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Transcript of PathologyPathology Department of Pathology Long jie.
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PathologyPathologyPathologyPathology
Department of Pathology
Long jie
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1. What is Pathology:
1) Scientific study of disease
Causes (etiology)
mechanisms (pathogenesis)
2) manifestation
progress
sequels
Investigation of
morphology
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2. Status of Pathology: a bridge
Anatomy
Histology and embryology
Physiology Biochemistry Cytology microbiology
pathologyClinical medicine
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3. Contents of pathology
pathology
General pathology
Systemic pathology
Cell,tissue damage
repair
Disorders of vascular flow
Inflammation
Neoplasm……
Cardiovascular system
Respiratory system
Digestive system……
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4. Methods in pathology
1) Autopsy
2) Biopsy
3) Cytology
4) Electron-microscopy
5) tissue and cell cultivation
6) Animal experiment
7) molecular biology
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5. morphological observations:
1) Gross level
2) Light microscopy
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Chapter 1Chapter 1Chapter 1Chapter 1
Cell injury and adaptation
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IntroductionIntroduction
Cells maintain normal homeostasis
Physiologic stresses
Pathologic stimuli
cells
adaptation Atrophy hypertrophy
hyperplasia metaplasia
injuryDegeneration (reversible)
Cell death (irreversible)
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AdaptationAdaptation (适(适应)应)
1. Atrophy ( 萎缩)2. Hypertrophy ( 肥大 )
3. Hyperplasia ( 增生 )
4. Metaplasia ( 化生 )
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Atrophy Atrophy (( 萎萎缩)缩)
Atrophy Atrophy (( 萎萎缩)缩)
Shrinkage in the size of the normal cell,
tissue and organ by the loss of cell
substance.
Decrease in Cell size or number
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Causes and typesCauses and types
1. Aging ( 生理性 ~)
2. Inadequate nutrition/ diminished blood supply ( 营养不良性 ~)
3. Pressure ( 压迫性 ~)
4. Reduced functional activity ( 废用性 ~)
5. Interrupted nerve supply ( 去神经性 ~)
6. Endocrine deficiency ( 内分泌性 ~)
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Pathologic changesPathologic changes
Grossly: The entire tissue or organ diminishes in size ,
weight and function. Microscopically: 1. Organelles degradation 2. Increased autophagic vacuoles 3. Residual bodies(e.g., lipofuscin)
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resultsresults
RecoverCell death
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Increase in the size of cells and
consequently an increase in the
size of the organ.
increase in cell size
Hypertrophy Hypertrophy (肥(肥大) 大)
Hypertrophy Hypertrophy (肥(肥大) 大)
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Causes and typesCauses and types
Physiologic hypertrophy ( 生理性~)
Pathologic hypertrophy (病理性~)
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Hypertrophy of myocardium
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Pathologic changesPathologic changes
Grossly:
Enlarged organ
Microscopically:
1. Increased in the size and number of Organelles
2. Bigger cells
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Physiologic hypertrophy of the uterus during pregnancy
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Increase in the number of cells and
consequently an increase in the size of
the organ or tissue.
Increase in cell number
Hyperplasia Hyperplasia (增(增生)生)
Hyperplasia Hyperplasia (增(增生)生)
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Causes and typesCauses and types
Physiologic hyperplasia ( 生理性~) Pathologic hyperplasia (病理性~)
Most forms of pathologic hyperplasia are instances of excessive hormonal or growth factor stimulation.
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Pathologic changesPathologic changes
Microscopically:
Increased cell mitosis
Grossly:
Enlarged organ
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resultsresults
RecoverCancerous proliferation
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A reversible change in which one adult c
ell type( epithelial or mesenchymal) is rep
laced by another adult cell type.
