Somatic death Flashcards
Primary changes during somatic death:
failure of circulatory, respiratory, and central nervous systems
Secondary changes after somatic death:
(ARLP DPA)
Algor mortis, Rigor mortis, Livor mortis, Postmortem clotting, Dessication, Putrefaction, Autolysis
Postmortem cooling at a rate of ~7°F/hour
Algor mortis
Stiffening of muscles postmortem, starts in the neck and head (2-3 hrs), persists for 3-4 days
Rigor mortis
Purplish discoloration of the body due to blood pooling; does not blanch after 10-12 hours
Livor mortis
Difference between postmortem lividity and ecchymosis: lividity disappears under pressure, ecchymosis does not
Postmortem lividity vs. Ecchymosis
Clot formed after death, RBCs settle from plasma, chicken fat present, assumes vessel shape, rubbery consistency
Postmortem clot
Clot formed before death, not detachable from vessels, no chicken fat, seldom assumes vessel shape, granular and friable
Antemortem clot
Drying and wrinkling of the anterior chamber of the eye postmortem
Dessication
Invasion of tissues by intestinal microorganisms postmortem
Putrefaction
Self-digestion of cells due to lysosomal enzyme release; lysosomes are known as the ‘suicide sac’ of the cell
Autolysis
Rotting or decomposition of the body by bacterial action
Putrefaction
Changes seen in putrefaction: Greenish-blue discoloration due to iron sulfide, muscle softening (autodigestion), corneal retraction, loss of rigor mortis, skin peeling, swelling of face
Putrefaction changes
Liberation of hydrolytic enzymes leading to self-digestion of cells, enhanced by putrefactive bacteria; no inflammatory response postmortem
Autolysis
Postmortem clot with settling and separation of RBCs from the fluid phase; appearance: Chicken fat (cleared area), Currant jelly (sediment of RBC); assumes blood vessel shape; rubbery consistency
Postmortem clot
Ante-mortem clot with tangled fibrin, irregular pattern; does not resemble blood vessels; consistency is granular, not rubbery
Ante-mortem clot
Drying and wrinkling of the cornea and anterior chamber postmortem
Dessication
1st to describe the 4 signs of inflammation
Cornelius Celsus
Redness due to increased blood flow to injury
Rubor (Redness)
Heat due to increased blood flow
Calor (Heat)
Swelling caused by capillary permeability and fluid extravasation
Tumor (Swelling)
Pain due to pressure on sensory nerves
Dolor (Pain)
Loss of function caused by destruction of functional units
Functio laesa (Loss of function)
Vascular and exudative response involving PMNs transitioning to microphages in tissues
Acute inflammation
Intermediate stage between acute and chronic inflammation
Subchronic inflammation
Vascular and fibroblastic response involving monocytes transitioning to macrophages in tissues
Chronic inflammation
Continuous abnormal proliferation of cells without control or purpose, e.g., leukemia
Neoplasia/Tumor
Chronic inflammation characterized by granuloma formation; focal aggregation of activated macrophages transformed into epithelial-like cells with pink cytoplasm, surrounded by lymphocytes and plasma cells
Granulomatous inflammation
Examples include syphilis (gummas), TB, leprosy, schistosomiasis, and Bartonella henselae
Conditions with granulomas
Resolution of inflammation with no destruction of normal tissue, neutralization of the offending agent, and clearance of mediators and inflammatory cells
Simple resolution
Replacement of lost or necrotic tissue with new tissue that is structurally and functionally similar to those destroyed
Regeneration
Grading system for tumor differentiation and treatment approach based on the percentage of differentiated and undifferentiated cells
Broder’s Classification
75-100% differentiated cells, 0-25% undifferentiated cells; Treatment: Surgery
Grade I
50-75% differentiated cells, 25-50% undifferentiated cells; Treatment: Surgery or Radiation
Grade II
25-50% differentiated cells, 50-75% undifferentiated cells; Treatment: Radiation
Grade III
0-25% differentiated cells, 75-100% undifferentiated cells; Treatment: Radiation
Grade IV
Active tumor cells; functional component of the tumor
Parenchyma
Connective tissue framework of the tumor; supportive component
Stroma
Based on capacity to produce death: Benign (e.g., mole) or Malignant
Types of tumor (1)
Based on histologic characteristics: Medullary (parenchyma > stroma) or Scirrhous (stroma > parenchyma)
Types of tumor (2)
Benign tumors are generally named with the suffix “-oma”
Benign tumor naming
Malignant tumors include mesenchymal/CT (“-sarcoma”), epithelial (“-carcinoma”), leukemia, and lymphoma
Malignant tumor naming
Benign tumor of squamous cells
Squamous cell papilloma
Malignant tumor of squamous cells
Squamous cell carcinoma
Malignant tumor of hepatocytes
Hepatoma/hepatocarcinoma
Malignant tumor of melanocytes
Melanoma/melanocarcinoma
Pregnancy occurring in the Fallopian tube
Ectopic pregnancy
Size, extent of spread to lymph nodes, +/- metastases; evaluated using TNM system
Staging
Staging system that includes tumor size (T), lymph node involvement (N), and metastases (M)
UICC TNM classification
Combines grading (differentiation) and staging (spread)
AJCS Grading + Staging
Primary tumor; classified by size and local extent
T (TNM system)
Carcinoma in situ
Tis
Non-invasive tumor
Ta
Cannot be evaluated
Tx
No evidence of tumor
T0
Lesion <2 cm
T1
T1 subclassifications: <0.5 cm (T1a), <1 cm (T1b), <2 cm (T1c)
T1 subclasses
Lesion 2-5 cm with muscle invasion
T2
Tumor invading skin/chest wall, T3a = deep muscle, T3b = through organ
T3
Tumor invasion/fixation, T4a = adjacent organ, T4b = fixation (e.g., bladder, colonic wall, edema in breast)
T4
Regional lymph node involvement
N (TNM system)
Not evaluable lymph node involvement
Nx
No regional lymph nodes involved
N0
1 mobile regional lymph node involved
N1
Multiple mobile regional lymph nodes involved
N2
Fixed regional lymph node involved
N3
Beyond regional lymph node involvement
N4
Distant metastasis classification
M (TNM system)
No evidence of metastases
M0
Distant metastases are present
M1
Distant metastases not evaluable
Mx
Compound tumors; may contain hair, teeth, bones; ‘monstrous tumors’ (Greek)
Teratomas
Fibroblast-derived benign tumor
Fibroma
Chondroblast-derived benign tumor
Chondroma
Osteoblast-derived benign tumor
Osteoma
Lipoblast-derived benign tumor
Lipoma
Epithelial tumor with glandular pattern
Adenoma
Epithelial tumor with finger-like or warty projections
Papilloma
Epithelial tumor forming a large cystic mass
Cystadenoma
Malignant mesenchymal/connective tissue tumor
Sarcomas
Malignant fibrous tissue tumor
Fibrosarcoma
Malignant cartilage tissue tumor
Chondrosarcoma
Malignant bone tissue tumor
Osteosarcoma
Malignant blood-forming tissue tumors
Leukemias/Lymphomas
Malignant epithelial tumor
Carcinomas
Malignant glandular epithelial tumor
Adenocarcinoma
Malignant squamous epithelial tumor
Squamous cell carcinoma
Most reliable feature of malignancy, allowing cancer cells to enter vessels and cavities for spread
Metastasis
Metastasis through penetration of natural body cavities, often in the peritoneal cavity
Seeding within body cavities
Most common pathway of spread for carcinomas
Lymphatic spread
Most common pathway of spread for sarcomas
Hematogenous spread
