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Stromal Vascular Dystrophies Actuality of the theme




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Stromal Vascular Dystrophies


Actuality of the theme: Stromal vascular dystrophies develop in stroma or walls of vessels. This leads to the disturbance of the nourishment of the cell’s parenchyma, reduction in their function, or disturbance in the function of the organs, which consist of the connective tissue (valves of heart, joints, serous shells and other). These dystrophies frequently are encountered in the pathology of man and the knowledge of them is necessary for mastering of rheumatic diseases, hypertonic disease, and they can be the complication of a number of the diseases, which are studied in our course of special pathologic anatomy, and in the course of therapy, the knowledge of them is also necessary for doctor for diagnostics, preventive maintenance, prescribing of the therapy of many illnesses.

Purpose (general): To know how to determine the special morphological features of the separate forms of stromal vascular dystrophies, their reason and the mechanism of development, outcome, and their significance to the organism.


           

^ The specific goals:                         Purposes of the initial level:

To be able:

1. To classify stromal vascular

dystrophies




2. To identify with the aid of macroscopic

and histological study, mucoid

swelling, fibrinoid swelling, general

and local hyalinosis, to determine their

reason, mechanism of development,

outcome, their significance to the

organism

1. To identify the basic components of

connective tissue of the extracellular

matrix (collagen, fibronectin, laminin,

glycosaminoglycans), cell (Department

of Histology, Biochemistry).

3. To identify the macro- and

microscopic signs of amyloidosis, to

classify it, to determine the reasons for

secondary amyloidosis, localization,

outcome, their significance to the

organism

2. To identify the structure of spleen,

kidneys, liver, intestine, their exterior

view (Departments of Human

Anatomy and Histology).

4. To identify the signs of stromal

vascular fatty dystrophies - obesity, to

determine its reasons, outcome, their

significance to the organism

3. To determine the localization of fatty

tissue in the organism (Department of

Human Anatomy).

5. To identify the signs of the

carbohydrate dystrophies of

myxedema, its reason




           

In order that you could clarify the initial level of your knowledge and skills, we propose you to answer the following tasks.


^ TASKS FOR SELF ASSESSMENT OF INITIAL LEVEL OF KNOWLEDGE-SKILLS


Task No 1.

In the connective tissue with the picrofuchsin staining of van Gizon, there was found fibres of red color. What can this be?

1. Elastin

2. Collagen

3. Fibronectin

4. Laminin


Task No 2.

It is known that amyloid can be found in the walls of vessels, the stroma of organs. In which of the named structures of kidney it can’t be amyloid?

1. Glomerulus

2. Epithelium of the ducts

3. Vessels

4. Stroma


Task No 3.

Among these organs, in which of these there can be secondary amyloidosis, there is an organ with the lymphoid follicles (white pulp), sinusoid type vessels with cells (red pulp). What organ is this?

1. Liver

2. Adrenal gland

3. Spleen

4. Kidney

5. Intestine


Standard Answers Tasks For Self Assessment Of Initial Level Of Knowledge-Skills:

1.-2; 2.-2; 3.-3;


The information, which is needed for completing the necessary knowledge-skills, can be found in the following literary sources.

1. Increase in weight, Prives M.G., Lysenko N.K., Bushkovich V.I., // Human Anatomy

“Hippocrates”,  2001, pg. 268-287.

2. Afanasev YU.M., Yurina I.A. // Histology, Cytology and Embryology - G., Medicine, 1999,

pg. 199-223, 436-440, 556-595, 597-607.


The basic theoretical questions, on basic of possible fulfillment for purposeful activity

1. Classification of stromal vascular dystrophies

2. Essence of mucoid swelling, its morphological signs, reason, outcome.

3. Essence of fibrinoid swelling, its morphological signs, reason, outcome, signification in the

different localization.

4. General and local hyalinosis, reason, morphology, outcome, significance to the organism.

5. Essence of amyloidosis, the composition of amyloid, the histological methods of its

development, classification.

6. Secondary amyloidosis, its reason, localization, outcome, signification.

7. Stromal vascular fatty dystrophy - obesity, its reason, morphology, outcome, signification.

8. Stromal vascular carbohydrate dystrophies - myxedema, reason, morphology.


Literature for mastering the necessary knowledge-skills on this theme:

1. Strukov A.I., Serov V.V., // Pathologic Anatomy. - Kharkov, “Fact”, -1999. - pg.70-90.

2. Lectures of Department on the theme “Stromal vascular dystrophies".

3. Graph of the logical structure of theme (application of №1).

4. Algorithm of the macroscopic description of preparations (application of №3 of the previous

theme).

