Chapter 2: Tissue Deposits Flashcards
State 6 Tissue Deposits Types
Mucinous & Myxomatous Degeneration Hyalinosis Amyloidosis Pathologic Calcification Gout Pathological Pigmentation
Define Mucinous & Mycomatous Degeneration & state their occurrence
Exaggerated Mucin Production In either: Connective Tissue Or Epithelium
Define Mucin & State where is it secreted (2 points)
Glycoprotein
Mucous secreting cells:
Respiratory Tract
GIT cells
Describe Mucin Gross Examination (4 points)
Fluid
Pale Grey
Transparent
Slimy
Describe Mucin Microscopic Examination
H&E: Pale Blue
State Mucinous & Myxomatous Degeneration sites (2 points)
Mucinous→ Epithelium
Myxomatous→ Connective Tissue
Mention Epithelial Mucoid Degeneration occurrence examples (2 points)
Catarrhal Inflammation
Mucoid Adenocarcinoma
Mention Connective Tissue Myxomatous Degeneration occurrence examples (3 points)
Myxoma → Subcutaneous Tissue
Myxedema
Connective Tissue tumors
Describe Connective Tissue Myxomatous Degeneration Microscopic Examination (5 points)
Few cells Have processes Star-shaped Separated by: Pale Blue Mucin Rounded Hyperchromatic nuclei
Pale Cytoplasm
Define Hyalinosis & state their occurrence (2 points)
Protein substance Deposition In either: Cells Or Connective Tissue material
Describe the protein substance deposited in Hyalinosis (4 points)
Glassy
Homogenous
Structureless
Eosinophilic
State Hyalinosis 2 types
Cellular
Connective Tissue
Mention Cellular Hyalinosis sub-types & where are they found (3 points)
Mallory→ Chronic Alcoholics Liver
Corpora Amylacia→ Old Males Prostate
Russell Bodie→ Rhinoscleroma Plasma Cells
Mention Connective Tissue Hyalinosis sub-types & where are they found (4 points)
Blood Vessels Walls (Arterioles & Capillaries)→ Benign Hypertension
Old scars
Thrombi
Tumors
Define Amyloidosis & where is it found (2 points)
Extracellular amyloid abnormal deposition
In many tissues
Describe Amyloid (3 points)
Group of substances
Have Common physical structure
Biochemical composition of variable Fibrilar protein
Describe stained Amyloid appearance (2 points)
LM→
H&E: Extracellular Homogenous Structurless Eosinophilic Hyaline material
Congo Red:
+ve
Describe Physical Amyloid Nature (2 points)
Amyloid forms:
Similar →
Morphological basis
Physical characteristics
Appearance
Heterogenous →
Chemically
State 2 main types of Amyloid Composition (Complex Proteins)
Fibril Proteins
Non-Fibrillar Components
Describe Fibril Protein Composition
About 95% Amyloid
State Fibril Proteins Types (3 points)
AL
AA
Other proteins
Describe AL Fibril protein (5 points)
Amyloid Light Chain
Derived from: Immunoglobulin light chain
Produced by: Immunoglobulin secreting cells
Seen: With plasma cell dycrasias
Included in: Primary Systemic Amyloidosis
Describe AA Fibril Protein (4 points)
Amyloid Associated
Synthesized in: Liver Found in: Secondary Amyloidosis High level in: Chronic Inflammatory Traumatic conditions
Describe Secondary Amyloidosis (2 points)
Includes largest diseases group
Associated with Amyloidosis
State the main other Fibril Proteins (3 points)
Transthyretin (TTR)
Aβ2-Microglobulin (Aβ2M)
Amyloid Protein (Aβ)
Describe Transthyretin [TTR] (5 points)
Serum protein Heredofamilial Amyloidosis most common form Example: Familial Amyloidosis Polyneuropathies Synthesized in: Liver Transports: Thyroxine Retinol
Describe Aβ2-Microglobulin (Aβ2M) occurrence
Long-term Hemodialysis
Describe Amyloid Protein occurrence[Aβ] (2 points)
Alzheimer’s disease In→ Cerebral: Plaques Blood Vessels
Describe Non-Fibrillar Components (2 points)
5-10% Amyloid Constant →In All Amyloid types Responsible for Amyloid: Stability Staining properties
State 2 Amyloidosis Distribution Classification
