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Cell Pathology
Faisal Majid
4th year (Endo BSc)
MM Education rep
union.ic.ac.uk/medic/muslim
[email protected]
1. Cancer
• Define the words hyperplasia and hypertrophy;
give 2 examples of each
• Explain the difference between metaplasia and
dysplasia giving two examples of each
• Define the words tumour, metastasis, carcinogen
• List four features which distinguish benign from
malignant tumours
• Define the terms necrosis, ulcer, degenerative,
sublethal injury
• Give two examples each of diseases caused by
infection and one example of a disease caused by
a chemical agent.
Definitions
• Hyperplasia -  Number of cells
• Prostate
• Endometrium
• Breast ducts
• Hypertrophy -  SIZE of cells
• Myocardium
• Muscle fibres
• Metaplasia – Change of cell TYPE
• Cervical where glandular → squamous epithelium
• Bronchioles where glandular → squamous epithelium
• Dysplasia – Abnormal Development, size, shape,
arrangement
• Cervical
• fibrous
tumour, metastasis, carcinogen
Classification
Benign
•Well differentiated
•Slow growth
•Encapsulated
•Non-metastatic
Malignant
•Varied
differentiation
•Rapid growth
•Invasive
•Metastatic potential
2. Haemodynamic disorders
• Describe the causes and consequences of
oedema at different sites
• Define thrombosis and give the causes
and potential consequences of such an
event.
• Define embolism and know about the
importance of pulmonary embolism in
clinical practice.
• Describe possible causes of haemorrhage
and potential outcomes
• Define shock and identify the possible
causes and mechanisms
• Define infarction and describe possible
causes.
Oedema
Causes:
Consequences:
•Raised hydrostatic
pressure
•Reduced plasma
osmotic pressure
•Lymphatic obstruction
•Sodium retention
•Inflammation
•Cellulitits
•Venous Eczema
•Venous Ulcer
•Pulmonary
•Cerebral
Thrombosis: Causes
Thrombosis
•Endothelial injury
•Atheromatous plaques
•Myocardial infarction
•Vasculitis
•Cigarette smoke
•Hypercholesterolaemia
•Resolution
•Organisation
•Re-cannulisation
•Propagation
•Embolisation
•PE
•Abnormal blood flow
•Turbulence
•Stasis
•Hypercoagulability
•Primary (genetic)
•Secondary (acquired)
•OCP
•Malignancy
•Smoking
•Pregnancy
•Coronary
•Deep Vein
Haemorrhage
Causes
•Trauma
•Vasculitits
•Vascular fragility
Consequences
•None
•Chronic anaemia
•Hypovolaemic shock
•Pressure
Shock
• Cardiovascular collapse -> hypotension, impaired
tissue perfusion, cellular hypoxia
• Causes:
• Hypovolaemic:
•
•
•
•
•
Severe haemorrhage
Massive trauma
Burns
Sepsis
Anaphylactic: hypersensitivity
• Cardiogenic: pump failure
•
•
•
•
Myocardial infarction
Massive pulmonary embolism
Myocardial damage
Tamponade
• Neurogenic: spinal trauma
Shock - Consequences
• Brain: ischaemic encephalopathy
• Heart: subendocardial
ischaemia/necrosis
• Kidneys: acute tubular necrosis
• GI tract: haemorrhagic enteropathy
• Lungs: ARDS
3. Inflammation
• List 4 causes of acute and 3 of chronic
inflammation
• State three possible outcomes of acute
inflammation due to a pyogenic microorganism
• Describe briefly how the microscopic
features of acute inflammation differ from
those of chronic inflammation
• Define the terms ‘resolution’;
‘suppuration’; ‘organisation’
• Describe the microscopic features of
granulomatous inflammation and give 2
examples
• Name two local, and two general, causes
for a failure of healing or repair.
Inflammation
•Acute
•Trauma
•Infection
•Physiochemical
•Foreign body
•Immune reactions
•RUBOR – redness
•TUMOUR – swelling (oedema)
•CALOR – heat
•DOLOR – pain
•Fever, shock
•Acute co-ordinated response vessels, cells and soluble
mediators
•Neutrophil is main cell
•Exudate formed
•Variety of outcomes……..
Outcome of
acute inflammation
SPREAD - INFECTION
•Blood – septicaemia
•Tissue - cellulitis
ABSCESS
Chronic inflammation
Inflammation of prolonged duration in which active inflammation,
tissue destruction and attempts at repair occur simultaneously
•Causes
•Persistent damage
•Persistent infection
•Prolonged exposure to
toxic agent
•Autoimmunity
•Significant damage
•Key cells are different
•MACROPHAGES
•LYMPHOCYTES
•NO exudate
•Special types
•GRANULOMATOUS
Granulomatous inflammation
•What is a granuloma? an aggregate of
macrophages
•What causes
granulomatous
inflammation?
