Done by:Tareq alsoudi

Chapter : Cell injury

General pathology laboratory material
2022-2023
Dr.Ghada AL-Jussani
MD,FRCPath (UK)
Iraqi Board in pathology (PhD)
European Board in pathology
Jordanian Board in pathology
Fellowship of royal college of pathologist (UK)
Assistant professor. Head of pathology ,microbiology
and forensic medicine department , faculty of medicine
Hashemite University
Objectives
• Cell Injury
• Inflammation
• Hemodynamics
Cell injury Adaptation

Adaptation
Reversible
Irreversible Reversible
injury

Irreversible
injury
Microscopic view of normal skeletal muscle (cross section)
Microscopic view of normal skeletal muscle (Longitudinal section)
❖Hypertrophy
Hypertrophied skeletal
muscle fibers
Q: Identify the
adaptive process in
this section
Answer : hypertrophy
of skeletal muscle .
Pathological hypertrophy

Patient has hypertension

,the adaptive process
occurs in his heart is
hypertrophy
Q:Identify the type of
adaptive process that
occurs in this heart of
70 years old man with
history of
hypertension?
Answer : pathological
hypertrophy
❖ This is cardiac hypertrophy
involving the left ventricle.
❖ The number of myocardial
fibers does not increase, but
their size can increase in
response to an increased
workload, leading to the
marked thickening of the left
ventricle in this patient with
systemic hypertension.

❖ Q:Gross picture of heart

from 65 years old patient ,
what do you expect this
patient to have ?
❖ Answer :hypertension
 Acromegaly , photographic view . Showing enlargement of jaw bones and
soft tissues , due to excessive production of growth hormone by pituitary gland after puberty & closure of
epiphyseal plates of bones.
Q:A 15-year- old
male has an
increase in
growth hormone
levels, which
adaptive
mechanism is
seen in his
picture?
Answer :
pathological
hypertrophy

Figure : Gigantism seen in young man (left) compared to normal (age-matched) young man (right)
.Due to hypertrophy of body organs & tissues including bones caused by increased growth hormone
by pituitary gland before puberty .
Skeletal muscle hypertrophy in heavy weight lifter ( physiological
hypertrophy )
 ❖Diagnosis :Hyperplasia, prostatic hyperplasia.((Pathological hypeplasia
❖ The normal adult male prostate is
about 3 to 4 cm in diameter and up
to 25 gm in weight.
❖ The number of prostatic glands, as
well as the stroma, has increased in
this enlarged prostate seen in
transverse section, and as a result,
the entire prostate has increased in
size, estimated at more than 70 gm.
❖ The pattern of increase here is not
uniform, but nodular. This increase
is in response to hormonal action on
the cells, but in this case is not a
normal physiologic process, but a
pathologic process that could
interfere with emptying of the
urinary bladder
❖ Q:Grossly nodular , enlarged
prostate , what do you expect to
see microscopically ?
❖ Answer :The number of prostatic
glands, as well as the stroma, has
increased in this enlarged prostate
seen in transverse section,
Diagnosis : Hyperplasia
Here is one of the nodules
of hyperplastic prostate,
with many glands along
with some intervening
stroma. The cells making
up the glands are normal
in appearance, but there
are just too many of them.
Gross appearance of prostate gland showing benign prostatic glandular hyperplasia
.
 ‫هذه الصورة غير مطلوبة ولكن ت إضافتها نظرا ‪%‬همية‬
‫ا‪BL‬حظات عليها ولوجود صورة مشابها لها ف س‪B‬يد ‪19‬‬
Microscopic view of normal endometrium
Endometrial hyperplasia showing numerous glands
 Diagnosis :Atrophy
▪ This is cerebral atrophy in a
patient with Alzheimer disease.
▪ The entire size of the brain is
reduced, but some parts are
more affected than others.
▪ The gyri are narrowed and
the intervening sulci are
widened, most pronounced
toward the frontal lobe region
shown here at the right.
▪ Q: 85 years old man with
history of amnesia, and loss of
recent memory since 5 years
ago , what do you expect this
patient to have from the gross
section of brain ?
▪ Answer :Dementia (brain
atrophy )
Atrophy
Q:An 18-year-old man
has lower limb nerve
injury; underwent
skeletal muscle biopsy.
Which of the following
represents his
findings?
Answer :Atrophy
((Disuse Atrophy ))
❑ some of these skeletal muscle
fibers here show atrophy,
compared to normal fibers. The ‫سفل‬$‫*حظات با‬+‫انظر ا‬
number of cells is the same
as before the atrophy
occurred, but the size of
some fibers is reduced. This
is a response to injury by
"downsizing" to conserve
the cell. In this case,
innervation to the small,
atrophic fibers was lost.
❑ The most common cause is
disuse atrophy
❑ In healthy people lack of
exercise
❑ In bedridden people they have
considerable atrophy
❑ Q:what is the special stain
used in this section that
showing atrophy of skeletal
muscle ?
❑ Answer Trichrome stain
 Diagnosis :Metaplasia of the normal esophageal squamous mucosa has occurred
here, with the appearance of gastric type columnar mucosa.

