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Metaplasia Definition: Metaplasia is a reversible change in which one adult cell type is replaced by another adult cell type.

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Metaplasia-Types Epithelial metaplasia Squamous metaplasia columnar epithelium (trachea, cervix, cholecyst) transitional epithelium (pelvis) Intestinal metaplasia Gastric glandular epithelium Pseudo-pyloric gland Metaplasia corpus and sinus gastric gland

Mesenchymal metaplasia Osseous, cartilage and adipose tissue metaplasia Fibroblasts Logo Metaplasia-Types Logo Metaplasia-Types

Squamous metaplasia normal Logo Logo Metaplasia-Types

Squamous metaplasia Logo Metaplasia-Types villi of normal trachea squamous metaplasia Logo Metaplasia-Types

Logo Metaplasia-significance Metaplasia---a double-edged sword Advantage Disadvantage Defending loss of normal function Cancer transformation Logo Adaptation

Increased demands Growth stimulation hypertrophy hyperplasia adaptation atrophy metaplasia Diminished nutrition

Chronic stimulation Low stimulation Pathological Logo Tissue Tissue and and Cellular Cellular Injury Injury

Logo Cell and tissue injury injury

Normal cells irreversible injury Adaptation reversible injury Logo Cell and tissue injury ---Causes 1

Hypoxia 2 Chemical agents 3 Physical agents 4 Biologic agents 5 Immunologic reactions 6 Genetic defects 7 Nutritional imbalances 8 Others

Logo Cell and tissue injury ---Mechanisms of cell injury ATP ATP depletion Irreversible mitochondria damage Loss of membrane permeability Overload of intracellular calcium and loss of calcium homeostasis Accumulation of oxygen-derived free radicals Logo

Cell and tissue injury ---Morphologic changes reversible injury Degeneration cellular injury irreversible injury cell death Necrosis

apoptosis Logo Cell and tissue injury Morphologic changes--Reversible injury ATP DNA Degeneration When cellular injury is sublethal and sustained, cells and tissues tend to accumulate substances in abnormal quantities. These materials may be endogenous or exogenous.

Logo Cell and tissue injury ---Morphologic changes reversible cell injury Cellular swelling Fatty change lipids proteins

Intra (extra)-cellular accumulations Amyloid change glycogen hyaline change mucoid change Pigments Logo Pathologic calcification Cell and tissue injury

Reversible injury--cellular swelling The commonest and earliest form of cell injury from almost all causes. Hypoxia infection intoxication mitochondria injury ATP Na+-K+ pump dysfunction Intracellular accumulation of Na+ and H2O The common site--- liver, kidney , heart Logo Cell and tissue injury Reversible injury--cellular swelling

Grossly: The affected organ is enlarged due to swelling. The cut surface bulges outwards and is slightly opaque. Cellular swelling of liver Logo Cell and tissue injury Reversible injury--cellular swelling LM: The cells are swollen. Small clear vacuoles are seen in the cells.

Normal cell Granularity change Viral hepatitis Hydropic change Logo Cell and tissue injury Reversible injury--cellular swelling

Logo Cell and tissue injury Reversible injury--cellular swelling Logo Cell and tissue injury Reversible injury--cellular swelling Hydropic degeneration of renal tubule

Logo Cell and tissue injury Reversible injury--cellular swelling EM: dilatation of endoplasmic reticulum and mitochondrial swelling dilatation of endoplasmic reticulum mitochondrial swelling Logo

Cell and tissue injury Reversible injury--cellular swelling Gross: The affected organ is enlarged due to swelling. The cut surface bulges outwards and is slightly opaque. LM: The cells are swollen. Small clear vacuoles in the cells. EM: swelling of endoplasmic reticulum and mitochondria : : : Logo

Cell and tissue injury Reversible injury--fatty change Definition: The accumulation of fat in nonfatty parenchymal cells. : Liver, heart, kidneys and other organs Gross: enlarges, yellow, soft, and greasy. LM: The fatty change appears as clear vacuoles within parenchymal cells. : : Logo Cell and tissue injury

Fatty change of liver alcohol abuse protein malnutrition obesity hepatotoxin diabetes Logo Cell and tissue injury Intracellular accumulations ---fatty change

Logo Cell and tissue injury Fatty change of liver LM: Small vacuoles around nucleus coalesce large vacuoles that displace the nucleus to the periphery of the cell. Logo Cell and tissue injury Fatty change of liver

Special staining Sudan III : orange red Osmic acid: black Logo Cell and tissue injury Fatty change of liver congestion: central parts of the lobules toxication: perilobules

Logo Fatty change of the liver Upper Left: gross appearance. Lower left: HE stain. Upper Right: Sudan III Logo stain for fat. Lower Right: electron microscopy Cell and tissue injury Intracellular accumulations ---fatty change of myocardium -- (

