;ons,intenseprolifera;onoflocalmicrobialfloraandfinally,bacterialinvasionofthewall,withthemassiveinfluxof

polymorphonuclears.Morphologytypes:conges;veappendici;scharacterizedbydistendedappendix,congestedphlegmonous

appendici;s,thewholeappendicularwallispurulentinfiltratedgangrenousappendici;s,characterizedbytheappearanceof

hemorrhagiculcera;onofthemucosaandareasofgangrenousnecrosisofthewall.Complica;onsofacuteappendici;sareoenserious:

perfora;on,usuallyfollowedbytheappearanceofapurulentperitoni;ssep;cthrombophlebi;sofmesoappendicularveinwithpylephlebi;sandsecondaryliverabscess. 11

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TypesofNephropathies

Glomerular

Acutetubularnecrosis

Ischemicnecrosis Nephrotoxicnecrosis

Urinary

Tract 5

Tubular Vascular Inters;;al

Glomerulonephri6s

Withnephro;csyndrome

Withnephri;csyndrome

Chronic

Nephroangiosclerosis

Benign Malign

Pyelonephri6s

Acute Chronic

Mostglomerulonephri;saretheresultofimmunologicalmechanisms,themostcommonlyinvolvedofwhichare:depositofcircula;ng

immunecomplexesintheglomerulilocalforma;onofimmunecomplexesbyreac;onbetweenacircula;ngan;bodyandanan;gen

fromglomerularbasementmembraneac;va;onofalterna;vepathwayofcomplementcell-mediatedimmunologicalmechanisms.

Glomerulonephri6scharacterizedbynephro6csyndrome:

Nephro;csyndromeisagroupofpathologicalcondi;onsarisingasaresultofincreasedbasementmembranepermeabilitybythe

glomerularcapillarylevel.Itischaracterizedby:proteinuria,hypoalbuminemia,generalizededema,hyperlipidemiaand

hypercholesterolemia.Inthiscategorycanbeclassified:

Glomerulonephri6swithminimalchange (lipoidnephrosis)affectsyoungchildrenandistheprototypediseasecharacterizedby

nephro;csyndrome.Glomerulonephri6swithfocalandsegmentallesions mayappearasaprimi;vedisease(idiopathic)orasa

consequenceofsystemicdiseasewithglomerularinvolvement(polyarteri;snodosa,subacutebacterialendocardi;sandsoon).Membranousglomerulonephri6sisthemaincauseofdevelopingnephro;csyndrome.E;ologyisunknownandaffectsyoungadults.

Some;mesthereisanassocia;onwithhepa;;sB,syphilis,malignancy,systemiclupus.

Ischaracterizedbymarkedthickening(5-10;mes),regularanddiffuseofglomerularcapillarybasementmembranesduetodepositsat

thislevelofelectrondenseimmunecomplexes.Glomerulonephri6ssecondarytosystemicdiseases:

diabe6cnephropathyischaracterizedbyglomerulosclerosis,whichmaybediffuse(diffusemesangialhyalinedeposits)ornodular(nodularmesangialhyalinedeposits-Kimmels;el-Wilsonnodules).Areassociatedwithdiabe;cmicroangiopathy,tubularatrophy,fibrosisandlympho-plasmacell

inters;;alinflammatoryinfiltrate.

amyloidnephropathyoccursinasystemicamyloidosis.Ischaracterizedbyamyloiddepositpredominantlysub-endothelialandmesangial,withgradualreplacementoftheen;reglomerularstructures.Lesionsaffec;ngalmostallglomeruliinvaryingdegrees. 12


13/25

Glomerulonephri6scharacterizedbynephri6csyndrome

Theseglomerulonephri;sarecausedbyinflamma;on,leadingtoglomerularcapillaryrupturewithsubsequenthemorrhageinthe

urinarytract.Nephri;csyndromeischaracterizedbythefollowingelements:haematuria,oliguria,azotemia,hypertension.Proteinuria

andedemamayoccur,butlowintensity.Themaintypesofglomerulonephri;sinthiscategoryare:

Poststreptococcalacuteglomerulonephri6s ismostoenasequelofaninfec;on(commontonsillar)with-hemoly;cstreptococcal

groupA.Renalimpairmentoccursaeraperiodof1-2weeks,pathogenesisbeingbycircula;ngimmunecomplexdeposit.Inchildren

evolu;onisusuallyfavorable,butinadultrenalfailuremayoccur.Affectedkidneyishypertrophied,turgid,edematous,thesurfaceis

smoothwithnumeroushaemorrhagicpointswhichcorrespondtoaffectedglomeruli.Glomeruliareaffecteddiffusely,beinghypertrophyandhypercellularity.

Subacuteglomerulonephri6s(rapidlyprogressive)ischaracterizedbysevereevolu;onwiththeadventofearlyrenalfailure.Canoccur

poststreptococcalassociatedwithsomesystemdiseases,ormaybeidiopathic.

Affectedglomeruliarehypertrophy,hypercellularityandmaydevelopthrombosisandcapillariesnecrosis.Typically,thereisa

prolifera;onofparietalcellsofBowmancapsulewithforma;onamul;layerstructurethatfillsthefilteringspace,calledepithelial

crescent.

