PARENCHYMATOUS

AND
STROMAL-VASCULAR
DEGENERATIONS

Lecturer – prof.G.I.Hubina-Vakulik
• Pathology - is not health, the science of
suffering
• In the pathology, medical students separately
study:
- the changes in the structure of tissues and
organs (pathologic anatomy, or pathologic
morphology),
- the changes of the function (pathologic
physiology)
- and metabolic changes (pathological
biological chemistry)
 Damage (injury)
1. Degeneration (dystrophy)
2. Necrosis
3. Apoptosis
• Degeneration is structural injuring in living
tissue, disturbance of metabolic and
functional peculiarities present too.

• Morphologic picture of degeneration is

accumulation of abnormal substances or
critic decreasing of substances in a tissue
• Ethiology of D.:
- exogenic (biologic, chemical, physical)
- endogenic (immune injuring
hypoxic,
genetic – storage diseases)
 Morphogenesis of D.:

• - infiltration (pathological substances entering

from outside the cell to the cytoplasm or from
blood serum in the vessel wall, into the stroma)
- decomposition (accumulation of pathological
substances due to destruction of the tissue
components)
- disturbed synthesis (synthesis and deposition of
abnormal substances)
- transformation (pathological changes in the
metabolism with dominance of a single
substance production)
 Classification:

Due to localisation: - parenchymatous

- stromal-vascular
- mixed
Due to origin: - innate
- acquired
Due to propagation: - local
- general
Due to dominantly disturbed metabolism:
- protein (disproteinosis)
- lipid (dislipidosis)
- carbohydrate
- mineral
 Parenhymotous D.

Classification of disproteinosis:
- hyalin-drops D
- hydropic D.
- horny D. (ichthyosis,leucoplakia)
 Parenchymatous hyalin-drops protein
degeneration in tubular epithelium of kidney
 Parenchymatous protein hydropic
degenerationin tubular epithelium of kidney
Parenchymatous protein horny degeneration in mucous
membrane of oral cavity (focus of leukoplakia)
• External examination of a newborn
revealed dry dull pale skin with uneven
surface and presence of gray scaling
plates. Which type of degeneration is this
pathology associated with?
• A. Horny B. Hydropic C. Hyalin-
drop D. Fibrinoid swelling
E. Mucoid swelling
 Parenchymatous dislipidosis

1.“goose” liver
Macroscopically liver is yellow, soft
consistency
Microscopically in the liver tissue
hepatocytes have lipid vacuoles in
cytoplasm
2.“tiger” heart
Parenchymatous lipid degeneration of liver.
Stain by H+E
Parenchymatous lipid degeneration of liver.
Stain by H+E. High magnification
Parenchymatous lipid degeneration of liver.
Histochemical stain by Sudan 3
 Parenchymatous lipid degeneration of
myocardium. Histochamical stain by Sudan 3
• . Autopsy of the patient who had suffered from
hypertension disease revealed considerable
enlarged flabby heart with widened cavities. The
myocardium was dull, clay-like, with white-
yellowish strips from the side of the myocardium
which were more pronounced in the papillary
muscles and trabeculas of the heart ventricles
(tiger’s heart). Which parenchymatous dystrophy
was present?
• A. Protein B. Fat C. Horny
D. Mucous E. Carbohydrate
• Autopsy of the patient who had suffered from
tuberculosis demonstrated that the liver weighed
1600 g, was flabby, light brown (goose).
Microscopy showed sudanophilic formations in
the hepatocyte cytoplasm on the periphery of the
lobules.
Which parenchymatous dystrophy was present?
A. Protein B. Hyalin drop C. Fatty D.
Horny E. Mucus
 Parenhymotous carbohydrate D.

