Cell Pathology

							           Cell Pathology
                               Faisal Majid
                       4th year (Endo BSc)
                        MM Education rep

union.ic.ac.uk/medic/muslim       fm103@ic.ac.uk
              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                 Malignant
•Well differentiated   •Varied
                       differentiation
•Slow growth           •Rapid growth
•Encapsulated          •Invasive
•Non-metastatic        •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      •Cellulitits
pressure                 •Venous Eczema
•Reduced plasma          •Venous Ulcer
osmotic pressure         •Pulmonary
•Lymphatic obstruction   •Cerebral
•Sodium retention
•Inflammation
Thrombosis: Causes
                 Thrombosis
•Endothelial injury         •Resolution
   •Atheromatous plaques    •Organisation
   •Myocardial infarction   •Re-cannulisation
   •Vasculitis
   •Cigarette smoke
                            •Propagation
   •Hypercholesterolaemia   •Embolisation
                            •PE
•Abnormal blood flow
   •Turbulence
   •Stasis                  •Coronary
                            •Deep Vein
•Hypercoagulability
   •Primary (genetic)
   •Secondary (acquired)
       •OCP
       •Malignancy
       •Smoking
       •Pregnancy
           Haemorrhage



Causes                Consequences
•Trauma               •None
•Vasculitits          •Chronic anaemia
•Vascular fragility   •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 micro-
  organism
• 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       SPREAD - INFECTION

acute inflammation
                     •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      •POOR BLOOD SUPPLY
     fibroblasts to make         •PERSISTENT FOREIGN
     collagen                    BODY
     •Vitamin A - required for
                                 •MOVEMENT
     epithelium
  •MINERAL DEFICIENCY
     •E.G. ZINC
  •SUPPRESSED
  •INFLAMMATION
     •E.G. By Steroids
     •Old age
     •Diabetes
        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.    Coagulative necrosis
2.    Liquefactive necrosis
3.    Caseous necrosis
4.    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
•   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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