Goodpasture'ssyndromeismostcommonlyseeninmenaroundtheageof20years.Pathogenicallyischaracterizedbydevelopment

ofan;bodieswithaffinityforglomerularandpulmonaralveolibasementmembranes.Clinicalismanifestedbyglomerulonephri;sand

pneumonicsyndrome.

Chronicglomerulonephri6s

Chronicglomerulonephri;sisthefinalstageofevolu;onofvariousglomerulopathies,clinicallycharacterizedbytheoccurrenceofrenal

failure.Affectedkidneyishypotrophy,increasedconsistencyandfinelygranularsurfaceonsec;on(smallkidney,white,granular).The

capsuleisadherentandonsec;onsurfacethereisathincor;cal,poorlydemarcatedfrommedullary.

Acutetubularnecrosisisthemajorcauseofacuterenalfailure.Acutetubularnecrosismaybetheresultofprolongedrenalischemiaortheac;onofnephrotoxicsubstances.

Ischemicnecrosisisaresultofshockofdifferente;ology,characterizedbysevererenalhypoperfusion:hemorrhagicshock,post

trauma;cshock,hemoly;cshock(incompa;bleperfusions),theshockcausedbyextensiveburnsorcrushsyndrome,endotoxicshock

(Sepsiwithgramnega;vegerms)andsoon

Affectedkidneyishypertrophied,swollen,andonthesurfaceofsec;onthereisacleardemarca;onbetweencor;calandpale

congestedmedullar.Inters;;umisswollenwithdiscreetgranulocytaireinfiltrate.

Nephrotoxicnecrosisiscausedbydirectac;onofatoxicsubstancesontubularepithelium(an;bio;cs,cytosta;cs,anesthe;cs,

mushroomtoxins,venomandsoon).Microscopically,isshowsextensivenecrosisoftubalepithelium,moreexpressedinproximal

tubules.Tubulorexislesionsaremuchlesscommonthaninacutetubularnecrosisduetoischemia.

Tubular

13


14/25

14

Causedbyarterialhypertension.Benignnephroangiosclerosisiscausedbyischemiaconsecu;velytoatherosclerosisand

arteriolosclerosisthataffectsrenalvessels.Smallarteriesandarteriolesundergoesaprocessofhyalinearteriolosclerosis.Interlobular

andarcuatelargearteriesshowsacharacteris;clesionthatconsistsinduplica;onofelas;clamina,fibrous;ssuehypertrophyofthe

media,withnarrowingofvasucularlumen(fibroelas;chyperplasia).Theselesionsexpandover;meandatglomerularcapillaries,

leadingtocompleteatrophyoftheaffectedglomeruli.Renaltubulesareatrophiedorhypertrophiedproperlyandinters;;umpresents

fibrosiswithlympho-plasmacellinfiltrate.

Malignnefroangiosclerosisischaracterizedbytheappearanceofhyperplas;carteriolosclerosis.Thisconsistsinconcentricthickening,inoverlappingsheets(inonionbulb)ofwallsofarterioles,withconsecu;velyreduc;onofthevascularlumen.Some;mesitcanappear

fibrinoidnecrosis(necro;zingarterioli;s)andthrombosesofafferentglomerulararterioles.Theselesionsextendtotheglomerular

capillaries,causinghyalinisa;onofglomeruli.Tubuleshavevaryingdegreesofatrophyandinters;;umpresentslympho-plasmacelland

granulocyteinflammatoryinfiltrate.

Vascular

14

Acutepyelonephri6siscausedbybacterialinfec;onpropagatedeitherbyhematogenouspathinthecourseofsepsis,eitherby

ascendingpathfromtheurethra,usuallyinvolvingEscherichiacoli.Aremostcommonlyaffectedwomen,especiallyduringpregnancy.

Clinically,thediseaseismanifestedbypollakiuria,dysuria,pyuria,hematuriaandbacteriuria.

Inascendinginfec;onsappearsapurulentexudateinthecalixandpelvisrenalis.Inrenalparenchymaisobservedradialpurulent

stria;onsfrompelvisrenalisintocor;cal,thatcanjoin,producingarenalabscess.Infec;onsbyhematogenouspathareleadingto

microabscessesdisseminatedinallrenalparenchyma.

Microscopically,thereisagranulocyteinflammatoryinfiltrateofvariableintensitythatini;allyinterestedpyelocalycealinters;;umandmucosa.

Chronicpyelonephri6smaycon;nueanacuteinflamma;onormayhavefromthebeginningcharactersofchronicity.Isanimportant

causeofchronicrenalfailure.Affectedkidneyissmall,withirregularsurfaceduetoretrac;lescarsconsecu;vehealingofacutephase

injuries.Thecapsuleisadherentandpyelocalycealmucosaisthickened.

Microscopically,lesionshavemul;focaldisposal,separatedbyareasofnormalparenchyma.Inoutbreaksareiden;fiedinters;;al

fibrosis,thepresenceofalympho-plasmacellinflammatoryinfiltrateandvarioustypesofglomerularlesions.Tubulescontainhyaline

cylinders,some;mesmakingpseudo;roidisa;onimages.Basically,achronicpyelonephri;scannotbedis;nguishedbychronic

glomerulonephri;sinbothdiseaseallrenalstructuresbeingaffectedinvaryingdegrees.

Inters;;al

14


15/25

Female

genital

System

6 Femalegenitalsystempathology

Vulva

Vagini;sareoen

causedby

pathogenssuchas

Candidaalbicans,

Gardnerella

vaginalisand

Trichomonas

vaginalis.