Change in cell type
Metaplasia Metaplasia (化(化生)生)
Metaplasia Metaplasia (化(化生)生)
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Causes and typesCauses and types
Squamous metaplasia
Intestinal epithelial ~
Bone or cartilage ~
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Pathologic changesPathologic changes
Microscopically:
1.cell type change
2. Epithelium __ Epithelium ;
mesenchymal__ mesenchymal
3. Adult cells
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resultsresults
RecoverInduce cancer transformation
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causes mechanisms morphology
Cell injuryCell injury (损伤)(损伤)
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Causes Causes
Oxygen deprivation
Chemical agents
Infectious agents
Immunologic reactions
Genetic defects
Nutritional imbalances
Physical agents
aging
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MechanismsMechanisms (self-study)(self-study)
Defects in plasma membrane
Hypoxia or generation of reactive
oxygen species
Loss of calcium homeostasis
Chemical injury
Genetic variation
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morphology morphology
Degeneration ( reversible )
Cell death ( irreversible )
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degenerationdegeneration (变(变性)性)
The injuried cell accumulate abnormal a
mounts of various substance in the cell o
r mesenchyma . Degeneration is always
accompanied by diminishing in function.
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typestypes
1. Cellular swelling ( 细胞水肿)2. Fatty change ( 脂肪变性 )
3. Hyaline change ( 玻璃样变 )
4. Amyloidosis ( 淀粉样变 )
5. Mucoid degeneration ( 黏液样变 )
6. Pathologic pigmentation ( 病理性色素沉着 )
7. Pathologic calcification ( 病理性钙化 )
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Cellular Cellular swellingswellingCellular Cellular swellingswelling
Hydropic change ( 水变性 )
Vacuolar degeneration ( 空泡变性 )
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morphologymorphologymorphologymorphology
Microscopically:
1. swollen cells balloon degeneration
2. Small clear vacuoles in the cytoplasm
3. Coarse granules in the cytoplasm( swollen organells).
Grossly:
entire organ : pallor,turgor,increased weight.
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Cellular swelling of liver
胞浆疏松化
气球样变性
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Fatty changeFatty changeFatty changeFatty change
Fatty degeneration ( 脂肪变性 )
Refer to any abnormal accumulation of triglycerides within parenchymal cells.
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Fatty change may caused by toxins, protei
n malnutrition, diabetes mellitus, obesity a
nd anoxia.
Alcohol abuse
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morphologymorphologymorphologymorphology
Microscopically: Clear lipid vacuoles / small droplets in the cytopl
asm of parenchymal cells.
Grossly: liver ----- enlarge, become yellow, soft and greasy. heart ----- tigered effect 虎斑心
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Fatty change of liver
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Hyaline changeHyaline changeHyaline changeHyaline change
Hyaline degeneration ( 透明变性 )
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morphologymorphologymorphologymorphology
Microscopically:
1. Homogeneous, pink, refractile( 折光) , hyaline protein accumulation
2. Occure in the cytoplasm, connective tissue, and walls of arteriole, the mechanisms are different.
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amyloidosisamyloidosisamyloidosisamyloidosis
Amyloid deposition
Amyloid degeneration
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morphologymorphologymorphologymorphology
Microscopically:
1. Homogeneous, pink, protein-glycosaminoglycan accumulation;
2. Occur in the extracellular tissue, basement membrane of blood vessels.
E.M.:
closely packed interlacing fibrils
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Pathological Pathological pigmentationpigmentationPathological Pathological pigmentationpigmentation
Colored substances that are either
exogenous or endogenous
accumulate in /out the cell.
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typestypes
1. Hemosiderin ( 含铁血黄素)2. lipofuscin ( 脂褐素 )
3. melanin ( 黑色素 )
……
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hemosiderinhemosiderin
hemoglobin-derived granular pigment golden-yellow to brown Accumulates in tissues when there is
local or systemic excess of iron.
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lipofuscinlipofuscin
wear-and-tear pigment
insoluble,brownish-yellow , granular
Accumulates in variety of tissues
(heart,liver and brain) as a function of
age or atrophy.
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melaninmelanin
Endogenous, brown-black pigment
formed by melanocyte
occur when the enzyme tyrosinase catal
yzes the oxidation of tyrosine to dihydro
xyphenylalanine
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Pathological Pathological calcificationcalcificationPathological Pathological calcificationcalcification
The abnormal deposition of
calcium salts in a wide variety of
tissues except bone and teeth.
