P4 - Cell Injury

Bharati Vidyapeeth Deemed University Medical College
Department of Pathology
Practical – 4
Cell Injury
Spot no. Name H.P.slide Gross
Reversible cell injury
1 Hydropic Change P3/1 E-46
2. Hyaline change P3/2
3. Fatty Change P3/3 E-27
Irreversible cell injury
Coagulative Necrosis
4 Testicular Infarct E-52
5 Spleen Infarct P3/5 E-59
6 Kidney Infarct E-41
Caseous Necrosis
7 Tuberculous lymph node E-01
Colliquative Necrosis
8 Lung Pyaemic abscess E-73
Gangrenous Necrosis
9 Gangrenous Necrosis intestine E-21
Draw
1. Hyaline change
2. Hydropic Change
3. Fatty change –Liver
4. Spleen Infarct
Write
1. Gross of Hydropic Change, Fatty change liver, Testicular Infarct,
Spleen Infarct, Kidney Infarct, Tuberculous lymph node, Lung
Pyaemic abscess, Gangrenous Necrosis intestine
2. Microscopy of Hyaline change, Hydropic Change, Fatty change –
Liver, Spleen Infarct
1
BVDU Medical College, Department of Pathology
Practical – 4
Reversible Cell Injury
1. Hydropic Change
Spot: 1 Slide: P4-1 Gross: E-46
Clinical History
A 35-year-old female had amenorrhea for 5 months. She came with P/v
bleeding, convulsions and was admitted in the hospital.
On examination: Fever, edema over feet. BP: 180/120 mm of Hg.
Urine examination: Albuminuria
Pregnancy test Positive in high dilution.
P/A: size of uterus was disproportionately large for the
stage of pregnancy.
USG: Hydatidiform mole
Gross
Specimen consists of small grey white tissue with part of placenta at the
upper pole. It shows multiple grapes like structures which are variable in size
measuring about 0.2cm or 1 cm and contain watery material. They look like
vesicles which are transparent. At the right lower end areas of hemorrhages
are seen.
Microscopy
Section shows chorionic villi showing central avascular core with hydropic
degeneration. There are no cells in the center. Few cytotrophoblast and
syncytiotrophoblastic cells are seen at the periphery.
2
Practical – 4
1. Hydropic Change
Spot: 1 Gross: E-46
BVUMC/PATH/E-46
Placenta
Grapes
like
structure
Back
3
Practical – 4
1. Hydropic Change
Spot: 1 Slide: P5-1
Net pic Net pic
4
Practical – 4
1. Hydropic Change
Spot: 2 Diagram
Normal
villus
Hydropic
Change
Cytotrophoblastic
proliferation
Syncytiotrophoblast
5
Practical – 4
2. Hyaline Change
Keloid -Skin
Spot: 2 Slide: P4-2
Clinical History
A 58 yrs. old female came with history of operation(hysterectomy) 5 years
back & now came with the C/O thickening of the area of incisional scar.
Microscopy
Section shows tissue lined by stratified squamous epithelium. Deeper tissue
shows abundant chronic inflammatory infiltrate & abundant increased
collagen bundles with glassy eosinophilic texture (hyaline change).
6
Practical – 4
2. Hyaline Change
Keloid -Skin
Spot: 2 Slide: P4-2
Net pic
7
Practical – 4
2. Hyaline Change
Keloid -Skin
Spot: 2 Diagram
Epidermis
Blood
vessel
Fibroblast
Hyaline
change
8
Practical – 4
3. Fatty Change
Clinical History
A 58-year-old male, diabetic and overweight came with enlarged soft liver and
pain in the right quadrant with tenderness.
Gross
The specimen shows a slice of liver. The organ appears enlarged. It is pale
yellow in color. The borders are rounded; c/s is greasy. Capsular surface is
smooth, shiny pale in color. The cut section is pale yellow in color. At one
end we can see friable liver tissue which has lost its normal consistency. N.B.
– The knife was greasy to touch.
Microscopy
Many Hepatocytes in this section show vacuolated cytoplasm. The nuclei are
pushed to the periphery and are compressed against the cell membrane.
SPECIAL STAIN:
Sudan black – Black
Sudan III –Orange
Sudan IV- Red
Oil red ‘O’ - Red
Osmic acid- Black
9
Practical – 4
3. Fatty Change
Spot: 3 Gross: E-27
BVUMC/PATH/E-27
Enlarged
yellow
fatty liver
10
Practical – 4
3. Fatty Change
Spot: 3 Slide: P5-5
Net pic Net pic
11
Practical – 4
3. Fatty Change
Spot: 3 Diagram
Portal
triad
Fatty
change
Central
vein
Sinusoidal
space
12
Practical – 4
4.Testicular infarct
Spot: 4 Gross: E-52
Clinical History
A 35-year-old male, laborer by occupation, came with complaints of acute
excruciating pain in the scrotum. He gave H/o lifting heavy sacs of grains.