Vagina

UterineBody

Vulvi;saremainlycausedbyinfec;ous

agents:Humanpapillomavirusinfec6on is

characterizedbytheappearanceofbenign

tumorlesions,calledacuminatecondyloma.

Theseforma;onsappearaspapillary,warty,

locatedonvulvartegumentsormucosa,

oenmul;pleandconfluent.Herpesviruses

infec6oniscommoninthevulva.Ini;ally

developarashwithblistersfilledwithclearfluid,thenareconvertedintopustulesthat

mayulcerate.Syphili6cinfec6oniscaused

bythespirochete(TreponemaPallidum).

Cervici;scanbedivided,dependingonthenatureofthee;ologicagent,

ininfec;ouscervici;sandnoninfec;ous.Bothcanmanifestasanacuteor

chronicinflamma;on.Itcanalsobeaffectedthepor;onofthethecervix

fromvagina(exocervici;s),orthecorrespondingsegmentofcervical

canal(endocervici;s).Noninfec6ouscervici6scanbecausedbychemicalirrita;on,useofvaginaltampons,diaphragmsandintrauterine

contracep;vedevices.Inacuteforms,thecervixishypertrophied,

erythematous,friable.Microscopicallyishighlightedstromaledema,

vascularconges;on,andinflammatoryinfiltratewithpolymorphonuclear

neutrophilsinchorion.Infec6ouscervici6smaycomplicatethose

noninfec;ousorcanmanifestfromthebeginningitself.Involvetheac;on

ofabiologicalagent.).Allfirstmanifestsasanacutecervici;s,oenwith

theappearanceofpurulentstriaeonthesurfaceofexocervixormuco-

purulentsecre;onsthatisremovedfromendocervicalcanal.

Acuteendometri6soenoccurconsecu;velytoa

birth,anabor;onorfollowinguterinesurgery.More

rarely,canoccurintheirabsence,asingonococcal

infec;onthroughascendentpathfromthevagina.

Uterinemucosaisswollenandcongested,with

desquama;onofsurfaceepithelium.Isiden;fiedamucoushypersecre;onwhichcanthenbecome

mucopurulentorpurulent.Endometriosisare

characterizedbythepresenceandprolifera;onof

endometrial;ssuenon-neoplas;canywhereelse

thaninthemucosaoftheuterus.Histologically,

ectopicendometriumcanbecompletelymadeupof

cytogenicchorionandglands,orcancontainonly

oneoftheseelements.Intermsofloca;on,canbe

describedtwotypesofendometriosis:externalandinternal.Internalendometriosis(adenomyosis)isthe

presenceofislandsofendometriuminmyometrium

thickness.

Bartholincystsoccurduetoglandularexcretory

ductsobstruc;onwithaccumula;onofsecre;on

productandconsecu;velyductaldilata;on.

Contentisclear,mucoid,translucent.Microbial

overgrowthcancausetheappearanceofanabscessBartholin,withforma;onofacircumscribed

purulentcollec;ons.Kera6ncystsinterestedoen

largelabia,aresuperficialandsmall(2-5mm).The

contentofthecys;cconsistsofacellularmass,

eosinophilicofkera;n,boundedbyflaened

squamousepithelium.

Mucinouscystsarecommonlylocatedatthe

ves;bularlevel,isseparatedbyamucous-secre;ng

epithelium,cuboidalorcylindricaltype,frequentlywithsquamousmetaplasia.

Cervix

15


16/25

16

Mammary

Gland7

MammaryGlandPathologies

Inflamma;ons:Mas;;s Fibrocys;cBreastDisease

Acutemas66sareusuallyrelatedtoinstalla;onof

lacta;on,usuallyaffec;ngprimiparous.Itisabacterial

infec;on(staphylococcusaureus,streptococcuspyogenic),

favoredbytheappearanceoffissures,rhagades,nipple

excoria;onduetoadifficultlacta;ons.Fromthislevel,the

infec;onspreadsindepthbycanalicularpath.

Inbreastappearhardareas,swollenandverypainful,at

whosecompressionisexpressedinthenippleapurulent

exudate.Microscopically,atthebeginningisasero-

fibrinousacuteinflamma;on,whichcanprogressto

suppura;veinflamma;onofabscessorphlegmontype.

Chronicmas66s(mas;;swithplasmocytes)arefoundin

mul;parous,duetomammaryductsobstruc;onby

secre;onscondensa;on.Thisinducesachronic

inflammatoryreac;onwithoccurrenceinmammarygland

massofsomeinduratedareas,fromwhichatpressureis

expressedplugsofcheesymaterial.

Microscopically,canbeiden;fieddilatedductswith

epitheliuminlargepartatrophiedandnecro;cmaterialin

lumen.Peri-andintraductalappearsagranulomatous

inflammatoryreac;on,withdepositsofcholesteroland

inflammatoryinfiltraterichinplasmocytes.Some;mesmay

occuraprocessofinters;;alfibrosiswithnippleretrac;on,

similartothatfrombreastcancer.