Q:Identify adaptive process

in this esophageal biopsy
Answer : Metaplasia
Q: Patient has history of
acidity and diagnosed as
reflux esophagitis , What is
the possible epithelial
changes that might occurs
in esophageal mucosa ?
Answer : Metaplasia from
squamous epithelium into
intestinal or columnar
epithelium )
Diagnosis :Columnar
metaplasia - Barret's
esophagus (metaplasia of
esophageal mucosa from
squamous epithelium into
intestinal type epithelium.
Q: what this lesion
predispose to or what is
the subsequent risk of
this lesion to develop?
Answer: adenocarcinoma
of esophagus
‫تذكير وشرح سريع‬
‫لهاي النقطة‬
Myossitis ossificans : Swelling in left femur.
Mesenchymal metaplasia in skeletal muscle after injury.
Reversible cell injury
1-Cellular swelling - Hydropic degeneration
1-Hydropic degeneration of the liver.(reversible changes)
Clear watery vacuoles seen within the cytoplasm.
2- Fatty change(Reversible changes)
The patient was chronic alcoholic. The presence of large
quantities of neutral fat within the liver cells result in a uniform
yellow appearance of the liver section.
Microscopic view of liver showing
fatty change.
Small & large cytoplasmic
vacuoles pushing nucleus to the
periphery .
Question : what is the type of lipid
in this liver biopsy ?
Answer :Triglycerides
Question :what are the conditions
that might associated with this
liver biopsy :
Answer: Diabetes ,
Hyperlipidemia , alcoholic ,
chemicals or drug reaction etc
Nuclear changes in irreversible injury
• Necrotic cells ,showing
nuclear pyknosis
karyorrhexis &
karyolysis.

