Cell Pathology

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Cell Pathology

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

union.ic.ac.uk/medic/muslim
fm103_at_ic.ac.uk
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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.

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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

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Classification

• Benign
• Well differentiated
• Slow growth
• Encapsulated
• Non-metastatic

• Malignant
• Varied differentiation
• Rapid growth
• Invasive
• Metastatic potential

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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.

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Oedema

• Causes
• Raised hydrostatic pressure
• Reduced plasma osmotic pressure
• Lymphatic obstruction
• Sodium retention
• Inflammation

• Consequences
• Cellulitits
• Venous Eczema
• Venous Ulcer
• Pulmonary
• Cerebral

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Thrombosis Causes
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Thrombosis

• Endothelial injury
• Atheromatous plaques
• Myocardial infarction
• Vasculitis
• Cigarette smoke
• Hypercholesterolaemia
• Abnormal blood flow
• Turbulence
• Stasis
• Hypercoagulability
• Primary (genetic)
• Secondary (acquired)
• OCP
• Malignancy
• Smoking
• Pregnancy

• Resolution
• Organisation
• Re-cannulisation
• Propagation
• Embolisation
• PE
• Coronary
• Deep Vein

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Haemorrhage

• Causes
• Trauma
• Vasculitits
• Vascular fragility

• Consequences
• None
• Chronic anaemia
• Hypovolaemic shock
• Pressure

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Shock

• Cardiovascular collapse -gt 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

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Shock - Consequences

• Brain ischaemic encephalopathy
• Heart subendocardial ischaemia/necrosis
• Kidneys acute tubular necrosis
• GI tract haemorrhagic enteropathy
• Lungs ARDS

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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.

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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..

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Outcome of acute inflammation

• SPREAD - INFECTION
• Blood septicaemia
• Tissue - cellulitis

ABSCESS
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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

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Granulomatous inflammation

• What is a granuloma? - an aggregate of
  macrophages
• What causes granulomatous inflammation?
• Infection TB
• Foreign material
• Reaction to tumours
• Immune diseases (sarcoid, crohns)

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What hinders repair

• GENERAL
• POOR NUTRITION - Protein needed for collagen
  tensile strength
• VITAMIN DEFICIENCY
• 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

• LOCAL
• POOR BLOOD SUPPLY
• PERSISTENT FOREIGN BODY
• MOVEMENT

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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

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Reversible vs irreversible injury

• Fatty change
• Cellular swelling

• Karyolysis- the dissolution of the nucleus - the
  nucleus swells and gradually loses its
  chromatin.
• Pyknosis - Shrunken nucleus with condensed
  chromatin.
• Karyorrhexis - rupture of the cell nucleus in
  which the chromatin disintegrates into formless
  granules that are extruded from the cell.
• Coagulative necrosis
• Liquefactive necrosis
• Caseous necrosis
• Fat Necrosis

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Necrosis
1 2
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1 2 3
Apoptosis
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The differences between apoptosis and necrosis

• Apoptosis may be physiological
• Apoptosis is an active energy dependent process
• Not associated with inflammation

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5. Autopsy Forensic medicine

• Explain how the need for consent from the
  deceaseds 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?

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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

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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

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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

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Cut
(or slash) The length of the injury is longer
than its depth
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Stab
(or penetrating injury) The depth of the wound
is greater than the width Knife/metal
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If in doubt

• Injury

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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.

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Helicobacter pylori

• Majority (70-80) asx
• Acute inflammation - neutrophils
• Chronic inflammation - lymphocytes
• Ulceration
• Perforation
• Intestinal Metaplasia
• Dysplasia
• Cancer
• Lymphoma Mucosa associated lymphoid tissue (MALT)

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Atherosclerosis

• Occludes arteries slowly (angina, myocardial
  scarring, dementia, claudication,)
• Occludes arteries suddenly plaque rupture
  (thrombosis, atheroembolization) or haemorrhages
  into plaques (MI, stroke, gangrene of the bowel)
• Weakens artery walls (aneurysms)

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