Condi;onthatoccursinwomenwithhormonalac;vity

causedbytheexcessofestrogen.Some;mesitcanevolve

tobreastcancer.Histologically,thediseaseischaracterized

byavariablelesionalcomplex,whichinessencecanbe

systema;zedintothreemajorcategories:

Simplefibrocys6cmofifica6on(non-prolifera;ve)isthe

mostcommonformofthedisease.Itischaracterizedbythe

appearance,oenunilateral,ofsingleormul;plemammary

nodules,elas;candmobiletosurrounding;ssues.They

consistofamassofstromalfibrosis,inwhicharefound

terminalductswithcys;cdilated.Prolifera6vefibrocys6c

modifica6onischaracterized,inaddi;ontopreviousform,

byprolifera;on(hyperplasia)ofductalepithelium.

Some;mesitcanbeverymarked,formingpapilliferous

structuresthatcanfilldistendedductallumen(ductal

papilloma).Sclerosingadenosisischaracterizedby

increasingthenumberofsmallductsoracini.Theyappear

microscopicallyasnests,cordonsofductalcellsembedded

inafibrousstroma.Some;mes,theductscanbeinalarge

number,placedbacktoback,beingdeformedbybandsof

fibrosis,inwhichcasethedifferen;aldiagnosiswithbreast

cancerisverydifficult.


17/25

OtherCondi6ons:Cryptorchidismislackofdescentofthetes;sintothescrotum.Itfrequentlyaccompaniesbytes;cularatrophy

withsterility,andanincreasedrateofmalignantdegenera;on.Torsionofsperma;ccord,compromisingbloodperfusion,which

canleadtotes;culargangrene.

Hydroceleiscausedbytheaccumula;onofserousfluid,withdistensionofthetunicavaginalis,formostofthe;meisidiopathic,

butmaybecongenital,secondarytoinfec;onorasaresultoflympha;cblockingoftumoralorigin.Hematoceleisan

accumula;onofbloodthatrelaxtunicavaginalis,isusuallyposrauma;c,butmayindicatethepresenceofarenaltumor.

Varicoceleisavaricosedilata;onofthesperma;ccordvein.Spermatoceleisacystoenintrates;cularcontainingsperm.

17

Male

Genital

System

8 MaleGenitalSystemPathologies

Tes;cular ProstatePathology

Inflamma;onofthetes;clesiscalledOrchi6s.Thesecanbe

acuteorchronic,andmaybeassociatedwithinflamma;onof

theepididymis(orchiepididymi;s).

Acuteorchi;sareoenofgonococcalnature,butmayalso

includesyphili;corviral,some;mescomplica;nganepidemic

paro;di;s.Theyarerarelyencounteredininflamma;onof

tuberculousnature.Affectedtes;cleisswollen,painfulandmicroscopicallyshowsapolymorphousinflammatoryinfiltrate,

predominantlywithneutrophils.Gonococcalorchi6sevolves

towardssuppura;on,withtheforma;onofabscess.Acute

orchi;sunhealedcanbecomechronic,andbilateralformscan

becomplicatedbysterility

Prostateinflamma;onsarecalledprosta66s.Theyare

oenbacterial(gonorrhea,streptococci,coli,etc..)

consecu;veofanurinaryinfec;on.

Acuteprosta;;sischaracterizedbyaglandularpainful

swelling,withurethralexpressionofasero-purulentfluidat

compression.Microscopically,thereisarichgranulocy;c

inflammatoryinfiltratelocatedintheprosta;cglandsand

stroma.Chronicprosta66saretheresultofrepeatedacute

inflamma;on.Clinically,ismanifestedbynocturiaand

dysuria,andin;meoccursprogressiveatrophyofthe

prostate.Some;mescanoccurcharacteris;cinjuriesfor

tuberculousprosta;;s.


18/25

18

Pathology

ofBlood9

Anemias

Post-Hemorrhagic:Acuteasaresultofsudden,severe,internalorexternalhemorrhage.Intheearly

stagesthereisnotadecreaseofhematocritandhemoglobinconcentra;onduetoconcomitantlossof

redbloodcellsandplasmafluid.Alilelater,hypervolemiaiscompensatedbythebodythroughan

increasedproduc;onofplasmaliquid,withtheadventofhemodilu;on.Chronicposthaemorrhagic

anemiasoccuraerrepeatedsmallhaemorrhages(gastriculcer,tumor,meno-metrorrhagiaandso

on).Anemiabecomessignificantonlyaerdeple;onofbodyirondeposits(irondeficiencyanemias)

Hemoly6c:causedbyanexcessivedestruc;onofredbloodcells,withreducingtheirlifespan.

Destruc;oncanoccurinmacrophagesfromspleen,bonemarrow,orwithinbloodvessels(intravascularhemolysis).Asacompensatoryresponse,erythropoiesisiss;mulated,anemiabecame

manifestonlywhendamagerateexceedstheproduc;onofredbloodcells.Hemoly;canemiais

characterizedbythefollowingelements:increasedserumlevelsofunconjugatedbilirubin,

appearanceinthebloodandurineoffreebilirubin(hemoglobinemiaandhemoglobinuria),

intensifica;onoferythropoiesis,Splenomegaly

IronDeficiency:canbecausedbyinadequatedietaryintake,anincreaseinbodyiron

requirements(pregnancy,growthperiod)ormaycomplicatemalabsorp;onsyndromes

andchronichemorrhages.Itischaracterizedbytheappearanceintheperipheralbloodoferythrocytesofsmallsize(microcytes),pale,hypochromic.Significantisadecrease

serumlevelofferri;n,whichreflectsadecreaseofironreservesinthebody.