Irreversible nuclear
changes
Microscopic view of liverbiopsy ,showing pyknosis, karyorrhexis & karyolysis
Karrhyorexis: nuclear chromatin fragmentation
Patterns of tissue necrosis
❑ Coagulative
❑ Liquefactive
❑ Caseous
❑ Fat
❑ Fibrinoid
❑ Gangrenous
 1- Coagulative necrosis
▪ Preservation
of architecture due to loss
of both proteins and
hydrolytic enzymes.
▪ Seen in solid organs as:
spleen, kidney and heart,and
adrenals except brain.
▪ Ex: Myocardial infarction.
• Normal cardiac muscle in longitudinal section shows a syncytium of
myocardial fibers with central nuclei. Faint pink intercalated discs
cross some of the fibers.
❑ Here is myocardium in
which the cells are dying
as a result of ischemic
injury from coronary artery
occlusion. This is early in
the process of necrosis.
The nuclei of the
myocardial fibers are
being lost.
❑ The cytoplasm is losing
its structure, because no
well-defined cross-
striations are seen.
❑ Q: What is the type of
necrosis in the
myocardium ?
❑ Answer :Coagulative
necrosis
❑ When many cells undergo
necrosis at once, then
definable patterns of necrosis
are produced, depending upon
the nature of the injury, the
type of tissue, and the length
of time. This is an example of
coagulative necrosis.
❑ Q:When does this type of
necrosis commonly seen ?
Answer :This is the typical pattern
with ischemia and infarction (loss
of blood supply and resultant
tissue anoxia).
Here, there is a wedge-shaped
pale area of coagulative necrosis
(infarction) in the cortex of the
kidney.
Q: Identify the organ :
Answer Spleen
Q: what is the lesion shown in
this Gross appearance of
spleen ?
Answer :Two large infarctions
(areas of coagulative necrosis)
are seen in this sectioned
spleen.
Since the etiology of
coagulative necrosis is usually
vascular with loss of blood
supply, the infarct occurs in a
vascular distribution. Thus,
infarcts are often wedge-
shaped with a base on the
organ capsule.
Question: Identify the
pathology in this brain ?
Answer :
Grossly, the cerebral infarction
at the upper left in this image,
in the distribution of the middle
cerebral artery, demonstrates
liquefactive necrosis.
Eventually, the removal of the
dead tissue leaves behind a
cavity.
This infarct in the
brain is organizing
and being resolved.
Q:What is the pattern
of necrosis in this
brain ?
Answer: The
liquefactive necrosis
which leads to
resolution with cystic
spaces as the necrotic
tissue is removed.
This is more extensive caseous necrosis, with
confluent cheesy tan granulomas in the upper
portion of this lung in a patient with tuberculosis.
The tissue destruction is so extensive that there are
areas of cavitation (cystic spaces) being formed as
the necrotic (mainly liquefied) debris drains out via
the bronchi.
Q:Identify the organ ?
Answer : Lung
Q: What is the pattern of necrosis in this lung
disease?
Answer : caseous necrosis
Q:What is the most probable cause of necrosis in
this lung .
Answer: Tuberculosis (TB)
Caseous Necrosis in
Large Tubeculous
lesion (TB) in the lung
Q:what is the
causative agent in this
lesion?
Answer:T.B bacilli
Microscopically, caseous
necrosis is characterized by
acellular pink areas of
necrosis, as seen here at the
upper right, surrounded by a
granulomatous inflammatory
process.
Diagnosis :Fat necrosis
in acute pancreatitis .
Grossly : White chalky foci in the
omentum
Fibrinoid necrosis in an
artery in a patient with
polyarteritis nodosa.
The wall of the artery shows a
circumferential bright pink area
of necrosis with protein
deposition & inflammation
(dark nuclei of neutrophils).
Q:Identify the pattern of
necrosis in this artery ?
Answer :Fibrinoid necrosis
Q: In which clinical situation
this lesion is mostly seen ?
Answer :Vasculitis
(polyarteritis nodosa )
This is gangrene of the lower
extremity. In this case the term
"wet" gangrene is more
applicable because of the
liquefactive component from
superimposed infection in
addition to the coagulative
necrosis from loss of blood
supply.
Q: Which disease is expected
that patient to have ?
Answer :This patient had
diabetes mellitus with severe
peripheral vascular disease.
Cytoplasmic organelle damage leads
to a variety of injury patterns, most
of which are best seen by electron
microscopy. Acute injuries tend to
damage an entire cell, so specific
organelle damage is beside the point.
However, in some cases the damage
can be cumulative over many years.
Here are Mallory bodies (the red
globular material) composed of
cytoskeletal filaments in liver cells
chronically damaged from alcoholism.
Q:What is the type of intracellular
red globular material seen in the
hepatocytes ?
Answer Mallory body ,These are a
type of "intermediate" filament.
Q;In which of liver disease this
picture is mostly expected to be
seen ?
Answer : Alcoholic liver disease
/Alcoholic hepatitis
❑ Intracellular accumulations of a
variety of materials can occur in
response to cellular injury.
❑ Here is steatosis, or fatty
metamorphosis (fatty change) of
the liver in which deranged
lipoprotein metabolism from
injury leads to accumulation of
lipid in the cytoplasm of
hepatocytes.
❑ Note the large, clear lipid droplets
that fill the cytoplasm of many
hepatocytes.
Q: Identify the pathology of this liver
biopsy ?
Answer : Steatosis (Fatty liver
changes )
Q: Section of the liver is seen in this
picture showing abundance of clear
vacuoles occupying the hepatocytes ,
what is the type of substance loaded
in this liver cells ?
Answer : Lipid droplet
(Triglycerides )
The liver injury with
chronic alcoholism leads
to fibrosis and regeneration
of the hepatocytes in
nodules. This firm, nodular
appearance of the liver as
seen here is called
cirrhosis.
Irreversible Injury to the
liver
This Congo red stain reveals
amorphous orange-red deposits of
amyloid, which is an abnormal
accumulation of breakdown
products of proteinaceous material
that can collect within cells and
tissues.
Q:What is the special stain used in
this section?
Answer:Congo red
Q: Congo red is special stain used to
demonstrate ------------.
Answer : Amyloid
Amyloidosisis is usually triggered
by an inflammatory disease, such as
rheumatoid arthritis. It most
commonly affects the kidneys, liver and
spleen.
Associated with Chronic diseases ,
Multiple Myeloma , Dialysis
associated amyloidosis , or might be
familial or hereditary .
The yellow-brown granular pigment seen
in the hepatocytes here is lipochrome
(lipofuscin) which accumulates over time
in cells (particularly liver and heart) as a
result of "wear and tear" with aging. It
is of no major consequence, but
illustrates the end result of the process of
autophagocytosis in which intracellular
debris is sequestered and turned into
these residual bodies of lipochrome
within the cell cytoplasm.
The brown coarsely granular material in
macrophages in this alveolus is
hemosiderin that has accumulated as
a result of the breakdown of RBC's and
release of the iron in heme. The
macrophages clear up this debris,
which is eventually recycled.
A Prussian blue reaction is seen in
this iron stain of the liver to
demonstrate large amounts of
hemosiderin that are present within
the cytoplasm of the hepatocytes and
Kupffer cells. Ordinarily, only a small
amount of hemosiderin would be
present in the fixed macrophage-like
cells in liver, the Kupffer cells, as part
of iron recycling.
Q: Identify the stain in this section ?
Answer : Prussian blue (Perl’s stain )
Q: In which condition this pathology is
expected to be seen ?
Answer :Hemachromatosis , iron
overload , hemolytic anemia,
repeated blood transfusion
‫ا تزيد كميته كثير ببطل بس يكون بال‬6 iron ‫ال‬
‫ بصير يطلع بال‬macrophages
‫ كمان‬parenchymal cells
These renal tubules contain
large amounts of hemosiderin,
as demonstrated by the
Prussian blue iron stain.
Q: Patient has large amount of
hemosiderin in renal tubules
(demonstrated by Prussian blue
reaction )what condition this
patient is expected to have ?