Systemic
Localized
Mention Systemic Amyloidosis Types (4 points)
Primary (AL)
Secondary/Reactive/Inflammatory (AA)
Haemodialysis-Associated (Aβ2M)
Heredofamilial
Describe Primary Systemic Amyloidosis [AL] (3 points)
Consists of AL Fibril Protein
Cases:
About 30%→Plasma Cell Dycrasias:
About 10%→Multiple Myeloma
(Most common):
Almost All→Either light chains
(Bence Jones Proteins):
κ
λ
Both→ In serum & Urine
Less often→Other Monoclonal
Gammopathies
Remaining 70% (True ‘Primary Idiopathic Amyloidosis’)→
Don’t have:
Evident B-cell proliferative disorder
Or
Any other associated diseasesMention organs where Primary Amyloidosis is severe in (7 points)
Heart Kidney Bowel Skin Peripheral Nerves Respiratory Tract Skeletal Muscle
Describe Secondary/Reactive/Inflammatory Amyloidosis [AA] (4 points)
Consists of AA Fibril Protein Occur As: Chronic Infectious Complication → Tuberculosis Bronchiectasis Leprosy Chronic: Osteomyelitis Pyelonephritis Skin Infections
Non-Infectious Chronic Inflammatory conditions with Tissue Destruction →
Autoimmune disorders:
Rheumatoid Arthritis
Inflammatory Bowel Disease
Some Tumors →
Renal Cell Carcinoma
Hodgkin’s Disease
Familial Mediterranean Fever (AA)
Mention organs where Secondary/Reactive/Inflammatory Amyloidosis [AA] is typically distributed in (5 points)
Solid Abdominal Viscera Examples: Kidney Liver Spleen Adrenal
Describe Haemodialysis-Associated Amyloidosis [Aβ2M] (2 points)
Derived from: β2-Microglobulin Patients: On Long-term dialysis For >10 years For Chronic Renal Failure
Define β2-Microglobulin
Normal MHC component
Mention where is Haemodialysis-Associated Amyloidosis (Aβ2M) deposits found in (5 points)
Vessel Walls: Synovium Joints Tendon Sheaths Subchondral Bones
State the 2 Heredofamilial Amyloidosis Types
Hereditary Polyneuropathic Amyloidosis (ATTR)
Familial Mediterranean Fever Amyloidosis (AA)
Describe Hereditary Polyneuropathic Amyloidosis [ATTR] (2 points)
Autosomal Dominant Disorder
Derived from: Transthyretin (ATTR) → Its structure contains a single amino acid substitution
Describe where is Hereditary Polyneuropathic Amyloidosis [ATTR] deposits found in & its results (5 points)
Peripheral & Autonomic Nerves
Muscular Weakness
Pain
Paraesthesia
Cardiomyopathy
Describe Familial Mediterranean Fever Amyloidosis [AA] (3 points)
Autosomal Recessive Disease
Inherited Disorder
In Mediterranean Region
Mention Localized Amyloidosis Types (3 points)
Senile:
Cardiac (ATTR)
Cerebral (Aβ, APrP)
Endocrine
Describe where is Senile Cardiac Amyloidosis [ATTR] found in (3 points)
50% >70 years old
Heart
Aorta
Describe Senile Cerebral Amyloidosis (Aβ, APrP) important diseases associated with it (2 points)
Alzheimer’s Disease (Aβ)
Down’s Syndrome
Describe Senile Endocrine Amyloidosis (2 points)
Some Endocrine lesions+ Amyloid Microscopic Deposits
Example:
Thyroid Medullary Carcinoma
Describe Amyloidosis Gross Appearance (2 points)
Affected organ:
Enlarged
Pale
Rubbery
Cut Surface: Parenchyma → Firm Waxy Iodine Test: \+ve
Describe Amyloidosis Deposits Microscopic Appearance (2 points)
Small amounts →
In Extracellular locations:
Small blood vessels walls
Cause 𝐌𝐢𝐜𝐫𝐨scopic changes & effects
Large amounts →
Cause:
𝐌𝐚𝐜𝐫𝐨scopic changes & effects
Pressure Atrophy
Which organ Amyloidosis is the most common & most serious and Give and reason for that
(2 points)
Kidney
Ill effects on Renal functions
Describe Heart Amyloidosis (4 points)
In Primary Systemic Amyloidosis> Secondary Systemic Amyloidosis
Myocardial Fibers Pressure Atrophy
Impaired Ventricular Function
Restrictive Cardiomyopathy
Define Pathologic Calcification
Calcium slats deposition
What are the sites where Pathologic Calcification cannot be seen in?