Aplas6c:resultofaltera;onofbonemarrowstemcellswithpancytopeniaoccurrenceandbonemarrowcelldepopula;on.

Impairmentmaybeidiopathicormaybeduetotheac;onofmarrowtoxicagents:chemotherapy,sulphonamides,benzene,

radia;on,viruses,etc.

Anemiaisoenmacrocy;c,andleukocytesandthrombocytesaregreatlyreducedinnumber.Thepopula;onofnormalbone

marrowisreplacedbyfat;ssueprolifera;on.

Dyshematopoie6c:resultof

deficienciesoffactorsrequiredfornormal

erythrocytematura;on,

despitetheexistenceofan

adequatenumberofmarrow

precursorsfortheirsynthesis.

Mostimportantinthis

categoryaremegaloblas;c

andirondeficiencyanemia.

Megaloblas6canemiasaretheconsequenceofareducedDNAsynthesis,dueto

deficiencyoffolicacidorvitaminB12.MostcommoncauseinvitaminB12deficiencyis

theabsenceofintrinsicfactornecessaryforintes;nalabsorp;onofthevitamin.This

deficiencyoccursinatrophicgastri;s(perniciousanemia).


19/25

19

Pathology

ofBlood9 PolycythemiaOrErythrocytosis,ischaracterizedbyincreasedtotalmassofcircula;ngerythrocytes,aprocessmostaccurately

reflectedbyincreasinghematocrit.Thedirectconsequenceisincreasedbloodviscosity,withaffec;ngitsflow

andthepossibleoccurrenceof;ssularhypoxia.Polycythemiamayberela;ve,occcurredasaresultofthe

decreaseinplasmavolume(hemoconcentra;on),andabsolute(perse),characterizedbyincreasednumberof

erythrocytes.

Primi6veerythrocytosis(polycythemiavera)isaneoplas;caltera;onofmul;potentstemcells,resul;nginprolifera;onof

allmarrowcelllines,butmoreoferythrocyteseries.Thediseaseoccursmainlyinmen,inoldageheredityseemstoplayan

importantrole.Inperipheralbloodisanincreaseinthenumberoferythrocytes(over6million/ml)withincreasing

hematocrit(60%)andhemoglobinconcentra;on(over2g%).Inaddi;on,increasesthenumberofleukocytesand

thrombocytes.Hematogenousmarrowishypercellular,withthepresenceofnumerousprecursorsofallcelllines.

Secondaryerythrocytosisistheconsequenceofhypersecre;onoferythropoie;n.Thisincreaseistypicallyreac;ve,consecu;velyto

aarterialhypoxia(highal;tudewithrarefiedair,lungdisease,hemoglobinopathies,etc.).Some;mes,thediseasemaybecausedby

theappearanceoferythropoie;n-secre;ngtumors(renalcarcinoma,livercarcinomaetc.).

Leukemiawillbediscussedinthetablededicatedtotumorsandcancers

Thrombocytopenia

Itisadecreaseinthrombocytesnumberbelow150.000/ml.Moreseveredecreases,under50.000/ml,increasetheriskfor

posrauma;chemorrhagesorbysurgery,andatvalueslessthan20.000/mlspontaneousbleedingoccurs.Thrombocytopeniamaybe

theresultofreducedmedullarythrombocytopoiesis(aplas;canemia,leukemia)ordestruc;on,excessivesequestra;onof

thrombocytesatspleenlevel.Themostcommonmanifesta;on,butnotpathognomonic,ofthrombocytopeniaispurpura

Primarythrombocytopenicpurpura(essen;al)haveimmune

e;ology,beingtheresultofappearanceinthebloodof

an;thrombocy;coran;megakaryocy;can;bodies.Thismay

occurinadultsasaconsequenceofseriouschronicdiseases

(collagenosis,leukemia,AIDS),orinchildrenduringviral

infec;ons.

Secondarythrombocytopenicpurpuramayoccurdueto

thromboly;cac;onofchemicalagents,drugs,orsecondaryto

myelo-orlymphoprolifera;veneoplas;cprocesses.


20/25

20

Pathology

ofBlood9

Lymphadeni;s

Lymphadeni;sareinflamma;onoflymphnodes,secondarytotheac;onof

exogenousagents,oenbiological(bacteria,viruses,parasites,etc.).

Acutelymphadeni6soccurinthelymphnodesthatdrainlymphfrom;ssularterritoriesinwhich

ittakeplaceanacuteinflammatoryprocess.Affectedlymphnodesarehypertrophied,havealow

consistencyandarepainfulatpalpa;on.Microscopiclymphnodehistologicalstructureisaltered

bytheappearanceofaprolifera;onofsinusalhis;omacrophages(sinushis;ocytosis)andtheoccurrenceofasubcapsulargranulocy;cinfiltra;on(catarrhallymphadeni;s).Some;mes

inflamma;oncangetasuppura;vecharacterwithextensiontosurrounding;ssues.

Chroniclymphadeni6smaybe:-Nonspecificchroniclymphadeni;saccompanieschronicinfec;onwithvarioussites,having

appropriateregionaltopography.Lymphnodesarehypertrophied,withfibro;ccapsulemicroscopicpresentssinusalhis;ocytosisand

hypertrophyoflymphoidfollicles.Specificchroniclymphadeni;sarecharacterizedbytheappearanceoflesionscharacteris;cof

underlyingdisease:intuberculosisappeartuberculousfolliclesandandcaseousnecrosis,insyphilis,vasculi;swithplasmocytesrichin

inflammatoryinfiltrate.