Orchiectomy was done. At operation, spermatic cord was found twisted.
Gross
Specimen of spermatic cord with testis. The testis is enlarged due to edema
and hemorrhage. The testis is converted into a soft, necrotic hemorrhagic
mass. The normal brown, meaty color is replaced by hemorrhagic black
coagulative necrosis of testis and epididymis.
Net pic Net pic
13
Practical – 4
4.Testicular infarct
Spot: 4 Gross: E-52
BVUMC/PATH/E-52
Spermatic
cord
Epididymis
with infarct
Testis with
infarct
Congested
vesseles
14
Practical – 4
5.Spleen infarct
Clinical History
A 55-year-old obese patient, diabetic and chronic smoker, had developed

myocardial infarction two weeks ago and was recovering from it. He had
acute pain in his left hypochondrium and tenderness over the spleen. He
had another attack of chest pain and collapsed and died. At autopsy spleen
showed an abnormal area under the capsule.
Gross
Specimen shows a slice of the spleen. The capsule is opaque. Cut section is
grayish black in color. The central portion near the lower border shows a
grayish white, homogenous, wedge shaped area measuring 1.0 x 0.3 cm. A
similar area of 1 mm in size is seen adjacent to it. The whitish granular area
is slightly depressed below the surrounding splenic parenchyma, which is
gray black in color.
Microscopy
Section shows spleen. Normal viable spleen with red and white pulp is seen
in one half of the section. The other half of the section shows coagulative
necrosis. The outlines of these cells are preserved (Tombstone appearance)
but cytoplasm appears deep eosinophilic & nuclei have not taken any stain.
The junction of viable and necrotic area shows a band of inflammatory
infiltrate with many congested blood vessels.
15
Practical – 4
5.Spleen infarct
Spot: 5 Gross: E-59
BVUMC/PATH/E-59
Splenic
notch
Normal
spleen
Two
areas of
infarct
Net pic
16
Practical – 4
5.Spleen infarct
Spot: 5 Slide: P4-4
Net pic
17
Practical – 4
5.Spleen infarct
Spot: 5 Diagram
Capsule
White pulp
Red pulp
Area of
infarct
18
Practical – 4
6. Kidney infarct
Spot: 6 Gross: E-41
Clinical History
A 29-year-old male, a known case of rheumatic mitral stenosis, developed
high grade fever with chills & dyspnea. On examination he had mild
splenomegaly, clubbing and petechial hemorrhages on the trunk. The patient
developed hematuria and right sided hemiplegia due to disseminated
thromboembolic phenomenon following SABE. He died within four days of
admission due to cardiorespiratory failure.
Gross
This is a specimen of one half of the bisected kidney measuring 10x4x0.5 cm.
Capsular surface of the kidney shows grayish brown capsule which appears to
be adherent & shows irregular areas of hemorrhages. Cut surface shows
cortex & medulla at the upper pole. The rest of the kidney shows multiple
wedge shaped areas of hemorrhages varying in size from 2-5 cm. Base of the
wedge is formed by the capsule of the kidney & apex is towards the hilum of
the kidney (Fresh hemorrhagic infarct). At the lower pole there is a wedge
shaped area which is pale gray in color & is surrounded by line of
demarcation. (Pale infarct).
Microscopy
Section from kidney shows glomeruli & tubules which appear pale, swollen
& their cellular details namely nuclei and cytoplasm are not well seen. This
is typical coagulative necrosis with ‘Tombstone’ appearance. The
surrounding area shows hemorrhages, & infiltration by neutrophils.
Net pic Net pic
//
19
Practical – 4
6. Kidney infarct
Spot: 6 Gross: E-41
BVUMC/PATH/E-41
Normal
kidney
Hemorrhagic
Infarct
Area of
pale
infarct
20
Practical – 4
7. TB Lymph node
Spot: 7 Gross: E-62
Clinical History
A 50 yr old male came with extensive pulmonary tuberculosis. He also showed
signs & symptoms of abdominal tuberculosis and tuberculous meningitis.
Lab Investigations showed ESR raised, Tuberculin test positive, sputum
positive for AFB. DLC – absolute lymphocytosis.
In spite of being on anti T.B. treatment he died on the 10th day of admission.
A Post Mortem exam was performed.