Accumulation of glycogen in epitheliocytes of renal

tubules due to diabetes mellitus

Pathogenesis:
Hyperglycemia → glucosuria → glucose infiltration
in tubule epithelium → glycogen synthesis from
glucose → accumulation of glycogen in
epitheliocytes → destruction of epiteliocytes →
glycogen appearances in a urine
 Glycogen granules are found in the distal
segments of tubule epithelium. Stain is PAS-
reaction (Best’s carmine is 2-nd stain)
• Microscopic study of the biopsy material from the female
patient who suffers from diabetes mellitus has revealed
that the epithelium of narrow and distal segments of the
tubules is high with light foamy cytoplasm. Staining with
Best’s carmine revealed red grains in the cytoplasm of
the epithelium and tubules. Which parenchymatous
dystrophy is present?
• Protein
• Fat
• Hyalin-drop
• Mucous
• Carbohydrate
In spleen macrophages glycogen preasents. Stain
by hematoxylin-eosin. Diagnosis: storage disease -
glicogenosis
 Stromal-vascular D.
Stromal-vascular disproteinoses:
- mucoid swelling
- fibrinoid swelling and fibrinoid necrosis
- hyalinosis
- amyloidosis
Mucoid swelling – is light reversible D.
Mucoid swelling appears in the stroma of tissue,
including wall of blood vessels

Metachromasia is characterized for mucoid

swelling.
Histochemical stain with toluidine blue is used
for the detection of metachromasia. If in a stroma
pinkish-purple color focus (not blue)
appearances it means phenomenon of
metachromasia presents. If phenomenon of
metachromasia presents it means mucoid
swelling develops.
 Mucoid swelling of arterial wall with
reumatism. Stained by toluidine blue
• . Histology of the deformed mitral valve revealed
marked basophilic reaction at staining with
hematoxylin-eosin of the connection tissue,
staining with toluidin blue showed
metachromasia reaction. Which changes in the
connective tissue can be revealed by these
reactions
• A. Amyloidosis B.Mucoid swelling
C. Hyalinosis D. Fibrinoid swelling
E. Fibrinous necrosis
 Fibrinoid swelling and fibrinoid
necrosis
are deep and irreversible D. in the stroma of
tissue, including wall of blood vessels.

Not only albumins and globulins, but also

fibrin impregnates to vessel wall and
stroma of tissue
Fibrinoid swelling and fibrinoid necrosis of
connective tissue in reumatism. Stained by
PAS-reaction.
• Skin biopsy of the patient with allergic
vasculitis demonstrated a thickened
homogenic vascular walls, PAS-positive,
with positive reaction to fibrin. Name the
type of mesenchymal degeneration.
• A. Fibrinoid swelling B.
Amyloidosis C. Mucoid swelling
D. Hyalinosis E. Lipidosis
 Hyalinosis
• – is pathological change in stroma or in
vessel wall; microscopically it has picture
of homogeneous, compact, eosinophilic
mass likes cartilage hyaline
Macroscopically, for example, hyalinosis of
spleen capsule has next picture: whitish,
compact thick membrane covers the
spleen focally or generally.
Hyalinosis of spleen capsule after
perisplenitis
 Hyalinosis (systemic or local)
1. Of connective tissue
2. Of vessels
- simple (with arterial hypertension),
- complex (with rheumatism),
- lipohyalin (with diabetes mellitus)
Hyalinosis of arteria wall in arterial
hypertention
 Autopsy of the man revealed the signs
of rheumatic heart defect, i.e. thickened
deformed cartilage-like valves with luster
surface. Which process is present in the
valves:
• A. Amyloidosis B. Fibrinoid
necrosis C. Fibrinoid swelling
D. Hyalinosis E. Degenerative
calcification
• Microscopy of the amputated lower extremity of
the patient with diabetes mellitus showed that the
lumens of the arterioles and small arteries were
narrowed, the middle membrane is thin, the
elastic plate was destroyed with accumulations of
homogenic eosinophilic masses in the
subendothelial space positive for lipids and beta-
lipoproteins. Which substance was revealed in the
subendothelial space?
• A. Fat-protein detritus B. Simple hyalin
C. Lipohyalin D. Complex hyalin E.
Amyloid
• .Microscopy of the kidneys from a man died of
systemic lupus erythematosus revealed sclerosed
glomeruli, the lumens of the small arteries and
arterioles are narrow, the median membrane is
thin, homogeneous, eosinophilic masses are
present in the subendothelial space.
Immunologically these masses contain immune
complexes and fibrin. Which substance is present
in the subendothelial space?
• A. Fat-protein detritus B. Simple hyalin
C. Lipohyalin D. Amyloid E.Complex
hyalin
 Amyloidosis
- It is stromal-vascular disproteinosis with
anomaly fibril protein synthesis by
amyloidoblasts (F-component)
- In stroma, in vascular wall F-component is
connected with P-component (plasmatic
proteins)
- P- and F-component are fixated on the
chondroitin sulfate of main substance of
connective tissue.
This compound substance is a very strong.
Amylum (latin.) – starch
-oid - it likes starch (white, compact,
greasy)

