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Uni ver si ty of S anto Tomas

Depar tm ent of Pathol og y


CELL REA CTI ONS TO
IN JU RY
PAR T 2

CELL DEA TH AND SO MA TI C


DEA TH

Emmanuel dela Fuente, MD


Alejandro Arevalo, MD
OBJECTIVES

3. To recognize the different lesions of


cell death
4. To discuss the etiopathogenesis of
the lesions
5. To explain the pathophysiologic
basis for the events in the situation
Activities for this morning’s class
include:
2. Lecturette on cell death and somatic
death
3. Discussion of situations using the format
as stated in the process approach
4. Recognition of lesions from actual gross
specimens and glass slides
Irreversible Injury

Cells may die if the injury is


persistent. It occurs in the living
body as a local or focal change
(autolysis, necrosis, apoptosis) and
the changes following it (gangrene,
dystrophic calcification) or result in
the end of life.
Irreversible Injury

The following are gross and microscopic


pictures.

Identify the following pathologic processes


as to their morphology and state the
etiopathogenesis and the organs where
these lesions are frequently encountered.
Identify this cell and differentiate this lesion
from necrosis and autolysis. State its significance
Process Approach to the Situations
2. State or list the facts of the clinical situations
presented
3. Define issues or problems in clinical situations
4. Make hypothesis on the possible pathogenesis
of the problem/s
5. Recognize the lesions of the different tissues/
organs presented
6. Make a clinico-pathologic correlation i.e., give
pathophysiologic basis to explain the clinical
problems
SITUATION NO. 1

A 65 year old man who has apparently been well


begins to experience chest pain while climbing to
the 5th floor of a building. After several minutes of
rest, the chest pain disappears. He seeks
consultation and is told that his blood pressure is
180/110. ECG reveals left ventricular hypertrophy.

One evening, while eating, he slumps on the table.


He is rushed to a nearby hospital where he is
pronounced dead on arrival.
Before proceeding to the next slides, do
the following:
• State the facts
• State the problem/s
• Make possible hypotheses to explain
the problem/s
• Predict possible lesions to explain the
problem and explain
Which of these 2 lesions of the opened coronary
arteries best explains the sudden course of events of
the patient? Describe and explain. (Arrows indicate
the arteries.)
1. How do you classify these lesions in the
coronary arteries using the concepts of
cell injury?
2. Discuss the etiopathogenesis of the
lesions
Which of these 2 coronary lesions correlates with the sudden
course of events of the patient?
1. What is the serious consequence of the lesion of your choice in the
previous slide.
2. Identify the lesion indicated by the arrow in the previous slide,
which is similar to the lesion seen in the picture on this slide.
Which of these 2 hearts correlates with the lesion in the
coronary artery and with the course of events of the patient?
Describe and classify the lesion.
Which of these 2 lesions corresponds to your choice in the
previous slide? Classify the lesion. Describe.
Classify these 2 lesions of the heart. Describe.
1. Briefly discuss the etiopathogenesis of the lesion,
including the biomolecular events.
2. Correlate the lesions with the clinical events.
3. Which of the following glass slides shows a
similar lesion as in this case?
- CV – 006
- CV – 016
- CV – 017
Con’t of Situation No.1
The dead man from the emergency room is
brought to the morgue of the hospital. After
a while, his wife and relatives go to the
morgue to claim his body. Upon seeing the
body, she and her grandchild touch his body
and try to move his left arm and observe
that it is cold and stiff. Her 4 year old
grandchild asks, “Bakit lola malamig at
matigas ang katawan ng lolo ko? Patay na
ba siya?”
1. What do you think were the basis for the
physician at the emergency room to pronounce
the man dead?
2. Discuss the medical concept of somatic death
3. Explain the post-mortem changes observed
4. What other changes do you expect?
5. Discuss the pathogenesis of these post-mortem
changes
Situation No. 2
Identify the lesion in this coronal section of the brain. Describe
and classify the lesion
Section of the affected area of the brain. Describe and
classify the lesion.

40 x 400 x
1. Discuss briefly the etiopathogenesis
of the lesion
2. Give possible signs and symptoms
3. Which of the following slides shows a
similar lesion as in this case?
- CV – 016
- LU – 014
SITUATION NO. 3
A 34 year old man has a pre-employment chest X-
ray and is interpreted as tuberculosis. Otherwise,
he is asymptomatic.
A gross section of the lung. Indicate the lesions and
describe.
A similar lesion in the hilar lymph nodes. Indicate
the lesion and describe.
A microscopic section of the lesion. Indicate the lesion,
describe, and classify.
1. Briefly discuss the etiopathogenesis of the lesion.
2. Give probable reasons as to why the patient is
asymptomatic
3. Which of the following glass slides shows a
similar lesion as in this case.
- LU – 003
- LU – 009
Situation No. 4
This picture shows an area of necrosis. Indicate and classify the
lesion. Discuss the etiopathogenesis.
Situation No.5
This is the foot of a 68 year old woman with a long history of
diabetes mellitus. Indicate, describe, and briefly discuss the
pathogenesis of the lesion.
Situation No. 6
Identify, describe, and classify the lesion seen in these pictures.
Discuss the etiopathogenesis.
EVEN IN DEATH THERE IS LIFE