: ,

Logo Cell and tissue injury Fatty change of myocardium Tiger stripe heart Bands of yellow streaks alternate with redbrown muscle appearance Fatty change are in yellow Myocardium are in red-brown Logo

Cell and tissue injury fatty change of myocardium Special stain Sudan III : orange red Osmic acid: black Logo Cell and tissue injury Myocardium fatty infiltration Logo

Cell and tissue injury Lipidcholesterol and cholesteryl esters Atherosclerosis Xanthomas inflammation and necrosis Atherosclerosis foam cells Logo Cell and tissue injury Intra (extra)-cellular

accumulations ---Proteins Reabsorbent droplets : renal tubules Russell bodies: plasma cells Defect in protein folding Logo Cell and tissue injury Intracellular accumulations---Proteins Reabsorbent droplets

Logo Cell and tissue injury Intracellular accumulations---Proteins Russell bodies , Logo Cell and tissue injury Intracellular accumulations---Proteins

Mallory -- Logo Cell and tissue injury Intra(extra)-cellular accumulations --- Hyaline change Definition: Various histological or cytological alterations characterized

by homogeneous, glasslike eosinophilic appearance in HE stained sections HE Logo Cell and tissue injury Hyaline change-Types Intracellular hyaline

Reabsorb droplets : renal tubules Mallory alcoholic bodies: hepatocytes Russell bodies: plasma cells Arterioles hyaline Collagenous fibrous tissue hyaline Logo

Cell and tissue injury Hyaline change-- Intracellular hyaline Logo Cell and tissue injury Hyaline change -- arterioles hyaline Hypertension and diabetes mellitus Extravasated plasma protein

Deposition of basement membrane Logo Cell and tissue injury Arterioles hyaline Logo Cell and tissue injury

Hyaline change ---Collagenous fibrous tissue hyaline Logo

Intra (extra) -cellular accumulations --- Amyloid change Amyloid change is a condition that occurs in a group of diseases, all having the localized or generalized deposition of amyloid. :

HE : Logo Cell and tissue injury Intra(extra) cellular accumulations ---Mucoid change Change characterized by accumulation of mucin in intracellular or extracellular loci.

: : , , Logo Cell and tissue injury Pathologic pigmentation

endogenous Hemosiderin Lipofuscin Melanin bilirubin exogenous

Carbon smut tattooing Logo exogenous Logo

Cell and tissue injury Pathologic pigmentation--Hemosiderin Heart failure cell Logo Cell and tissue injury Pathologic pigmentation--Lipofuscin Logo Cell and tissue injury Pathologic pigmentation-- Melanin

Logo Cell and tissue injury Pathologic pigmentation-- bilirubin Logo Cell and tissue injury Pathologic calcification Definition: Abnormal deposits of calcium salts occur in any tissues except bones and teeth

Types: dystrophic calcification metastatic calcification , D Logo Cell and tissue injury Pathologic calcification Dystrophic calcification

Logo Cell and tissue injury Pathologic calcification Metastatic calcification Logo Morphologic changes of tissue and cellular injury reversible cell injury Cellular swelling Fatty change

lipids proteins Intra (extra)-cellular accumulations Amyloid change glycogen hyaline change mucoid change Pigments Logo Pathologic calcification

Tissue and Cellular injury Reversible injury irreversible injury Cell death Logo Tissue and Cellular injury Irreversible injury --Cell death

Severe damage involve nucleus Metabolism stop Structure destroy Function lose Irreversible injury Cell death necrosis

apoptosis Logo Tissue and Cellular injury Necrosis A sequence of morphologic changes that follow cell death in living tissue. The morphologic appearance of necrosis is the result of two essentially concurrent processes: Enzymatic digestion of the cells (autolysis & heterolysis ) Denaturation of proteins Logo

Tissue and Cellular injury Morphology of necrotic cells 1 Changes in the nucleus Karyolysis Pyknosis ( ) Karyorrhexis 2 Changes in cytoplasm and cellular membrane

3 Increased Eosinophilia ( : Vacuolated and moth-eaten appearance ( cellular membrane breakageinflammation Calcification ( Changes in mesenchyma Logo

Tissue and Cellular injury Morphology of necrotic cells 1 Changes in the nucleus Karyolysis : dissolution of the nucleus (the basophilia of the chromatin fade) Pyknosis ( ): nuclear shrinkage and condensation of chromatin (increased basophilia) Karyorrhexis : the pyknotic nucleus fragments

normal pyknosis karyorrhexis karyolysis Logo Tissue and Cellular injury Morphology of necrotic cells pyknosis karyorrhexis karyolysis

Logo Morphology of necrotic cells Cytoplasm: increased eosinophilia loss of RNA and denatured protein Logo Tissue and Cellular injury Types of necrosis coagulative necrosis

necrosis liquefaction necrosis caseous necrosis Specialized necrosis gangrene fibrnoid necrosis Enzymatic digestion of the cells Denaturation of proteins fat necrosis