•Infection – TB
•Foreign material
•Reaction to tumours
•Immune diseases
(sarcoid, crohn’s)
What hinders repair
•GENERAL
•POOR NUTRITION Protein needed for
collagen tensile strength
•VITAMIN DEFICIENCY •LOCAL
•Vitamin C – needed by
fibroblasts to make
collagen
•Vitamin A - required for
epithelium
•MINERAL DEFICIENCY
•E.G. ZINC
•SUPPRESSED
•INFLAMMATION
•E.G. By Steroids
•Old age
•Diabetes
•POOR BLOOD SUPPLY
•PERSISTENT FOREIGN
BODY
•MOVEMENT
4. Cell injury
• List the causes of cell injury
• List the mechanisms of cell injury
• Define (and give examples of)
hyperplasia, hypertrophy, atrophy,
metasplasia and dysplasia
• Describe the morphological changes
associated with reversible and
irreversible injury
• Describe the differences between
apoptosis and necrosis
Reversible vs irreversible injury
•Fatty change
•Cellular swelling
1.
Karyolysis- the dissolution of the nucleus - the nucleus
swells and gradually loses its chromatin.
2.
Pyknosis - Shrunken nucleus with condensed chromatin.
3.
Karyorrhexis - rupture of the cell nucleus in which the
chromatin disintegrates into formless granules that are
extruded from the cell.
1.
2.
3.
4.
Coagulative necrosis
Liquefactive necrosis
Caseous necrosis
Fat Necrosis
Necrosis
1
2
1
Apoptosis
2
3
The differences between apoptosis and
necrosis
1. Apoptosis may be physiological
2. Apoptosis is an active energy
dependent process
3. Not associated with inflammation
5. Autopsy & Forensic medicine
• Explain how the need for consent from the deceased’s’
relatives differs for a Coroners’ and a Hospital Autopsy.
• List four types of death that must be reported to the
Coroner.
• List two reasons for conducting Hospital Autopsies.
• List four causes of sudden unexpected death in the
community.
• What is a bruise? Give an example of a mechanism of injury
that would lead to a bruise.
• What is an abrasion? Give an example of a mechanism of
injury that would lead to an abrasion.
• What is a laceration? Give an example of a mechanism of
injury that would lead to a laceration.
• What is the difference between a cut and a stab? Other than
a knife, what might cause such a wound?
• What is the best generic term to use when describing
physical damage to a patient?
Bruise
• An extraversated collection of blood which has leaked from
damaged small arteries, venules and veins but not
capillaries
• Fragility of vessels, coagulation state etc all effect bruising
• May take hours or days to form
• May get patterned bruises (can see better with special light
sources)
• Deep bruising may never be seen on the surface
• Blunt trauma
Abrasion 1
• A graze or scratch
• The most superficial of blunt trauma injuries
• Confined to the epidermis (strict definition) but may
actually extend into the superficial dermis due to skin
anatomy)
• Can occur before and after death
• Friction burn, Whip, Stamp
Laceration 1
•
A split to the skin
•
The result of blunt force overstretching the skin
•
Usually pass through the full thickness of the skin
•
They are deep and will bleed
•
Margins ragged with crushing and bruising
•
“Bridging fibres” arch across the skin defect
•
•
Common where skin can be compressed between the force and underlying
bone
Eg Scalp, elbow, shin
•
•
Rare over soft fleshy areas
Eg Buttocks, breasts
•
Fall, Punch, Kick
Cut
(or slash)
The length of the injury is longer than
its depth
Stab
(or penetrating injury)
The depth of the wound is greater than
the width
Knife/metal
If in doubt…
Injury
6. Cell pathology case study
• Using the example of Helicobacter
pylori infection of the stomach,
discuss the varied outcomes of
infection and why these occur, and
how inflammation can lead to cancer
or lymphoma in this organ.
• List 2 major complications of peptic
ulcers and describe the
consequences of these.
• Using the example of a case of
atherosclerosis, list 3 major
outcomes of this arterial disease.
Helicobacter pylori
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Majority (70-80%) asx
Acute inflammation - neutrophils
Chronic inflammation - lymphocytes
Ulceration
Perforation
Intestinal Metaplasia
Dysplasia
Cancer
Lymphoma: Mucosa associated
lymphoid tissue (MALT)
Atherosclerosis
1. Occludes arteries
slowly (angina,
myocardial scarring,
dementia,
claudication,)
2. Occludes arteries
suddenly plaque
rupture (thrombosis,
atheroembolization)
or haemorrhages
into plaques (MI,
stroke, gangrene of
the bowel)
3. Weakens artery walls
(aneurysms)
Thank You
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