(2 points)
Bone
Teeth
What are the 3 types of pathologic calcification?
Dystrophic
Metastatic
Stone formation
Where are stones formed? (2 points)
Pathologic Calcification:
Dystrophic
Metastatic
Describe the tissues where
dystrophic pathologic calcification can be seen in (3 points)
Non Viable
Diseased
Or
Necrotic
How is the blood calcium level in dystrophic pathologic calcification?
Normal
Give examples of sites where stoned are formed in dystrophic pathologic calcification (4 points)
Necrotic tissue
Atherosclerosis
Cells
Heart Valves
What are the types of necrosis that have stones formed in them? (4 points)
Fat
Coagulative
Liquefactive
Caseous
Where exactly are stones formed in Atherosclerosis?
Central Necrotic Core
Where exactly are stones formed in cells?
Psammoma bodies
What is the condition of the heart valves after stone formation?
Damaged
Aging
Describe the tissues where
metastatic pathologic calcification can be seen in (2 points)
Normal
Viable
What does metastatic pathologic calcification cause?
Hypercalcemia
What causes Hypercalcemia? (4 points)
Increased PTH secretion
Bone Destruction
Vitamin D disorders
Excess Calcium intake
Give examples to increased PTH secretion (2 points)
Ectopic PTH secretion
Increased Parathyroid tumor
Give examples to bone destruction
3 points
Osteolytic tumors
Paget’s disease
Immobilization
Give examples to Vitamin D disorders
2 points
Vitamin D toxicity
Sarcoidosis
Give an example to excess calcium intake
Milk alkali syndrome
What causes milk alkali syndrome?
2 points
Nephrocalcinosis
Renal stones
Antiacid Self-therapy
What causes Nephrocalcinosis & Renal stones?
Milk
Where is Calcium deposited in? (4 points)
Lungs
Kidneys
Stomach
Arteries
What is the effect of depositing calcium in lungs?
Respiratory Failure
What are the effects of depositing calcium in Kidneys? (2 points)
Kindey Failure
Nephrocalcinosis
What are the effects of depositing calcium in Arteries? (2 points)
Ischemic Ulcers with
Necrosis
Where exactly is calcium deposited in Arteries?
Skin small blood vessels
State the name of the condition in which calcium is deposited in skin small blood vessels
Calciphylaxis
What are the 2 substances involved in Gout formation?
Purine
Serum Uric Acid
Describe Purine
Nucleoprotein
What happens to Purine in Gout formation?
Its metabolism disturbed
What is the effect of disturbed Purine metabolism on Serum uric acid?
Increases
What does Serum uric acid form when increased?
Crystals deposits
Where are Serum uric acid crystals deposits mainly found in?
Big toe’s Metatarsophalangeal joint
State another site where Serum uric acid crystals deposits can be found in
Kidney
What follows the deposition of Serum acid crystals?
