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CHAPTER 1
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SECTION 2 CELL INJURY
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Reversible
Irreversible
Cellular Swelling
Fatty Change
Hyaline Change
Amyloid Change
Mucoid Change
Pathologic Pigmentation
Pathologic Calcification
Cell Death
Degeneration
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Reversible Cell Injury
Intracellular &/or extracellular abnormal
accumulation:
Excess amounts of various normal
substances (water,lipids,proteins,pigments)
Abnormal substances (exogenous,
endogenous)
Degeneration
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Cellular Swelling
Intracellular accumulation
Sodium
Water
(hydropic degeneration)
(1)
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Cellular Swelling (2)
Morphology
NE:
LM:
EM：
Cloudy swelling
Increase in the weight
the organs
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Cellular Swelling (3)
Morphology
NE:
LM:
EM：
Large
Small & fine granules in the cytoplasm
the cells
Ballooning change
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Cellular Swelling (4)
Morphology
NE:
LM:
EM：
Swelling
Endoplasmic reticulum
Mitochondria
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Injurious agents
Mitochondria damage
Mechanisms
Water & sodium
within the cells
Cellular swelling
ATP
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Fatty Change
Intracellular abnormal accumulation:
Triglycerides
(1)
Steatosis
Often occurred in the liver and the heart
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Morphology
Fatty Change (2)
NE:
LM:
EM：
Large
Yellow
Soft
Greasy
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Morphology
Fatty Change (3)
NE:
LM:
EM：
Round, clear vacuoles
Orange-red color by staining with
Sudan Ⅲ or Oil Red O (Frozen tissue
sections!)
Fat vacuoles
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Morphology
Fatty Change (4)
NE:
LM:
EM： Membrane-bound inclusions
Liposomes
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Fatty Change of the Liver
Mild fatty change:
Not affect the gross appearance
With progressive accumulation:
NE
Large
Yellow
Soft
Greasy
Fatty Liver: Severe & diffuse fatty change
(1)
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Fatty liver
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LM
Fatty Change of the Liver (2)
Fat vacuoles
Small , in the cytoplasm
around the nucleus
Displacing the nucleus
to the cell periphery
Fatty cysts
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Fatty change of the liver（Sudan Ⅲ）
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Mechnisms
Fatty Change of the Liver (3)
Overproduction of triglycerides
Excessive entry of free fatty acids into liver
Enhanced fatty acid synthesis from acetate
Decreased fatty acid oxidation
Decreased apoprotein synthesis
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Fatty Change of the Myocardium
Mild fatty change:
Not affect the gross appearance
With progressive accumulation:
NE
Tigered effect
Apparent bands of yellowed myocardium
alternating with bands of
dark,red-brown,uninvolved myocardium
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Fatty change
of heart
muscle
(tigered effect)
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Fatty change of
heart muscle
(tigered effect)
Sudan-
hematoxylin
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A homogeneous, translucent, pink
appearance in HE staining
Hyaline Change
Intracellular or extracellular abnormal
accumulation:
Proteins
A descriptive morphologic term
(1)
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Hyaline change in arteriolosclerosis
e.g. Hypertension, Diabetes
Hyaline change in connective tissues
e.g. Old scars
Hyaline change within the cytoplasm
e.g. Nephrotic syndrome, Russell
bodies, Mallory body
Hyaline Change (2)
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Hyaline change in arteriolosclerosis
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Vascular pathology in hypertension. A, Hyaline arteriolosclerosis. The
arteriolar wall is hyalinized, and the lumen is markedly narrowed.
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Chronic glomerulonephritis
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Protein reabsorption droplets in the renal tubular epithelium
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Mallory bodies in liver cells
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Amyloidosis
Extracellular abnormal accumulation:
Amyloid
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Physicochemical characteristics of amyloid
+Iodine--- a brown color--- +H2SO4 --- blue
Staining: Congo red--- red,
HE--- homogeneous pink
EM: nonbranching fibrils 7.5-10 nm wide
X-ray: a pleated –sheet structure
(rendering protein very resistant to
enzymatic degradation, contributing
to its accumulation in tissues)
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Mucoid Change
Extracellular abnormal accumulation:
Mucopolysaccharide
(Glycosaminoglycans, Hyaluronic Acid)
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Pathologic Pigmentation
Intracellular & extracellular abnormal
accumulation:
Exogenous
Endogenous
Colored substances
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Pathologic Pigmentation
Exogenous
Endogenous
✓ Hemosiderin
✓ Lipofuscin
✓ Melanin
✓ Carbon
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Carbon
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Hemosiderin granules in macrophages in the alveolus
Hemosiderin
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Hemosiderin granules in liver cells. A, H&E B, Prussian blue reaction
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Lipofuscin
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Melanin
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Pathologic Calcification
Intracellular & extracellular abnormal
accumulation:
Calcium salts
1. Except for the bones and teeth
2. Pathologic conditions
(1)
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Metastatic calcification in the wall of the stomach
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Dystrophic Calcification
In areas of necrosis
No calcium metabolic derangements
Metastatic calcification
In normal tissues
Some calcium metabolic derangements
Pathologic Calcification (2)
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2. Apoptosis
1. Necrosis
Cell Death
Irreversible Cell Injury
A sequence of morphologic changes
that follow cell death in living tissue
A distinctive and important mode
of cell death regulated by genes
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Necrosis
Two essentially concurrent processes to
produce the morphologic changes :
1. Enzymatic digestion of the cell
2. Denaturation of proteins
(1)
Autolysis
Heterolysis
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Necrosis
Basic pathologic changes
Types of necrosis
Sequences of necrosis
(2)
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Necrosis
Basic Pathologic Changes
(3)
Nuclear changes
Karyolysis
Pyknosis
Karyorrhexis
Cytoplasm Increased eosinophilia
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Necrosis
Types of Necrosis
(4)
Liquefactive necrosis
Fat necrosis
Coagulative necrosis
Caseous necrosis
Gangrene
Fibrinoid necrosis
![Cell Injury[1]](https://img.pdfslide.us/doc/110x75/563dba79550346aa9aa5f218/cell-injury1-56a51a5ef0c98.jpg)
