MHAM

COLLEGE OF MEDICINECLASS 2024

Cellular Pathology Part 2
Dr. Abelardo Alera| August 26, 2021
GENERAL PATHOLOGY

Outline
I. Patterns of Necrosis in Tissues and Organs
A. Coagulation necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fat necrosis
E. Gangrenous necrosis
F. Fibrinoid necrosis
II. Mechanism of Cell Injury Principles

LEGENDS
Presentations remember lecturer previous
exams

Example:
• Important sentence might come out in exams.
• Important points that lecturer said but not in book or
ppt.

I. PATTERNS OF NECROSIS IN TISSUES

AND ORGANS

1.Coagulation necrosis
→ Myocardial infarction, solid organs
2. Liquefactive necrosis
→ Gangrenous in DM, Brain, Pus,
Intestines, GIT
3. Caseous necrosis
→ Tuberculosis, lungs, lymph nodes
4. Fat necrosis
→ Pancreatitis
5. Gangrenous necrosis
→ Inflammation
6. Fibrinoid necrosis
→ Blood vessels

• Wet gangrene
→ (+) Bacterial Infection
• Dry gangrene
→ Accompanying accumulative necrosis

IMPORTANT: Remember to study the morphology

part
Remember: Draw and label this properly in the
exam in lab
---REVIEW THE PICTURES FROM THE LAB
SESSION----

GENPATH TRANS 1.02.1 | Trans Team: Macaayan, Nadera, Banuag, Baunto, H. Rasul, Macabangon, Alinoor | Editor: Alcuitas, Alvarez, Bernadez1 of 7
• Suppurative exudate → mitochondrial damage: caused by hypoxia
→ Microscopically: fibrin clot, and toxins
polymorphonuclear leukocytes, necrotic → influx of calcium: damages the
debris mitochondria, release of enzymes
→ oxidative stress: free radical (ROS)
causes injury

• Clinicopathologic correlations
→ growth factor deprivation -> neurons die/
no antigens or cytokine -> lymphocytes
die
→ DNA damage -> radiation/chemotherapy
→ protein misfolding -> Alzheimer’s disease

Note: *Cytokines are soluble substances

responsible for telling the lymphocytes to increase
the number
*Lymphocytes should not be killing normal tissue.
When this happen, it has to be removed by the
body

• Key Concepts: • Intracellular accumulations caused by

→ Necroptosis metabolic derangement
▪ programmed cell death a. Lipids
▪ not caspase-dependent inflammatory b. Cholesterol
response c. Proteins
→ Pyroptosis d. Hyaline Change
▪ caspase-dependent destruction of e. Glycogen
infected cells
→ Apoptosis
▪ only for normal, non-infected cells

Pathogenesis or mechanism of apoptosis when

a patient is exposed to viral Hep B

5 STEPS:
1. Exposure (contact)
2. Goes inside the circulation
3. Virus invades the hepatocytes
4. Caspases inside the infected cells is
stimulated and damage the cell
5. Destruction of infected cells (PYROPTOSIS)

II. MECHANISM OF CELL INJURY

PRINCIPLES
→ Cellular response depends on the injury’s
nature, duration, severity
→ Consequence of the injury depends on the
type, state, adaptability → Viral hepatitis, chronic alcoholism, and
→ Injury is/are results of biochemical consumption of fatty meals will result in
mechanisms acting on essential cellular problems in the liver.
components → Macrophages will eliminate the cholesterol that
has accumulated in the area.
• Cellular injury
→ depletion of ATP: fundamental cause of
necrotic cell death
GENPATH TRANS 1.02.2| Trans Team: Macaayan, Nadera, Banuag, Baunto, H. Rasul, Macabangon, Alinoor | Editor: Alcuitas, Alvarez, Bernadez 2 of 7
 → When there is diabetes, an amorphous
substance hyaline change is deposited in
the glomerulus.
→ If you see kidney problem diabetes on your
board exam, the answer to this is
glomerular sclerosis, which means that
there is hyaline change of the glomerulus.

Glycogen Enzyme Deficiency Prevalence

Storage
Disease Type

I Von Gierke’s glucose -6- Less than

Disease phosphatase 200,000
people in the
U.S.
population

II Pompe’s acid maltase 1 in 40, 000

Disease

III Cori’s Glycogen 1 in every

Disease debrancher 100,000 live
births

IV Andersen Glycogen branching ?

Disease enzyme

V McArdie Muscle glycogen 1 in 100,000

Disease phosphorylase

VI Hers’ Liver glycogen ?