Gross
Specimen consists of numerous matted lymph nodes measuring 6 cm in
size. The largest lymph node measures 2 cms and the smallest measures
1cms. External surface is grayish white, slightly nodular & irregular at places.
Cut surface shows grey white, circumscribed, nodular appearance with few
showing creamy granular, cheese like material which is caseous necrosis.
Microscopy
Lymph nodes show multiple tubercles of variable size. The tubercles show
central area of caseation surrounded by epithelioid cells, giant cells,
lymphocytes & peripherally fibroblasts.
AFB stain was positive for AFB.
Net pic
21
Practical – 4
7. TB Lymph node
Spot: 7 Gross: E-62
BVUMC/PATH/E-62
Matted
lymph
nodes
22
Practical – 4
8. Lung Pyaemic abscess
Spot: 8 Gross: E - 73
Clinical History
A 30 yrs. old male came with c/o high grade fever, cough with purulent foul
smelling expectoration, chest-pain and weight loss. He had H/O jaw swelling,
which turned out to be dental sepsis. It was drained but he had not completed
antibiotic course. X-ray showed pneumonia. In spite of treatment, he
developed high grade fever, respiratory distress and delirium and died of
cardiac arrest.
Gross
Specimen of piece of lung is displayed. Pleura is thickened & opaque
suggestive of pleurisy. The cut surface shows consolidation. There are many
cavities ranging from 2 mm to 2 cms all over the lung. In the lumen of the
cavities white necrotic material is seen. At upper end, there are larger cavities
which are empty and their walls are shaggy.
Net pic Net pic
23
Practical – 4
8. Lung Pyaemic abscess
Spot:8 Gross: E - 73
BVUMC/PATH/E-73
Multiple
abscess
cavities
24
Practical – 4
9.Gangrenous necrosis- Small Intestine
Spot: 9 Gross: E-21
Clinical History
A 12-year-old boy had acute pain in abdomen & vomiting of two days’
duration. On X-ray examination there were multiple fluid levels suggestive of
intestinal obstruction. On laparotomy, loops of the small intestine were found
twisted around each other. One large loop of intestine looked bluish black &
swollen. This was resected & end to end anastomosis was done. The
devitalized loop had foul smelling, hemorrhagic fluid in lumen.
Gross
Specimen of loop of small intestine is displayed and measures about 15 cm
in length. It is brownish black in color. The serosal surface appears dull, with
many congested blood vessels. The wall appears edematous. The mucosal
surface is blackish.
25
Practical – 4
9.Gangrenous necrosis- Small Intestine
Spot: 9 Gross: E-21
BVUMC/PATH/GIT 21
Black,
swollen,
oedematous
small
intestine
Dull serosa,
with many
congested
blood vessels
26
Practical – 4
Write
1.Gross & Microscopy of Hydropic Change E- 46
Gross: Specimen consists of small grey white tissue with part of placenta at the
upper pole. It shows multiple grapes like structures which are variable in size
measuring about 0.2cm or 1 cm and contain watery material. They look like
vesicles which are transparent. At the right lower end areas of hemorrhages are
seen.
Microscopy :Section shows chorionic villi showing central avascular core with
hydropic degeneration. There are no cells in the center. Few cytotrophoblast and
syncytiotrophoblastic cells are seen at the periphery.
2.Microscopy of Hyaline Change
Section shows tissue lined by stratified squamous epithelium. Deeper tissue shows
abundant chronic inflammatory infiltrate & abundant increased collagen bundles
with glassy eosinophilic texture (hyaline change).
3.Gross & microscopy of Fatty change liver - E-27
Gross:The specimen shows a slice of liver. The organ appears enlarged. It is pale
yellow in color. The borders are rounded; c/s is greasy. Capsular surface is smooth,
shiny pale in color. The cut section is pale yellow in color. At one end we can see
friable liver tissue which has lost its normal consistency. N.B. – The knife was greasy
to touch.
Microscopy:Many Hepatocytes in this section show vacuolated cytoplasm. The
nuclei are pushed to the periphery and are compressed against the cell
membrane.
4.Gross testicular infarct E-52
Gross: Specimen of spermatic cord with testis. The testis is enlarged due to edema
and hemorrhage. The testis is converted into a soft, necrotic hemorrhagic mass.
The normal brown, meaty color is replaced by hemorrhagic black coagulative
necrosis of testis and epididymis.