Reac6vesplenomegalyaccompaniessomeacuteorchronicinflamma;onsuchasbacterial,viral,

parasi;corimmunological.Inbacterialinfec;onspleenismoderatelyincreasedinvolume,redpulp

beingintenselypopulatedwithmacrophagesandpolymorphonuclearneutrophils.Insep;cemia

mayappearabscessesandsep;csplenicinfarcts,aswellasinvolvementofcapsuleand

surroundingstructures(perispleni;s).Ininfec;ousmononucleosissplenomegalyisdueto

occurrenceofaninfiltraterichinlymphocytesandimmunoblastslocatedinthesinusesand

medullarycordons.Inmalaria,thespleenismuchhypertrophied(10kg),ofgray-blackishcolour

duetoincreasedan;malarialpigmentcontent(hemateina).

Conges6vesplenomegalyoccursinportalhypertension(hepa;ccirrhosis,heartfailure).Thespleenismoderately

hypertrophied,hard,withfibro;ccapsule.Microscopically,intheearlystages,sinusoidsaredilated,withalargenumber

ofmacrophages.Inadvancedstages,redpulptendstobecomehypocellularduetoaprocessoffibrosis.

Infiltra6vesplenomegalycanoccurinseveralcircumstances:intrasplenicadventofcellularinfiltrates(macrophagesin

haemoly;canemia,malignantcellsinlymphomaorleukemia)orextracellulardepositsofabnormalsubstances

(amyloidosis).

Others:Splenomegalyduetoprimi;veormetasta;csplenictumoralprocesses/Splenomegalyduetooccurrenceatthislevelof

hyda;dcysts.

Splenomegaly


21/25

Endocrine 10

***NopeZappala,thesearenottesHcles

PathologyofHypophysis

Injuriesassociatedwithhypofunc;on

ofadenohypophysis:

Pituitarycachexiaiscausedby

panhypopituitarism,canbeproduced

byanyfactorthatdestroysthepituitarygland(varioustumors,

postpartumnecrosisofpituitary

gland).Selec6vedeficitsofoneor

morepituitaryhormones:growth

hormonedeficiency(retarda;onin

growth),gonadotropindeficiency

(delayedsexualmatura;on),TSH

deficiency(hypothyroidism),ACTH

deficiency(hypocor;cism).

Injuriesofneurohypophysis:

ADHsecre6ondeficiencyismanifested

bydiabetesinsipidus(polyuria,

dehydra;on,permanentthirst).Canoccurconsecu;velytoanyprocessthat

leadstothedestruc;onofthe

posteriorhypophysis(trauma,tumors,

inflamma;onandsoon).

Ectopicsecre6onofADHisthe

preroga;veofsometumorssuchas

smallcelllungcarcinoma.Itis

characterizedbyreten;onofwater

andconcentratedurine.

Thyroidi;sAcutethyroidi6sareusuallybacterial,occurringasaresultofinfec;oushematogenous

dissemina;on,rarelyspreadfromaneighboringorgan.Thethyroidisenlargedinvolumeandpainful.

Themostcommonencounteredaresuppura;veforms,abscessorphlegmontype

Subacutethyroidi6s(deQuervain)havemostlikelyavirale;ology(mumpsvirus,Coxsakieetc).Itisaself-limited

inflamma;on,characterizedbyfocaldestruc;onsofthyroid;ssuewithgranulomtoaselesions.Inadvancedstages

mayoccuraprocessoffibrosiswithsymptomsofhypothyroidism.Thethyroidisenlargedinvolume,notadhering

tothesurroundingorgans,increasedconsistencyandirregularsurface

Hashimoto'sthyroidi6s(diffuselymphocy;cthyroidi;s)isanautoimmunediseasewithfamilialaggrega;on,morecommonin

women.Inadvancedformsismanifestedbyhypothyroidism.Thethyroidisdiffuselyandmoderatelyincreasedinvolume,with

increasedconsistencyandintactcapsule,nonadhesive

21

Riedlthyroidi6s(ligneousthyroidi;s)hasunknowne;ologyandmayclinicallymimicthecarcinoma.Thethyroidisusuallyreducedin

volume,withirregularsurface,adherentcapsuleandveryhighconsistency.


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22

Endocrine 10Goi;er

Definetheincreaseinvolumeandweightofthethyroid,intheabsenceof

inflammatoryprocessesortumors.Fromafunc;onalperspec;ve,theremaybe

simplegoiters,withoutendocrinedisorders,andgoitersassociatedwithhyper-

orhypothyroidism.

WithEuthyroidsm WithHyperthyroidism WithHypothyroidism

(Simple,non-toxic)arecausedby

iodinedeficiencyduetoeitheran

insufficientexogenousoranincreased

needofthebody(pregnancy,growth

period,etc..).Iodinedeficiencyleads

toadefec;vesynthesisofthyroid

hormones,withconsequentdecreaseofserumlevelofthese.This

abnormalityisfeltbyhypophysis,

whichwillintensifythesynthesisof

TSH.Underitsac;onwillproduces

compensatoryhypertrophyand

hyperplasiaofthyroidfollicular

epitheliumwiththeadventofgoiter.