Answer: This patient had

chronic hematuria.
❑ The black streaks seen
between lobules of lung
beneath the pleural surface
are due to accumulation of
anthracotic pigment. This
anthracosis of the lung is
not harmful and comes
from the carbonaceous
material breathed in from
dirty air typical of
industrialized regions of
the planet.
❑ Persons who smoke would
have even more of this
pigment.
Q: this is the Gross appearance
of the lung of patient who was
Coal miner worker , what is the
black streaks that is seen
between lobules of the lung
refer to ?
Answer :Anthracotic pigment
Here is anthracotic pigment in
macrophages in a hilar lymph
node. Anthracosis is nothing
more than accumulation of
carbon pigment from
breathing dirty air. Smokers
have the most pronounced
anthracosis. The anthracotic
pigment looks bad, but it
causes no major organ
dysfunction.
❑ This is dystrophic calcification
in the wall of the stomach. At
the far left is an artery with
calcification in its wall. There
are also irregular bluish-purple
deposits of calcium in the
submucosa. Calcium is more
likely to be deposited in
tissues that are damaged.
Q:Identify the pathology in
depicted picture ?
Answer : Dystrophic calcification
Q:In which tissue this pathology
might occur or commonly seen ?
Answer : In necrotic or diseased
tissue
Q: What is the serum level of
calcium expected in the patient
who has dystrophic calcification
in depicted picture ?
Answer:Normal calcium
Q:A 55-year-old male
diagnosed with
Multiple Myeloma
underwent bone
marrow biopsy. What
is the pinkish material
that appears in the
picture?
Answer :Russel body
(Protein )
‫ب أدخلني مدخل صدق‬ ‫وقل ر ّ‬
‫وأخرجني مخرج صدق وأجعل‬
‫لي من لدنك سلطانًا نصيرًا‬