5. Gross & microscopy of spleen infarct E- 59
Gross: Specimen shows a slice of the spleen. The capsule is opaque. Cut section is
grayish black in color. The central portion near the lower border shows a grayish
white, homogenous, wedge shaped area measuring 1.0 x 0.3 cm. A similar area of
1 mm in size is seen adjacent to it. The whitish granular area is slightly depressed
below the surrounding splenic parenchyma, which is gray black in color.
27
Practical – 4
Microscopy:Section shows spleen. Normal viable spleen with red and white pulp is
seen in one half of the section. The other half of the section shows coagulative
necrosis. The outlines of these cells are preserved (Tombstone appearance) but
cytoplasm
appears deep eosinophilic & nuclei have not taken any stain. The junction of viable
and necrotic area shows a band of inflammatory infiltrate with many congested
blood vessels.
6. Gross of kidney infarct E - 41
Gross: This is a specimen of one half of the bisected kidney measuring 10x4x0.5
cm. Capsular surface of the kidney shows grayish brown capsule which appears to
be adherent & shows irregular areas of hemorrhages. Cut surface shows cortex &
medulla at the upper pole. The rest of the kidney shows multiple wedge shaped
areas of hemorrhages varying in size from 2-5 cm. Base of the wedge is formed by
the capsule of the kidney & apex is towards the hilum of the kidney (Fresh
hemorrhagic infarct). At the lower pole there is a wedge shaped area which is pale
gray in color & is surrounded by line of demarcation. (Pale infarct).
7. Gross Tuberculous lymph node E-01
Gross: Specimen consists of numerous matted lymph nodes measuring 6 ×3 cm in
size. The largest lymph node measures 2×1 cms and the smallest measures 1cms.
External surface is grayish white, slightly nodular & irregular at places. Cut surface
shows grey white, circumscribed, nodular appearance with few showing creamy
granular, cheese like material which is caseous necrosis.
8. Gross of Pyaemic abscess lung E-73
Gross: Specimen of piece of lung is displayed. Pleura is thickened & opaque
suggestive of pleurisy. The cut surface shows consolidation. There are many
cavities ranging from 2 mm to 2 cms all over the lung. In the lumen of the cavities
white necrotic material is seen. At upper end, there are larger cavities which are
empty and their walls are shaggy.
9. Gross Gangrenous Necrosis- Small Intestine E-21
Gross: Specimen of loop of small intestine is displayed and measures about 15 cm
in length. It is brownish black in color. The serosal surface appears dull, with many
congested blood vessels. The wall appears edematous. The mucosal surface is
blackish.
28
Practical – 4
1.Questions and answers (Optional writing)
1.What is hypertrophy? Give Examples
Hypertrophy refers to an increase in the size of cells, resulting in an increase in the
size of the organ. Hypertrophy can be physiologic or pathologic and is caused by
increased functional demand or by stimulation by hormones and growth factors.
The most common stimulus for hypertrophy of muscle is increased workload e.g.
the bulging muscles of bodybuilders, growth of the uterus during pregnancy.
2. What is hyperplasia? Give Examples.
Hyperplasia is an increase in the number of cells in an organ or tissue, usually
resulting in increased mass of the organ or tissue. Hyperplasia can be physiologic or
pathologic. Physiologic hyperplasia can be divided into: (1) hormonal hyperplasia,
which increases the functional capacity of a tissue when needed e.g. proliferation
of the glandular epithelium of the female breast at puberty and during pregnancy,
and (2) compensatory hyperplasia, which increases tissue mass after damage or
partial resection e.g. endometrial hyperplasia, benign prostatic hyperplasia.
3. What is Atrophy? Give Examples.
Atrophy is reduced size of an organ or tissue resulting from a decrease in cell size
and number. Atrophy can be physiologic or pathologic. The uterus decreases in size
shortly after parturition-physiologic atrophy. Atrophy of disuse, denervation
atrophy, senile atrophy- pathologic atrophy.
4. What is metaplasia? Give Examples.
Metaplasia is a reversible change in which one differentiated cell type (epithelial or
mesenchymal) is replaced by another cell type. Epithelial metaplasia is columnar to
squamous, as occurs in the respiratory tract in response to chronic irritation.
Connective tissue metaplasia is the formation of cartilage, bone, or adipose tissue
(mesenchymal tissues) in tissues that normally do not contain these elements. For
example, bone formation in muscle, designated myositis ossificans, occasionally
occurs after intramuscular hemorrhage.