Disease phosphorylase

VII Tarui’s Muscle Approximately

disease phosphofructokinase 100 reported
cases
• Problem in the renal epithelium → Glycogen storage disease is the
→ Hyaline change (glomerular sclerosis) accumulation of abnormal glycogen which
can kill the cells and the tissue.
→ The problem really is in the enzyme defect.
If the enzyme is not there, then the
glycogen may not be degraded and
accumulates.

• Abnormal Pigment Accumulation of

Endogenous and Exogenous

• Diabetes mellitus
→ When a patient develops diabetes, we see
changes in the glomerulus such as pinkish
material (hyaline deposition). It is for this
reason that dialysis is required.

GENPATH TRANS 1.02.2| Trans Team: Macaayan, Nadera, Banuag, Baunto, H. Rasul, Macabangon, Alinoor | Editor: Alcuitas, Alvarez, Bernadez 3 of 7
“Wear and tear” pigment (also known as
Lipofuscin) seen in the liver and heart (especially
in the liver) What is the organ responsible for maintaining
calcium in our body?
→ PARATHYROID GLAND

What is the function of the valve in the heart?

→ Prevent backflow
→ Everything going back and forth, is going to
fail later and is going to work harder.

• Cellular aging
→ Decline in cellular function due to genetic
abnormality, accumulation of cellular
Lungs- blood pigments and alveolar spaces are damage.
used to identify the tissue.
Why is it that doctors have a long life?
What is the diagnosis? → because doctors are intelligent so they will
→ Anthracosis live long. (Dr. Alera)
→ Wherein black pigments can be seen in the
Why do intelligent people live long?
lungs
→ they think twice before making the next
What is the pigment involved? move. (Doc Lek)
→ Carbon
• Cellular aging
Why is it present there? → decline in cellular function due to genetic
→ The patient is living in the urban areas where abnormality, accumulation of cellular
pollution is high, or the patient is a smoker. damage.
→ individuals age because their cells age.
• Calcification- Dystrophic vs Metastatic Although public attention on the aging
process has traditionally focused on its
→ Dystrophic
▪ encountered in areas of necrosis cosmetic manifestations, aging has
▪ i.e., dead tissue; degenerated tissue important health consequences, because
age is one of the strongest independent
risk factors for many chronic diseases,
→ Metastatic
such as cancer, Alzheimer disease, and
▪ encountered in normal tissue caused
ischemic heart disease.
by increased calcium
(hyperparathyroidism) → it is not simply a consequence of cells’
▪ i.e., Increased Calcium “running out of steam,” but in fact is
regulated by a limited number of genes
and signaling pathways that are
evolutionarily conserved from yeast to
mammals.

GENPATH TRANS 1.02.2| Trans Team: Macaayan, Nadera, Banuag, Baunto, H. Rasul, Macabangon, Alinoor | Editor: Alcuitas, Alvarez, Bernadez 4 of 7
 → several abnormalities contribute to the If the man is focusing on the health services,
aging of cells as follows: most likely the people are going to be healthy, then
a. Accumulation of mutations in DNA if they're healthy they're going to live a long life.
b. Decreased cellular replication Elderly people live long because one of the main
c. Defective protein homeostasis reasons is they are financially stable compared to
d. Persistent inflammation others who cannot afford going to hospital.

Certain areas where the local government could

produce or come up with institutions who can cater
for people.

Depressed areas don't have doctors because

there's no money.

Trivia questions by Doc Alera:

1. Is cellular aging normal or abnormal?
→ It is normal (before without the modern
technology/ modern concept)
→ It is abnormal (in modern technology)
because in modern technology, there are
many ways to prolong life

Dr. Alera’s point of view: We will go back to the 2. Is it true that if the antibiotics expire today, we
basic principle can still use them for up to 6 months?
→ FALSE!
Doctors live long and that is not true. Some
doctors smoke and drink a lot of alcohol and they 3. Why is it that cells die? Why do we have
die young which is true. senescence cells? (telomere discussion)

Common death among doctors is heart attack

and this is complicated by our stressful lifestyle.

It's not the occupation, it is really the person

made of (he is talking about intelligence 😅) this is
the intelligent person who is going to learn so
much. → there will come a time that there is no
telomere for replication
Go up the ladder in different positions, so if you
bought the ladder you will end up being the Case questions
president, senator, and the director of the office 1. A 50year-old chronic alcoholic presents to the
because of intelligence. If the person is intelligent emergency room with 12 hours of severe
there will come a point in your life that you will abdominal pain. The pain radiates to the back and
accomplish so much, then you will have a is associated with an urge to vomit. Physical
occupation that has a high salary. diagnosis discloses exquisite abdominal
tenderness. Laboratory studies show elevated
More money for your stress management, health serum amylase. Which of the following morphologic
maintenance and especially for your happiness and changes would be expected in the pancreatic tissue
nutrition, so if the person is intelligent then he will of this patient?
learn how to earn money and the money will be A. Coagulative necrosis
used for balance of health. B. Caseous necrosis
C. Fat necrosis
If an intelligent person is sick then he has money D. Fibrinoid necrosis
to go to hospital. E. Liquefactive necrosis