Additional literature:

1. Serov V.V., Yarygin A.D., Paukov V.S. // Pathologic Anatomy Atlas. - G. Medicine. - 1986.-

pg. 27-42.

2. Shlopov V.G. // The Basic of Pathologic Anatomy of Man. - Kiev, 1999. - pg. 51-62.


You will carry out the following purposeful tasks.


Task No 1.

The dissection of a young woman’s mitral valve shows that the valve is insignificantly thickened on the edge. Microscopically, in the valve the bundle of fibers and cells are moved apart, the masses between them stained bluish with hematoxylin-eosin staining and also showed metachromasia with toluidine-blue staining. What type of changes does this refer to?

1. Amyloidosis

2. Hyalinosis

3. Mucoid swelling

4. Fibrinoid swelling

5. Sclerosis (Fibrosis)


Task No 2.

During the study of the internal organs of a fetus, which died as a result of entanglement by umbilical cord in the neck and development of asphyxia, it was discovered, that the wall of the majority of arterioles is homogeneous, eosinophilic, PAS positive and impregnated with complex chemical substance. Metachromasia with toluidine-blue staining was absent. Which type of dystrophy enumerated below does refer to this?

1. Fibrinoid swelling

2. Mucoid swelling

3. Hyalinosis

4. Hyline - drop dystrophy

5. Amyloidosis


Task No 3.

A young woman was ill with infectious allergic vasculitis for several months. She died of the hemorrhage in the brain. The walls of arteries were unevenly thickened with homogeneous, eosinophilic, PAS positive sections. Positive reaction to the fibrin. There was no metachromasia with toluidine-blue staining. Which type of dystrophy does this microscopic picture refer to?

1. Mucoid swelling

2. Fibrinoid swelling

3. Sclerosis (Fibrosis)

4. Hyalinosis

5. Amyloidosis


Task No 4.

During a dissection on a middle age man, who was ill for 15 years with osteomyelitis of right tibia, it was discovered splenomegally (sharply enlarged spleen). The tissue of spleen was dense, brown-reddish in colour and with waxy appearance. Semitransparent granules are located diffusely in the pulp, and under microscopic examination there are follicles, substituted by homogeneous, eosinophilic masses. Congo-red staining on the tissue of the spleen shows pink colour, and brick red masses. Which type of dystrophy does this refer to?

1. Mucoid swelling

2. Fibrinoid swelling

3. Sclerosis (Fibrosis)

4. Hyalinosis

5. Amyloidosis


Task No 5.

During a microscopic examination of atherosclerotic plaque, the student focused on the fact that not all sections of plaque were stained pink colour. The student drew his attention on the section, in which among the collagen fibres there was a set of optically empty vacuoles. Then it was stained with Sudan 3 and saw, that this section turned into orange colour. What process does this refer to?

1. Amyloidosis

2. Parenchymal fatty dystrophy

3. Hyalinosis

4. Lipidosis

5. Vacuole (hydropic) dystrophy


Task No 6.

During a microscopic examination of the vessels of right lower extremity, which was amputated in connection with the development of diabetic gangrene, pathologist noted that the walls of arterioles are sharply thickened and their opening was narrowed. There was deposition of homogeneous, pink colour masses in the wall of arterioles. Histochemical study in the composition of these masses along with other components, revealed the presences of beta-lipoproteid. Additional histochemical staining with iodine Grun, these masses are stained green colour. Staining with toluidine-blue does not revealed metachromasia. What substance was present in the wall of the vessels?

1. Amyloid

2. Glycoaminoglycans

3. Simple Hyline

4. Lipohyline

5. Fibrin


Task No 7.

During the analysis of a remote tumour of soft tissues of the thigh, anatomical pathologist diagnosed it as fibrosarcoma. In the stroma of tumour, it was intensively pink with non structured masses. Congo-red staining revealed negative result. What process did develop in the tumour?

1. Local hyalinosis

2. Amyloidosis

3. Fibrinoid necrosis

4. Sclerosis

5. Mucoid swelling

Task No 8.

