Done by :Morad Abu Qamar

Pathology lab 2

Caseous necrosis, hilar lymph node, lung This is the gross appearance of caseous necrosis in a hilar lymph node infected with tuberculosis. The node has a cheesy tan to white appearance. Caseous necrosis is really just a combination of coagulative and liquefactive necrosis that is most characteristic of granulomatous inflammation.

hilar lymph node

Caseous necrosis, extensive in lung.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 , مهم) being formed as the necrotic (mainly liquefied) debris drains out via the bronchi.

Caseous necrosis, lung, high power microscopicMicroscopically, caseous necrosis is characterized by acellular pink areas of necrosis, as seen here at the upper right, surrounded by a granulomatous inflammatory process.

Granuloma (causative agent surrounded by macrophage

and other inflammatory cells)

“ we will take it at inflammation lectures “

Gangrenous necrosis, footThis is gangrene, or necrosis of many tissues in a body part. In this case, the toes were involved in a frostbite injury. This is an example of "dry" gangrene in which there is mainly coagulative necrosis from the anoxic injury.

dry" gangrene coagulative necrosis

مهم

Gangrenous necrosis, lower extremity.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. This patient had diabetes mellitus with severe peripheral vascular

disease.

Liquefactive necrosis Wet due to infection (bacteria mainly)

مهمـــــــــــــــة

Neurofibrillary tangles(proteins), Alzheimer disease.Here are neurofibrillary tangles in neurons of a patient with Alzheimer's disease. The cytoskeletal filaments are grouped together in the elongated pink tangles.

Fatty change, liverIntracellular 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.

Amyloid deposition, Congo red stain.(very important) 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.

Amyloid : protein accumulated outside the cells.

Amuloid by congo ”بتنعرف“ red stain

Alpha-1-antitrypsin deficiency with globules in liver, PAS stain.Sometimes cellular injury can lead to accumulation of a specific product. Here, the red globules seen in this PAS stained section of liver are accumulations of alpha-1-antitrypsin in a patient with a congenital defect involving cellular metabolism and release of this substance.

Lipochrome in hepatocytes. "wear and tear" with aging “very impotant” The yellow-brown granular pigment seen in the hepatocytes here is lipochrome (lipofuscin, small granules ) 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.

We can differentiate between hemosiderin and lipofuscin by :

prussian blue stain

Blue(positive) ----lipofuscinNot blue (-)--- hemosiderin

Hemosiderin in pulmonary macrophagesThe 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.

brown coarsely granular material (Hemosiderin) in macrophages that cover macrophage / large granules

Hemosiderosis of liver, iron stain.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.

Hemosiderin deposition in renal tubules, iron stainThese renal tubules contain large amounts of hemosiderin, as demonstrated by the Prussian blue iron stain. This patient had chronic hematuria.

Scleral icterus (jaundice) seen in eye (مهمة جدا جدا جدا)he sclera of the eye is yellow because the patient has jaundice, or icterus. The normally white sclerae of the eyes is a good place on physical examination to look for icterus.

Due to bilirubin pigment

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Bilirubin in liver (cholestasis)The yellow-green globular material seen within small bile ductules in the liver is bilirubin pigment. This is hepatic cholestasis. A problem with excretion of bile, or an obstruction to flow of bile, could cause this appearance. This patient would exhibit jaundice.

The yellow-green globular material(bilirubin)

Anthracotic pigmentation seen on surface of lung.. 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

Black color pigment exogenous (carbon)

Anthracotic pigment in macrophages of hilar lymph nodeHere 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.

Dystrophic calcification, stomach. his 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.

Calcification : purple due to deposition calcium

** if this patient take drug lead to destruct the wall ---previous injury –chemical –

dystrophic

Metastatic calcification of lung with hypercalcemia .Here is so-called "metastatic calcification" in the lung of a patient with a very high serum calcium level (hypercalcemia).**here lung is normal , the problem from outside due increase (parathyroid hormone/ vitamin D )

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