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typestypes
1. Dystrophic calcification
( 营养不良性钙化)
2. Metastatic calcification
( 转移性钙化 )
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morphologymorphology
Microscopically:
Intracellular and /or extracellular basophilic deposits.
Grossly:
white granules or clumps, felt as gritty deposits.
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Cell deathCell death (细胞死亡)(细胞死亡)
when the nuclear is severly injuried , the
cell show irreversible changes includ
ing cell cessation of metabolic versati
lity,damage of structure and loss of f
unction.
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typestypes
1. necrosis ( 坏死 )
2. apoptosis ( 凋亡 )
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necrosisnecrosisnecrosisnecrosis
A sequence of morphologic changes
that follow partial cells death in
living tissue.
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microscopically:
Increased eosinophilia ,more glassy homogeneous
Cytoplasm becomes vacuolated and appears moth-eaten
Nuclear changes:
pyknosis (核固缩) karyorrhexis (核碎裂) karyolysis ( 核溶解)
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typestypes
Caseous necrosis ( 干酪样坏死 )
gangrene ( 坏疽 )
Dry~( 干性坏疽 )
Moist ~( 湿性坏疽 )Gas ~( 气性坏疽 )
Coagulative ~( 凝固性坏死)
Liquefactive ~( 液化性坏死 )
Fibrinoid ~( 纤维素样坏死 )
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Coagulative Coagulative necrosisnecrosis
Coagulative Coagulative necrosisnecrosis
Preservation of the basic structural outline of the cell or tissue by denaturation of proteins in the dead cell.
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grossly:
The necrosis area become swollen, fi
rm ,dull, and lustreless, yellowish.
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坏死区
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microscopically:
Nuclei change
Cytoplasm is granular, take up more eosin than normal
Outline of necrosis cells can be recognised
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Caseous necrosisCaseous necrosis
tuberculous infection; Cheesy, white gross appearance; Microscopially, structureless , amor
phous granular debris; the tissue architecture is completely obliterated.
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gangrenegangrene
Necrotic lesion + infected by organisms which cause putrefaction;
grossly: brown,green or black discolouration of the tissue;
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Dry gangrene:
skin surface Following arterial obstruction Liable to affect the limbs (e.g. toes 脚
趾) dry Mild infection Clear borderline
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moist gangrene:
Splanchnic organs Venous congestion + arterial obstruction Liable to affect bowel, gall bladder, uter
us,lung e.t. moist severe infection unclear borderline
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gas gangrene:
Deep ,open wound Infected with clostridial organisms. gas Alveolate tissue toxicosis
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liquefactive necrliquefactive necrosisosis
liquefactive necrliquefactive necrosisosis
The enzymes decompose the necrosis tissue into fluid.
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grossly:
The necrosis area become sofen, and t
urns into turbid fluid.
(brain, spinal cord)
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microscopically:
Profound loss of the previous histological architecture.
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Types (self-study):
Fat necrosis ( 脂肪坏死 )Purulence ( 化脓 )Lytic necrosis ( 溶解性坏死 )
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Fibrinoid Fibrinoid necrosisnecrosis
Fibrinoid Fibrinoid necrosisnecrosis
Commen feature of collagen or connective tissue diseases and accelerated hypertention.
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microscopically: The necrosis tissue is filamentous or gran
ule , brightly eosinophilic fibrinoid substance .
Collagen Immunoglobulin fibrin
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Sequels of necrosisSequels of necrosis
Autolyze ( 自溶 ) Dissolved and absorbed ( 溶解吸收 ) Expelled ( 分离排出 ) Organization ( 机化 ) Encapisulation ( 包裹 ) Undergo dystrophic calcification ( 钙化 )
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Erosion ( 糜烂 )Ulcer ( 溃疡 )Sinus ( 窦道 )Fistula ( 瘘管 )Cavity ( 空腔 )
Terms:
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apoptosisapoptosis
Programmed cell deathdying cell: Shrink and
compact Affect single cell form apoptotic bodies no inflammatory reaction
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凋亡小体
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