2. A 68year-old man with a history of

gastroesophageal reflux disease suffers a massive
GENPATH TRANS 1.02.2| Trans Team: Macaayan, Nadera, Banuag, Baunto, H. Rasul, Macabangon, Alinoor | Editor: Alcuitas, Alvarez, Bernadez 5 of 7
stroke and expires. The esophagus at autopsy is affected heart muscle would demonstrate which of
shown in the image. Histologic examination of the the following morphologic changes?
abnormal tissue shows intestine-like epithelium → So, this is the heart, a solid organ, What
composed of goblet cells and surface cells similar type of necrosis? Coagulative necrosis
to those of incompletely intestinalized gastric
mucosa. There is no evidence of nuclear atypia. 6. A 22 year-old construction worker sticks himself
Which of the following terms best describes this with a sharp, rusty nail. Within 24 hours, the wound
morphologic response to persistent injury in the has enlarged to become a 1cm sore that drains
esophagus of this patient. thick, purulent material. This skin wound illustrates
A. Atypical hyperplasia which of the following morphologic types of
B. Complex hyperplasia necrosis?
C. Glandular hyperplasia → Liquefactive necrosis
D. Simple hyperplasia
E. Squamous metaplasia You only remember the 3 things
1. Abscess
→ Squamous is for the cervix and upper 2. Brain
airway 3. Intestine
→ Esophagus is glandular because the
intestinal epithelium is more resistant to 7. A 40 year-old man is pulled from the ocean after
hydrochloric acid a boating accident and resuscitated. Six hours
later, the patient develops acute renal failure.
3. A CT scan of a 43year-old woman with a Kidney biopsy reveals evidence of karyorrhexis and
parathyroid adenoma and hyperparathyroidism karyolysis in renal tubular epithelial cells. Which of
reveals extensive calcium deposits in the lungs and the following biochemical events preceded these
kidney parenchyma. These radiologic findings are pathologic changes?
best explained by which of the following → The patient died because of drowning
mechanisms of disease?
A. Arteriosclerosis Why is there a kidney problem?
B. Dystrophic calcification → Because of loss of oxygen (hypoxia)
C. Granulomatous inflammation → if you don't give oxygen to the brain within
D. Metastatic calcification 10 minutes, you will have neuronal death. If
E. Tumor embolism the heart muscle is not given oxygen
through the blood supply within 20- 30 min.,
→ Dystrophic is disease that is degenerated you will have dead heart muscle.
→ The time frame is very important
4. A 28year-old woman is pinned by falling debris
during a hurricane. An X-ray film of the leg reveals What is so important about oxygenation?
a compound fracture of the right tibia. The leg is → When someone collapses, the heart stops
immobilized in a cast for 6 weeks. When the cast is beating but that is not the problem. The
removed, the patient notices that her right leg is problem are the neurons.
weak and visibly smaller in circumference than the
left leg. Which of the following terms best describes How long can the neurons last without oxygen?
this change in the patient's leg muscle? → 10 minutes
What type of cellular adaptation?
→ Atrophy Key points
→ No blood supply, no hormones, no nutrition, • Dystrophic calcification
no movement → Is the abnormal deposition of calcium
phosphate in dead or dying tissue
5. A 70year-old man is hospitalized after suffering a → Is an important component of the
mild stroke. While in the hospital, he suddenly pathogenesis of atheroslerotic disease and
develops crushing substernal chest pain. Analysis valvular heart disease
of serum proteins and ECG confirm a diagnosis of • Metastatic calcification
acute myocardial infarction. The patient → Is calcium deposition in normal tissues as a
subsequently develops an arrhythmia and expires. consequence of hypercalcemia:
A cross section of the left ventricle of an autopsy is ▪ Increased PTH with subsequent
shown in the image. Histologic examination of the boneresorption
GENPATH TRANS 1.02.2| Trans Team: Macaayan, Nadera, Banuag, Baunto, H. Rasul, Macabangon, Alinoor | Editor: Alcuitas, Alvarez, Bernadez 6 of 7
▪ Bone destruction
▪ Vitamin D disorders (intoxication,
Sarcoidosis, williams syndrome)
▪ Renal failure with 2° ↑PTH

GENPATH TRANS 1.02.2| Trans Team: Macaayan, Nadera, Banuag, Baunto, H. Rasul, Macabangon, Alinoor | Editor: Alcuitas, Alvarez, Bernadez 7 of 7