Download Objective ACD3.1 Discuss, with examples, changes that occur in

Case Example for C1 Adaptation and Cell Death
Margret S. Magid, MD
Learning Goal 3:
Apply knowledge of cellular physiology, metabolism, and macromolecular synthesis to discuss cellular
and subcellular responses to sublethal injury or stress on cells; how these responses affect morphologic
appearance at the cell and tissue level; and how they can affect organ function.
Objective ACD3.1 Discuss, with examples, changes that occur in cellular organelles or cytoskeletal
proteins of different cell types in response to environmental alterations.
……………………………………………………………………………………………………..
Clinical History: A 42-year-old African-American man died of cerebral hemorrhage. He had a
longstanding history of poorly controlled hypertension (BP = 190/125 mm Hg).
Gross Specimen: Postmortem examination of his heart showed that it weighed 650 grams (Normal =
300-350 grams). The heart was cut in cross-sectional "bread loaf" slices. In this image, the rounded left
ventricle is on the right and the triangular right ventricle is on the left. The wall of the left ventricle
concentrically measured approximately 2 cm in width (normal width, ~1 cm). The histological section you
will be reviewing was taken from the area indicated by the box.
Histological Section of Patient's Heart: This is a transmural histological section of the patient's heart
whose location is indicated in the previous gross image.
For orientation of this slide:



The left ventricular cavity is the empty space at the left of the slide (marked with a heart icon).
(The endocardium cannot be appreciated at this magnification.)
An arrow indicates a papillary muscle. At the lower right corner is the epicardium, with a star
icon indicating the epicardial fat.
The myocardium of the wall of the left ventricle occupies the rest of the slide.
Look at this slide at higher magnification in the area marked by the box.
Compare the patient's myocardium (above) with the normal myocardium (below) observed at the same
magnification. (Note: The difference in staining of the cytoplasm in these two slides is artifactual, due to
different staining methods.)
QUESTIONS:
1. Describe the histological changes in the patient’s cells compared to normal. Your answer should
discuss both the cytoplasm and nuclei.
Cytoplasm: The myocardial cells are larger than normal, with abundant eosinophilic cytoplasm
[i.e., picks up the pink eosin stain]. (As mentioned previously, the very marked eosinophilia of the
cytoplasm in this particular case compared to normal largely reflects staining technique).
Nuclei: The nuclei are larger than normal and hyperchromatic (darkly basophilic).
2. Had ultrastructural examination of the myocytes been performed by electron microscopy, what
intracellular component would be most likely to have been increased in the cells?
There will be increased numbers of myofilaments, which enable the cell to respond to increased work
load.
3. What is your diagnosis for the morphological change you see in the myocardium (i.e., what
pathological diagnostic term would appear on the report)?
Left ventricular (myocardial) hypertrophy.
4. Define the term.
Hypertrophy is an increase in the size of cells, resulting in an increase in the size of the organ. The
enlargement of the cells is due to an increase in amount of cell organelles.
5. Is this morphological change indicative of adaptation, reversible cellular injury, or cell death?
Hypertrophy is a morphological change indicative of adaptation (an adjusted state of cellular
homeostasis, generally reversible, in response to lower grade, sublethal stress – which may be both
pathological and physiological. The cell avoids injury by adjusting its level of functioning to
compensate for the stress).
6. What specific clinical etiology has caused the myocardial change in this patient? Can you think of
another clinical etiology that would result in a similar appearance?
Hypertension caused the myocardial hypertrophy in this patient.
Other causes of adaptive left ventricular myocardial hypertrophy include forms of left ventricular
outflow obstruction (e.g., aortic stenosis, coarctation of the aorta).