Simplegoitermaybediffuseor

nodular.Simpledifusegoiterisaccompaniedbyeuthyroidism,andis

characterizedbyauniformdamageof

allthyroidianmass.Maybeendemic,

occurringinmountainareas(Andes,

Alps,Carpathians).Evolvesintwo

stages:hyperplas;cphase,colloid

involu;onphase

(toxic)aremanifestedclinicallybya

complexclinicalpicture:irritability,

tremor,heatintolerance,tachycardia

witharrhythmia,diarrhea,menstrual

disordersetc..Morphologicallycanbe

dis;nguished:Diffusetoxicgoiter

(exophtalmosgoiter,Graves-

BasedowDisease)isthemostfrequent

goiterassociatedwithhyperthyroidism.Thediseasehasa

hereditarycomponent,andin;mate

produc;onmechanismis

autoimmune...Clinically,presents

signsandsymptomsof

hyperthyroidism,plusexophthalmia

andinfiltra;vedermatopathy.

Thethyroidisoverallenlargedin

volume,butoenwithunequallobesishard,brileandhighlyvascularized

thecapsuleisintegraland

nonadhesive.Toxicnodulargoiteris

rare,occursmorefrequentlyin

womenwithahistoryofsimplegoiter.

Thethyroidisunevenincreasedin

volume,withthepresenceofnodules

ofvaryingsizes.

maybeencounteredinchildrenfrom

goitrousregions,asaresultofchronic

deficitofiodineoradministra;onof

an;thyroidagents.Ithasahereditary

characterresul;ngfromco-blood

families.Arenodulargoiters,inwhich

predominatemicroscopicaspectsof

pseudo-thyroidianhyperplasia.

Hypothyroidismismanifestedinadultsthroughmyxedemaandinchildrenby

cre;nism.

Myxedemaischaracterizedbya

localizededemapredominantlyonthe

face,tongueandhand,dryskinwith

tendencytopeeling,lilehairand

harshly.Tothiscanbeaddedcold

intolerance,tendencytogainweight,

mentalretarda;on,cons;pa;onetc.Cre;nismofthyroidiancauseis

manifestedmainlybyseveremental

retarda;on,delayedbone

development,macroglossiaand

protuberantabdomen.Thethyroidis

muchincreasedinvolume,with

markedepithelialhyperplasia.

and the spaces between them


23/25

23

Pathology

ofCNS11

Histo

Review

DuraMater

Skull

PiaMater

Arachnoid

andthespacesbetweenthem

Epidural(Extradural)

Subdural

Subarachnoid,containingCSF

Cerebral

Infarc;on

infarc;on(soening)istheresultofatotalandpersistentischemia,causedbycerebralarteryocclusion.Themaincausesofthiseventare:thrombosis,embolism.clinicalconsequencesdependontheplaceofvascularobstruc;on

andthepossibilityofdevelopmentofcollateralcircula;on.Mostcommonlyitisaffectedmiddlecerebralartery.In

thiscaseoccurscontrolateralparalysis,withmotorandsensorydeficit,andaphasia.

Cerebralinfarc;onmaybesingleormul;ple,ofvarioussizes,dependingonthesizeofarteryaffected.Ingeneral,

infarc;onsofthrombo;ccausearewhite,andthosecausedbyemboliareredinfarcts.

Microscopicallystandsaliquefac;onnecrosisduetotheemergenceofalargeamountoflipidsfromthe

disintegra;onofthemyelinsheath.

Non

trauma;c

brain

hemorrhage

Intracerebralhemorrhage(apoplexy)isdefinedasbleedingwithinthebrainsubstance.Mostfrequentlyoccursinthebasalnuclei,theinternalcapsuleandthalamus.Themostfrequentlyinvolvedintheproduc;onofintracerebral

hemorrhageisarterialhypertension.Undertheac;onofthisthereisadecreaseintheresistanceofwallsofbrain

arterioles,withtheforma;onofmicroaneurysms,whichcanbeeasilybroken.Morerarely,areinvolved

arteriovenousmalforma;ons,hemorrhagesdiathesesortumoralprocesses.

Subarachnoidhemorrhageisableedingintothesubarachnoidspace.Mostoenitistheresultofaruptured

aneurysminthearteriesofWillispolygon.Some;messubarachnoidhemorrhagemayalsohavetrauma;ccause.

Posttrauma;c

brain

hemorrhage

Epiduralhematomausuallyoccursasaresultoftrauma;cfractureofthetemporalbone,withthemiddle

meningealarteryinjuryandaccumula;onofbloodintheextraduralspace.Clinically,itischaracterizedbyashortasymptoma;cperiod,andthenoccurcompressivecerebralphenomenaand,intheabsenceoftreatment,death.

Subduralhematomaistheresultoftrauma;cruptureoftheconnec;onveinsbetweencerebralsubstanceand

venoussinusesofthedura,withtheaccumula;onofbloodbetweenthearachnoidandduramater.Typically

locatesinthefronto-parietalregion.Itischaracterizedbygradualappearanceofsignsofcompressionofthebrain

(some;mesoveraperiodofseveralweek).


24/25

Pathology

ofCNS11

Meningi;s

inflamma;onoftheconjunc;vemembranesthatcoverthecentralnervous

systemorgans.Maybeaffectedroughmeninges,processwearinginthiscase

thenameofpachymeningi;s,orsomeninges(arachnoid,piamaterand

subarachnoidspace),definedwiththeleptomeningi;sterm.

