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SITUATIONAL ANALYSIS

CELL REACTIONS TO INJURY


Part 1
Cell Adaptation and Injury

Prepared by
Emmanuel R. de la Fuente, M.D.
Objectives
2.Recognize the essential morphologic
features of important cell reactions to
injury
3.Correlate the morphologic features
with the situational events
4.Briefly discuss the etiopathogenesis
including their biomolecular aspects
This morning’s activities should include
the following:
2. Lecturette by group facilitator which
may be a separate activity or
integrated with discussion of the
situations.
3. Discussion of situations
4. Morphologic recognition of lesions
on actual specimens and slides
SITUATION NO. 1
A 60-year-old man had been hypertensive for
the past 20 years with blood pressures
ranging from 150/90 to 180/110. Compliance
to anti-hypertensive medications was poor.
Chest X-ray disclosed significant enlargement
of the left ventricle of the heart.
Slide1. Indicate which of these two hearts
probable represents the heart of this patient?
Describe and explain why?

640 gm 220 gm
Slide 2. Which of the following transverse
sections of the heart illustrates the patient’s
heart? Explain why and describe.

3 cm
1 cm

A B
Slide 3. Which of the following microscopic features
is probably a representation of the left ventricle?
Explain why and describe.
Slide 4. Discuss the biomolecular basis for this
nuclear features.
1. Briefly discuss the etiopathogenesis of the lesion,
including the biomolecular events.
2.Correlate the lesions with the situational events.
3. Which of the ff. glass slides have features
consistent with the patient’s history?
- Glass slide CV-001, CV-004A, and CV-017
4. Select a heart from the museum or from the
available gross hearts that illustrates the heart of
this case.
Situation No. 2
Slide 1. The testicle at the left side is normal. Describe the
testicle at the right side. Give conditions that may give rise to
such a testicle. Discuss the pathogenesis for such a lesion.
Slide 2. Which of the areas in this section of the testicle
illustrates the lesion in the previous picture. Describe.
Situation No. 3
Slide 1. This is a section of the skeletal muscle of a lower
extremity. Describe your observations. Discuss the possible
etiopathogenesis of the lesion including the biomolecular events.
Situation No. 4
Slide 1. This brain is from an 95 yr old man who showed severe
memory loss and impaired intellectual capacity. Describe the
gross and discuss possible etiopathogenesis. What is the
expected microscopic findings.
SITUATION NO. 5
A 57-year-old menopausic woman had
intermittent vaginal bleeding for the past two
years. The bleeding was subsequently
determined to originate from the
endometrium. Work-ups disclosed an
ovarian tumor that is known to secrete large
amount of estrogen.
Slide 1. Which of these two uteri most probably is the cause of
bleeding? Explain. Describe the gross lesion.
Slide 2. Two microscopic sections of endometria.
Which of the 2 illustrates the patient’s endometrium?
Explain why and describe. (Same magnifications)
1.Briefly discuss the etiopathogenesis of
the lesion, including the biomolecular
events.
2.Correlate the lesions with the
situational events.
3. Study the following glass slides.
Which slide is similar to the lesion of
the case?
- E – 10 and FRS-001
SITUATION NO. 6

A 32 year old sexually promiscuous woman


had repeated infections of the cervix.
Slide 1. Two microscopic sections of the cervix. Which of
the 2 is the expected lesion taking into consideration the
history of the patient? Indicate the lesion and describe.
1. Explain why this is an expected lesion.
2. Briefly discuss the etiopathogenesis of the
lesion.
3. Study the following glass slides. Which of the
following slides is similar to the lesion of this
case?

- FRS-002 and CE-03


Situation No. 7
Slide 1. This is a biopsy of the esophagus of a 54 yr. old woman
with dyspepsia. Identify and describe the lesion. Discuss
possible etiopathogenesis.
SITUATION NO. 8
A 64-year-old policeman while getting drunk
and smoking heavily in a beer house was
shot in the head by another customer who
got irritated with the smoke. He died on the
spot. Investigation revealed that his behavior
indicated an addiction to alcohol beverages
and cigarettes.
Without proceeding to the next set of slides, which
of the following organs do you expect lesions to
be present? State the lesion and explain.
2. Brain 6. Spleen
3. Lungs 7. Thyroid
4. Heart 8. Prostate
5. Liver 9. Testicle
6. Gastrointestinal tract
Slide 1. A section of the gross liver. Describe.
Slide 2. Two microscopic sections of the liver. Which
of the 2 is more consistent with the gross lesion?
Describe and discuss the pathogenesis of the lesion.
Slide 3. The external surface of the gross lung.
Indicate the lesion and describe.
Slide 4. Two microscopic sections of the lung.
Which of the 2 is more consistent with the
history of the patient? Explain why and
describe. (arrows indicate the respiratory bronchioles)
Slide 5. A section of a hilar lymph node. Describe
Slide 6. A section of the renal proximal tubules.
Indicate the lesion and describe.
1. Briefly discuss the etiopathogenesis of these
lesions, including the biomolecular events.
2. Correlate the lesions with the situational events.
3. Study the following glass slides. Which of the
following lesions is/are similar to the lesions of the
liver and lungs?
- GI-018, GI-019, and GI-020
- LIV-001
- LU – 010 and LU - 017
Situation No. 9
Slide 1. A 52 year old man developed jaundice. The
liver was enlarged. The conjugated bilirubin was
markedly elevated. Indicate the lesion, describe, and
discuss the possible etiopathogenesis.
Situation no. 10
Slide 1. A child had received repeated blood transfusion
because of hemolytic anemia. This is the liver. Indicate,
describe, and discuss the pathogenesis of the lesion.
Discuss possible outcomes.

H & E stain Prussian Blue stain


THE KEY TO SURVIVING
ENVIRONMENTAL CHANGES IS
THE ABILITY TO ADAPT.