JSC “ Astana Medical University”

Department of pathological anatomy

Topic: Parenchymal dysproteinosis: hyaline-drop, hydrophilic, horny.

Parenchymal lipidosis. Fatty dystrophy of the myocardium, liver,
kidneys.Parenchymal carbohydrate dystrophies (glycogenoses).
 PLAN

1. Definition of the term "dystrophy", the essence of the process

2. Classification and general morphological mechanisms of
dystrophy
3. The essence and classification of parenchymal
dysproteinoses
4. Parenchymal lipidosis
5. Parenchymal carbohydrate dystrophies
6. Macro and micro preparations
 Dystrophy

Dystrophy (from Greek dys - disturbance and trophe - feed) - a

complex pathological process, which is based on the defect of
tissue (cellular) metabolism, leading to structural changes.
Therefore, dystrophy is considered as one of the types of damage.
Trophic is a set of mechanisms that determine the metabolism and
structural organization of tissue (cells), which are necessary to send
a specialized function. Among these mechanisms, cellular and
extracellular are isolated. Cellular mechanisms are provided by the
structural organization of the cell and its autoregulation.
 Morphogenesis

Among the mechanisms leading to the development of changes characteristic of

dystrophy is infiltration, decomposition , perverted synthesis and transformation.
Infiltration - excessive penetration of metabolic products from blood and lymph into cells
or intercellular substance with their subsequent accumulation in connection with the
deficiency of enzyme systems metabolizing these products. Such, for example, are the
infiltration of the epithelium of the proximal tubules of the kidneys by the grossly
dispersed protein in nephrotic syndrome, infiltration of cholesterol and lipoproteins of
the intima of the aorta and large arteries in atherosclerosis.
Decomposition - the decay of ultrastructure of cells and intercellular substance, leading
to a disruption of tissue (cellular) metabolism and the accumulation of products of
impaired metabolism in tissue (cell). Such are the fatty degeneration of cardiomyocytes
in case of diphtheria intoxication, fibrinoid swelling of the connective tissue in rheumatic
diseases.
Perverted synthesis is the synthesis in cells or tissues of substances not
found in them in the norm. These include: the synthesis of the abnormal
protein amyloid in the cell and the abnormal protein-polysaccharide
complexes of amyloid in the intercellular substance; Synthesis of alcoholic
hyaline protein with hepatocyte; Synthesis of glycogen in the epithelium of
the narrow nephron segment in diabetes mellitus.
Transformation - the formation of products of one type of exchange from
common source products, which are used to build proteins, fats and
carbohydrates. Such, for example, is the transformation of the components
of fats and carbohydrates into proteins, the enhanced polymerization of
glucose into glycogen, and others.
In the classification of dystrophies adhere to several principles. Dystrophies are
distinguished:

1. Depending on the predominance of morphological changes in specialized elements of

the parenchyma or stroma and vessels:
• parenchymal;
• stromal-vascular;
• mixed.
2. By the predominance of violations of one or another type of exchange:
• protein;
• fat;
• carbohydrate;
• mineral.
3. Depending on the influence of genetic factors:
• Acquired;
• hereditary.
4. By the prevalence of the process:
• common;
• local.
 Parenchymal dystrophy

Parenchymal dystrophies are manifestations of metabolic disorders in highly

specialized cells. Therefore, parenchymal dystrophies are dominated by
disorders of the cellular mechanisms of trophism. Different kinds of
parenchymal dystrophies reflect the insufficiency of a certain physiological
(enzymatic) mechanism serving a special function of the cell (hepatocyte,
nephrocyte, cardiomyocyte, etc.). In connection with this, various patho- and
morphogenetic mechanisms participate in different organs (liver, kidneys,
heart, etc.) in the development of the same type of dystrophy. It follows that
the transition of one type of parenchymal dystrophy to another species is
excluded, only a combination of different types of this dystrophy is possible.
Depending on the violations of one or another type of metabolism,
parenchymal dystrophy is divided into protein (dysproteinosis), fat (lipidose)
and carbohydrate.
 Parenchymal protein dystrophy (dysproteinosis)