Logo Tissue and Cellular injury Coagulative necrosis Gross The necrosis area is swollen, firm and pale. LM:

The dead cells preserve their basic structural outline but only indistinctly appearing as a mass of coagulated pink-staining, homogeneous Sites: Infarcts of solid organs--heart, spleen, kidney Logo Tissue and Cellular injury Coagulative necrosis Anemic infarct of kidney

The necrosis area is firm and pale. Logo Tissue and Cellular injury Coagulative necrosis Logo Tissue and Cellular injury coagulative necrosis of heart Logo

Tissue and Cellular injury Liquefactive necrosis Soft and liquid. Discharge of the liquid grossly contents forms a cystic space. , LM: The tissue structure dissolve by enzymes digestion of the cells

Brain after ischemic injury (rich in lipid) Pancreatitis (rich in protease) Types: Abscesses lytic necrosis Logo Tissue and Cellular injury Liquefactive necrosis Coagulative necrosis Liquefactive necrosis

Logo Tissue and Cellular injury Liquefactive necrosis Logo - Liquefactive necrosis Liquefactive necrosis of hepatocytes lytic necrosis

Logo Tissue and Cellular injury Special types of necrosis Caseous necrosis Gangrene Fat necrosis Fibrinoid necrosis Logo Tissue and Cellular injury

caseous necrosis most often in TB Gross: white or light yellow, cheesy. LM: amorphous granular debris tissue, architecture is completely obliterated Logo Tissue and Cellular injury caseous necrosis

Logo Tissue and Cellular injury Gangrene Necrosis of big tissue with secondary putrefactive organisms infection Black and green appearance

Dry gangrenes Gangrene Wet gangrene Gas gangrene Logo Tissue and Cellular injury Dry gangrenes Occurs on the skin surface following arterial obstruction. It is particularly liable to affect the limbs, especially the toes.

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frostbite injury Logo Tissue and Cellular injury dry, black, clear border with surrounding normal tissue Logo Tissue and Cellular injury Wet gangrene

Conditions: occurs in naturally moist tissues and organs. Both arterial and venous obstruction; Character: wet swollen, foulsmelling, black or green. Location: small intestine, appendix, lung, uterus, limbs ( ) (

) Logo Tissue and Cellular injury Wet gangrene Soft, swollen, dark. Logo Tissue and Cellular injury

Gas gangrene Conditions: deep contaminated wounds in which there is considerable muscle damaged by gas forming bacteria. Character: swollen obviously, gas bubbles formation war wounds

Logo Tissue and Cellular injury Fibrinoid necrosis

Logo Tissue and Cellular injury Fat necrosis Logo Tissue and Cellular injury

Fat necrosis LM: shadowy outlines of necrotic fat cells, with basophilic calcium deposits and a surrounding inflammation reaction Logo Tissue and Cellular injury Types of necrosis coagulative necrosis

necrosis liquefaction necrosis caseous necrosis Specialized necrosis gangrene fibrnoid necrosis Enzymatic digestion of the cells Denaturation of proteins

fat necrosis Logo Tissue and Cellular injury Physiologic importance Lysis and absorption

Amount of necrotic cells Isolation and discharge Ability of cells

Organization Compensatory capacity Encapsulation calcification Logo Tissue and Cellular injury Sequel of necrosis

-- Lysis and absorption Logo Tissue and Cellular injury Sequel of necrosis -- Isolation and discharge

Logo Tissue and Cellular injury Sequel of necrosis -- Isolation and discharge Ulcer & erosion

ulcer cavity Logo Tissue and Cellular injury Sequel of necrosis -- Isolation and discharge Logo

Tissue and Cellular injury Sequel of necrosis-- Organization necrosis Granulation tissue Logo

Tissue and Cellular injury Sequel of necrosis-- Encapsulation Logo Apoptosis 1972, falling off

A form of cell death A way to eliminate unwanted host cells through activation of a coordinated, internally programmed series of events programmed cell death A single cell death in living bodies controlled by the genes which is a energy-dependent suicide process. Logo

Apoptosis Difference between apoptosis and necrosis Apoptosis Cell shrinkage Chromatin condensation nucleus fragments Formation of cytoplasmic blebs and apoptotic bodies Phagocytosis of apoptotic cells or bodies No inflammation Logo

Apoptosis Morphological changes LM: Single cells or small clusters of cells Round or oval mass of eosinophilic cytoplasm with dense nuclear chromatin fragments Logo Apoptosis Morphological changes

Logo Apoptosis Logo Apoptosis (TUNEL)

caspases DNA Logo Apoptosis

Logo Apoptosis

ATP DNA 180-200bp ATP DNA

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