Staining
- iodine + acid sulfuric + amyloid= bluish
color (macro-)
- Congo red + amyloid = red color (micro-)
 Classification of amyloidosis
• 1. idiopathic (primary)
• 2. genetic or hereditary (family)
• 3. acquired (secondary)
• 4. senile
• Amyloidosis of liver
Macroscopically the liver is light color,
almost white, very thick consistency. The
surface is smooth.
Microscopically congo red stain:
homogeneous, dense, congophilic mass
are found along sinusoids, in the vascular
wall of the portal tracts, in the stroma
Normal kidneys
Amyloidosis of kidney
Amyloidosis of kidney. Stain by
congo red
Sago-spleen (microscopical picture)
Sebaceous spleen (microscopical picture)
• A patient ages 42 had suffered from bronchiectasis and
died of renal failure. Autopsy revealed enlarged dense
pale yellow kidneys. Microscopy revealed accumulations
of amorphic eosinophilic and congophilic substance in
the walls of the vessels, basal membrane of the tubules,
capillary loops, mesangium of the glomeruli and
connective tissue of the stroma. Which of the processes
is most probable?
• A. Secondary amyloidosis . B. Idiopathic
amyloidosis C. Hereditary amyloidosis
D. Hyalinosis E. Senile amyloidosis
• Autopsy of a man aged 56 who had suffered
from fibrous-cavernous pulmonary tuberculosis
revealed enlarged dense spleen. On cut section
the tissue of the spleen is brown-pink, smooth
with wax-like surface. Microscopy revealed
diffuse congophilic staining.
• Which process is observed in the spleen?
A. Glaze spleen B. Porphyrin spleen
C. Sago spleen D. Sebaceous spleen
E. Cyanotic induration of the spleen
 Stromal-vascular dislipidosis
• Obesity
1 stage - excess weight - up to 29%
2 stage – 30 – 49%
3 stage - 50 – 99%
4 stage - 100%

Cachexia
Cachexia
Obesity
 Classification of obesity to origin:
1. Alimentary
2. Metabolic
3. Cerebral
4. Endocrinal
5. Family-constitutional
Obesity of a heart (stromal-
vascular lipid degeneration)
Wall of heart ventricle with obesity
Wall of heart ventricle with obesity.
Stain by H+E
Wall of heart ventricle with obesity. Stain by
H+E
• A 45-year old man died of sudden cardiac arrest.
Symmetrical stage III obesity, rupture of the wall of the
right ventricle with hemopericardium, excessive fat under
the epicardium were revealed. Microscopy showed that
fatty tissue of the epicardium involved the myocardium
causing muscular fiber atrophy. Which pathological
process is most probable?
• A. Fatty degeneration of the myocardium
• B. Obesity of the heart
• C. Coronary artery disease
• D. Acute myocardial infarction
• E. Hypertension disease
 Stromal-vascular carbohydrite D.
- Mucus D of stroma occurs due to metabolic
disorders of glycoproteins and
glycosaminoglycans in main substance of
connective tissue.
Stroma of organ becomes similar to mucus, and
parenchymatous cells become stellate
- Mucopolysaccharidoses – storage diseases
with genetic inactivation of specific enzymes