Most of the cytoplasm proteins (simple and complex) are in conjunction

with lipids, forming lipoprotein complexes. These complexes form the
basis of membranes of mitochondria, endoplasmic reticulum, lamellar
complex and other structures. In addition to the associated proteins, the
cytoplasm also contains free proteins. Many of the latter have a function
of enzymes.
The essence of parenchymal disproteinosis consists in changing the
physicochemical and morphological properties of cell proteins: they
undergo denaturation and coagulation or, conversely, colliquation, which
leads to hydration of the cytoplasm; In those cases where the
connections between proteins and lipids is violated, destruction of the
membrane structures of the cell occurs. In the outcome of these
disorders, coagulation (dry) or colliquated (wet) necrosis may develop.
Parenchymal dysproteinosis is referred to as hyaline-drop, hydrophilic
and horny dystrophy.
 Hyaline-drop dystrophy

With hyaline-droplet degeneration, large hyaline-like protein droplets appear

in the cytoplasm, merging with each other and filling the body cells with the
destruction of ultrastructural elements of the cell. In a number of cases,
hyaline-droplet dystrophy concludes with focal coagulation necrosis of the
cell.
This type of disproteinosis is often found in the kidneys, rarely in the liver and
very rarely in the myocardium.
 Hydropic degeneration

Hydropic, or wet, dystrophy is characterized by the appearance in the cell of

vacuoles filled with cytoplasmic fluid. It is observed more often in the
epithelium of the skin and kidney tubules, in hepatocytes, muscle and nerve
cells, as well as in the cells of the adrenal cortex.
 Horn dystrophy

Horny dystrophy, or pathological keratinization, is characterized by excessive

formation of horny substance in keratinizing epithelium (hyperkeratosis, ichthyosis)
or the formation of horny substance where it does not normally exist (pathological
keratinization on the mucous membranes, or leukoplakia, the formation of "cancer
pearls" in squamous cell carcinoma ). The process can be local or common.
The causes of horny dystrophy are diverse: dysplasia of the skin, chronic
inflammation, viral infections, etc.
 Parenchymal fatty degenerations (dyslipidosis)

The cytoplasm of cells contains mainly lipids, which form complex labile fat-
protein, complexes with proteins-lipoproteins. These complexes form the
basis of cell membranes. Lipids together with proteins are an integral part of
cellular ultrastructure. In addition to lipoproteins, neutral fats are also found in
the cytoplasm, which are esters of glycerol and fatty acids.
To detect fats, unfixed frozen slices or fixed in formalin tissues are used.
Histochemically, fats are detected using a number of methods: Sudan III
stains them red, Sudan IV and osmium acid into black, Nile Blue sulphate
stains fatty acids in a dark color, and neutral fats in red.
 Fatty dystrophy of the myocardium

In the myocardium, fatty degeneration is characterized by the appearance in the

muscle cells of the smallest fat droplets (pulverized obesity). With the increase of
changes, these drops (small droplet obesity) completely replace the cytoplasm.
Most of the mitochondria decays in this case, the transverse striation of the fibers
disappears. The process has a focal character and is observed in groups of
muscle cells located along the vein of the venous capillaries and small veins.
 Fatty liver

Gross specimen: the liver is enlarged, yellow, the surface is smooth, flabby consistency.
Synonyms: fatty hepatosis, steatosis, goose liver.
Types of parenchymal fatty dystrophy: 1-local 2- diffuse. Microscopic examination
distinguishes the following types: 1 - microvesicular fatty degeneration (with destruction of
mitochondria and accumulation of fats in ultrastructure of hepatocytes) 2 - large-droplet
fatty degeneration (as a stage of pulverized obesity → small-, medium- and large-droplet
obesity with accumulation of fats in the cytoplasm of hepatocytes)
The causes of chronic fatty hepatosis: hypoxia , endocrine-metabolic diseases (diabetes,
obesity, etc.); сhronic intoxication (endo- and exogenous); Inaccuracies in the diet.
 Parenchymal carbohydrate dystrophies

Carbohydrates, which are determined in cells and tissues and can be

identified histochemically, are divided into polysaccharides, of which only
glycogen, glycosaminoglycans and glycoproteins are detected in animal
tissues. Glycosaminoglycans distinguish neutral, strongly associated with
proteins, and acidic, which include hyaluronic, chondroitin-sulfuric acid and
heparin. Acid glycosaminoglycans as biopolymers are able to enter into
fragile compounds with a number of metabolites and carry out their
transport. The main representatives of glycoproteins are mucins and
mucoids. Mucins form the basis of mucus, produced by the epithelium of the
mucous membranes and glands, mucoids are part of many tissues.