5. What are the morphological changes in reversible cell injury?
Reversible injury is characterized by generalized swelling of the cell and its
organelles; blebbing of the plasma membrane; detachment of ribosomes from the
ER; and clumping of nuclear chromatin. These morphologic changes are associated
with decreased generation of ATP, loss of cell membrane integrity, defects in protein
synthesis, cytoskeletal damage, and DNA damage
29
Practical – 4
6. What are the ultra-structural changes in reversible cell injury?
The ultra-structural changes of reversible cell injury include:
a) Plasma membrane alterations, such as blebbing, blunting, and loss of
microvilli
b) Mitochondrial changes, including swelling and the appearance of
small amorphous densities
c) Dilation of the ER, with detachment of polysomes; intracytoplasmic
myelin figures may be present (see later)
d) Nuclear alterations, with disaggregation of granular and fibrillar
elements.
7. What are the causes of fatty change or steatosis?
The causes of steatosis include toxins, protein malnutrition, diabetes mellitus,
obesity, alcohol abuse and anoxia.
8. Which organs are affected by the fatty change or steatosis?
The terms steatosis and fatty change describe abnormal accumulations of
triglycerides within parenchymal cells. Fatty change is often seen in the liver
because it is the major organ involved in fat metabolism, but it also occurs in
heart, muscle, and kidney.
9.Define necrosis?
The sum of morphological changes that follow cell death in living tissue and organ.
The morphologic appearance of necrosis is the result of denaturation of intracellular
proteins and enzymatic digestion of the lethally injured cell.
10.What are the morphological changes seen in necrosis?
The morphologic appearance of necrosis is the result of denaturation of intracellular
proteins and enzymatic digestion of the lethally injured cell. Necrotic cells show
increased eosinophilia, attributable in part to the loss of cytoplasmic RNA and in
part to denatured cytoplasmic proteins. The necrotic cell has a glassier
homogeneous appearance, mainly as a result of the loss of glycogen particles.
When enzymes have digested the cytoplasmic organelles, the cytoplasm becomes
vacuolated and appears moth-eaten.
Nuclear changes appear in one of three patterns, all due to nonspecific breakdown
of DNA. The basophilia of the chromatin may fade (Karyolysis), a change that
presumably reflects loss of DNA because of enzymatic degradation by
endonucleases. A second pattern (which is also seen in apoptotic cell death) is
30
Practical – 4
Pyknosis, characterized by nuclear shrinkage and increased basophilia. Here the
chromatin condenses into a solid, shrunken basophilic mass. In the third pattern,
known as Karyorrhexis, the pyknotic nucleus undergoes fragmentation. With the
passage of time (a day or two), the nucleus in the necrotic cell totally disappears.
11.Describe the morphological changes seen in fat necrosis?
Fat necrosis is a to focal areas of fat destruction, typically resulting from release of
activated pancreatic lipases into the substance of the pancreas and the peritoneal
cavity. In pancreatitis, pancreatic enzymes leak out of acinar cells and liquefy the
membranes of fat cells in the peritoneum. The released lipases split the triglyceride
esters contained within fat cells. The fatty acids, so derived, combine with calcium
to produce grossly visible chalky-white areas (fat saponification). On histologic
examination the necrosis takes the form of foci of shadowy outlines of necrotic fat
cells, with basophilic calcium deposits, surrounded by an inflammatory reaction.
12.Describe the morphological changes seen in fibrinoid necrosis?
Fibrinoid necrosis is a special form of necrosis usually seen in immune reactions
involving blood vessels. This pattern of necrosis typically occurs when complexes of
antigens and antibodies are deposited in the walls of arteries. Deposits of these
“immune complexes,” together with fibrin that has leaked out of vessels, result in a
bright pink and amorphous appearance in H&E stains, called “fibrinoid” (fibrin-like).
13.What is the fate of necrotic cell?
Ultimately, in the living patient most necrotic cells and their contents disappear by
phagocytosis of the debris and enzymatic digestion by leukocytes. If necrotic cells
and cellular debris are not promptly destroyed and reabsorbed, they tend to attract
calcium salts and other minerals and to become calcified called dystrophic
calcification.
14.What are the microscopic features of fat necrosis?
It has large foci of smudged adipocytes showing enlarged cells with eosinophilic
cytoplasm & very faint nuclei. In between these adipocytes basophilic bluish
granular material is seen, which is calcium deposits due to dystrophic calcification.
Peripherally there is infiltration by polymorphs.
15.Why is it called fibrinoid necrosis?
The blood vessels show an intensely eosinophilic, structure less material
within the vessel wall. This has the same staining characteristic of fibrin. Hence
this is called fibrinoid necrosis.
31

P4 - Cell Injury

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P4 - Cell Injury

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Bharati Vidyapeeth Deemed University Medical College

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Spot: 2 Slide: P4-2

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A 55-year-old obese patient, diabetic and chronic smoker, had developed

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