Inflammation with foreign body giant cell reaction
State the name given for the body giant cell
Tophi
What are the effects of the deposition of Serum uric acid crystals in the Kidney?
(5 points)
Urate stones Interstitial Inflammation Fibrosis Chronic Renal Failure Distal Convoluting Tubules damage
What is caused when Distal Convoluting Tubules are damaged?
Polyuria
What are the 2 types of Pathological Pigmentation?
Endogenous
Exogenous
What causes pathological endogenous pigmentation? (4 points)
Lipofuscin
Melanin
Bilirubin
Hemosidrin
What are the ways in which pathological endogenous pigmentation are presented in the body?
Inhalation
Ingestion
Tattoo
What is the condition in which pathological endogenous pigmentation is presented in the body through inhalation?
Anthracosis
What could be ingested leading to pathological endogenous pigmentation?
Lead poison
What results in the formation of Lipofuscin?
The action of free radicals on cell membrane lipids
Describe the structure of Lipofuscin
Complex
What is Lipofuscin made of?
Lipid
Protein
What is the color of the granules of Lipofuscin?
Brownish Yellow
Describe the solubility of Lipofuscin
Insoluble
What is Lipofuscin pigment described as?
Wear and Tear
Where can Lipofuscin granules be found in?
Both sides of nucleus
Where does Lipofuscin accumulate in?
Patients
Cells
Which cells does Lipofuscin accumulate in?
Myocardial
Which patients is Lipofuscin accumulation found in?
Elderly
Where exactly is Lipofuscin accumulation found in Elderly patients?
Hepatocytes
Where exactly does Lipofuscin accumulate in Myocardial cells?
Both nuclei poles
Define Brown Atrophy?
Combination of:
Lipofuscin accumulation
Organs atrophy
Define Hemosidrin
Hemoglobin derived pigment
What does Hemosidrin consist of?
Ferritin aggregates
What does Hemosidrin contain?
Iron
What is the stain used to identify Hemosidrin in tissues?
Prussian Blue Dye
What is the color of Hemosidrin when stained?
Golden Brown
What is Hemosidrin considered as?
Physiologic iron store
Where is Hemosidrin found in?
Tissue Macrophages
Describe the amount of Hemosidrin in tissue macrophages
Small
Which organs [having tissue macrophages] are Hemosidrin found in? (3 points)
Liver Bone marrow Spleen Pancreas Skin Heart
Give an example to a Liver condition in which Hemosidrin deposits can be seen
Micronodular Cirrhosis
Give an example to a Liver condition in which Hemosidrin deposits can be seen
Diabetes Mellitus
What is the color of Hemosidrin when seen in a diabitic patient?
Bronze
What are the 2 types of Hemosidrin
Local
Systemic
Define Local Hemosidrosis
Local Hemosidrin Deposition
What causes Local Hemosidrosis?
Local tissue hemorrhage
Define Systemic Hemosidrosis
Generalized hemosidrin deposition
Does Systemic Hemosidrosis causes tissue damage?
No
What causes Systemic Hemosidrosis?
4 points
Hemorrhage
Multiple blood transfusion
Excessive dietary iron intake +
Alcohol consumption
Define Hemochromatosis
More extensive Hemosidrin accumulation
Where can Hemochromatosis be seen in?
Parenchymal cells
What are the Parenchymal cells associated with when observing Hemochromatosis in them?
(3 points)
Tissue damage
Scarring
Organ Dysfunction
What are the 2 Hemochromatosis types?
Primary
Secondary
Describe Primary Hemochromatosis
Hereditary
What causes Primary Hemochromatosis?
Gene mutation
What does this gene mutation result in?
Duodenum excessive iron absorption
Which patients can Secondary Hemochromatosis be seen in?
Hereditary hemolytic anemic patients
When is Secondary Hemochromatosis seen with Hereditary hemolytic anemic patients?
After multiple blood transfusions