Bacterial Tuberculous Viral

(enterovirus,mumpsvirus,Epstein-Barrvirus,etc.)predominantlyaffectsyoung

ages,usuallywithabenignevolu;on.

Thediseaseischaracterizedbythe

appearanceofanintensecephalalgia

andthediagnosisismadebyspinal

puncture(CSFwithnumerous

lymphocytes,increasedamountof

proteinandnormalglucosecontent).

occurssecondary,inthecontextofgeneralizedmiliarytuberculosis.Itisa

non-purulentinflammatoryprocess,

withpredilectloca;oninthebrain.Here

mayoccurexuda;veorprolifera;ve

(miliarytubercles)lesions.Maybe

complicatedbymeningealfibrosisand

consequentobstruc;onofventricular

system.

Meningococcalmeningi;saffectsmostlychildren,ischaracterized

bytheappearanceofasero-

purulentinflammatoryexudate,

yellowish.Exudatecontainsa

smallamountoffibrinanda

largenumberofgranulocytes

andmacrophages.Brain

substanceisedematous,with

punctatehemorrhagesandperi

vascularinflammatoryinfiltrate.

Pneumococcalmeningi;sis

characterizedbytheappearance

ofgreenexudate,jellyhas

increasedtendencyto

delimita;on(forma;on

ofenclosedspacesfilledwith

pus)Staphylococcalandstreptococcalmeningi;sare

secondarytoneighborly

suppura;veprocesses.Exudate

hassero-purulentappearancefor

streptococcusandyellowish,

creamyforstaphylococcusthe

processhaveanincreased

tendencyforintracerebral

abscessforma;on,epi-orsubdural.

Encephalomyeli;s

(definedinflamma;onofcerebralsubstance(encephali;s)andofspinalcord(myeli;s).

Importantinmedicalprac;ceareinflamma;onsofvirale;ology,andofthese,dueto

theirseriousness,polipomyeli;sandrabiesencephali;s.

Poliomyeli6s(infan6leparalysis)iscausedbyoneofthreetypesofpolioviruses.Itisan

acuteinflamma;onthatpar;cularlyinterestedintheanteriorcornsofthespinalcord,

leadingtodestruc;onofmotorneuronswithparalysisandatrophyofcorrespondingsoma;cmuscle.Macroscopically,medullaspinalisiswithintensehyperemia,edematous

(glassy)aspectwithhemorrhagicsuffusionsonsec;on.Rabiesencephali6siscausedby

therabiesvirus,transmiedbythebiteofinfectedanimals.Fromtheentrancegate,virus

spreadsbyaxonalpathun;lspinalcord,brainandinternalorgans(includingsalivary

gland).Thediseasemanifestsitselfasasevereencephali;swithincreasedCNS

excitability,violentmusclecontrac;onsandconvulsionstriggeredbyminimals;muli.

Histologically,thediseaseischaracterizedbyneuronaldegenera;on,perivascular

lymphocy;cinflammatoryinfiltrateinthecerebralhemispheres,cerebellumandspinal

cordpathognomonicareBabes-Negricorpuscles 24

andthespacesbetweenthem


25/25

25

Mul;ple

Sclerosis

Mul;plesclerosisisthemostcommondemyelina;ngchronicdiseaseoftheCNS.Predominantlyaffectsyoung

women,withaprogressiveevolu;on,occurringinspikes.E;ologyisunknown.

Characteris;clesionsarerepresentedbyplatesofsclerosisvisiblebynakedeyeinthecerebralwhitesubstance

andspinalcord.Itpresentsasovalpatches,irregular,insizesupto2cm,translucent,withcolorvariable,

dependingontheirage.Thesecorrespondtoareasofaxonaldemyelina;on.Microscopically,thereiscomplete

disappearanceofthemyelinsheathintheseareas,withlocalprolifera;onofglialcellsandconnec;ve;ssue.

Alzheimers

Disease

Isadegenera;vediseaseofunknowne;ology,whichisthemostimportantcauseofdemen;a.En;tyreferstodemen;aoccurringatanyage,associatedwithclinicalmanifesta;onsandspecificpathologicalchanges.

Clinicalmanifesta;ons:

slowlyprogressiveintellectualdeteriora;on:ini;allyshorttermmemoryloss,thenandthelong-termmemory,inabilitytowrite,count,speak,etc..

motorproblems:contracturesandparalyzesspecifictoterminalphaseMorphologicalabnormali;es:

neurofibrillarydisorder:intraneuronalfascicles(microtubulesandneurofilament)disorganiza;onincerebralcortex

neuri;cplaques(senile):eosinophilsneuronalprocesseswithcenterconsis;ngofaamyloiddepositsinthecerebralcortexandhippocampus

neuronalgranulocyte-vacuolardegenera;onatpyramidlevel Hiranobodies:dendri;ceosinophilicinclusions generalizedcerebralatrophymoreexpressedinhippocampusandfrontalareas.

Pathology

ofCNS11

Histo

Review

DuraMater

Skull

PiaMater

Arachnoid

p

Epidural(Extradural)

Subdural

Subarachnoid,containingCSF

ThisworkisnotsubsHtuteofdoctorPaiusansmaterial,evenifevrysinglewordisextractedbyhiswordfilessoit

willmatcheswhatweneedforthefinalexamMayTheForceBeWithYou

Morpho Review Complete

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