A middle aged man was ill with chronic fibrous-cavernous pulmonary tuberculosis. He died suddenly as a result of pulmonary hemorrhage from the tubercular cavity. At the autopsy, kidneys are increased in the sizes, dense, pale, with the waxy like appearance. Histological study revealed that, the majority of balls are increased in volume, the quantity of cells in them is reduced, in the walls of the efferent and afferent arterioles, in the capillary loops and mesengium of glomerulus, in the basal laminae of ducts and in the stroma, there was deposition of the Stylishness- positive, homogeneous, pink masses, which stained red colour with Congo-red staining. What form of dystrophy did take place in the kidneys?

1. Lipidosis;

2. Amyloidosis

3. Lipohyalinosis

4. Hyaline drop dystrophy

5. Fibrinoid swelling.


Task No 9.

During microscopic examination of atherosclerotic plaque, the anatomical pathologist focused on the fact that not all fibrous sections of platelet they were stained pink colour. Attention was drawn on the section which was basophilically stained, in which collagen fibres were thickened, that swelled, friable located. Anatomical pathologist knew that for determining this form of stromal vascular dystrophy it is necessary to obtain the histochemical staining, based on the phenomenon of metachromasia. What staining did the anatomical pathologist select?

1. Sudan III

2. Congo-red

3. Toluidine-blue;

4. Osmium acid

5. Metilviolet


Task No 10.

During a dissection of woman with the diagnosis of stomach cancer, there was cachexia (sharp exhaustion) whereby thinning of subcutaneous fat cellulose tissue was noted, which intermuscular fibrous connective tissue and stroma of organs were substituted by mucoid mass, that contains a large quantity of glycoproteins. What do these changes refer to?

1. Mucoidn swelling

2. Lipidosis

3. Lipohyalinosis

4. Carbohydrate dystrophy

5. Fibrinoid swelling.


The methodical instructions for students practical work on the theme of Stromal vascular dystrophies


At the beginning of the lesson, you will be assessed on your understanding of the home tasks. Then test control will be given to check preparation of your home task. Independently, you must study macro-preparations of “Glazy Spleen”, “amyloidosis of kidney”, and micro-preparations of “hyalinosis of the vessels of spleen”, “amyloidosis of kidney” with hematoxylin-eosine and Congo-red staining, “Simple Heart Obesity”. Use the algorithm of morphological diagnostics of stromal vascular dystrophies (Appendix 2). Study the microphotograph and solve the situation tasks.

The lesson completes the analysis of the sum of the independent work of each student by assessing the description of micro-preparations and knowledge in mastering the test.


^ The flow chart of the Lesson

in sequence

Stages

Time

in min.

The teaching aids of the means of the instruction

Equipment

Place of the conducting the lesson

1.

Checking and correction of the initial level

5

Test tasks




Training room

2.

Independent work. Description of the macro- and of the micro-preparations

60

Chart of logical structure (Appendix № 1), the algorithm of the study of macro-preparations and micro-preparations

Microscope, macro- and micro-preparations, the micro photogram




3.

Self-assessment and the correction of mastering the material

30

Purposeful training tasks







4.

Total test control

15

Collector of the tests







5.

Conclusion of the results of the lesson

10












Appendix №1


Stromal Vascular Dystrophies






Proteinous Dystrophies





Mucoid and Fibrinoid Swelling



Etiology

Pathogenesis

Morphological changes





Localization

Microscopic changes








General Hyalinosis



Etiology

Pathogenesis

Morphological changes

Outcome

Significance





Localization

Local Hyalinosis




Etiology



Outcome


Amyloidosis



Morphological changes







Primary

Secondary



Morphological changes







Localization

Microscopic changes










Appendix №1

(Continuation)



Fatty Dystrophy





Disturbance in neutral fat metabolism - Obesity





Etiology

Localization

Outcome

Significance



Fat depots

Reversible


Disturbance in cholesterol






Localization



Elastic and elastic-muscular type arteries

Appendix №2


Algorithm of morphological diagnostics of the stromal vascular dystrophies


Localization



Connective Tissues

Stroma of organ

Wall of vessels

Fat Depots


Macroscopic changes are not revealed

Macroscopically it reveals only in the capsule of organs as a transparent bright glassy substance, which resembles the transparent cartilage

Organs are enlarged, dense, in the section they have the waxy appearance (sago, waxy spleen, the kidneys)

Excessive deposit of fat in the fatty depot (subcutaneous fat cellulose, cellulose, which surrounds organs)








Microscopic: Basic substance is connective tissue, edematic, stains metachromasia, basophilic




The deposit of homogeneous non structural substance, which is stains eosinophilic – pink colour, metachromasia with Gentin Violet, Congo-red, Iodine-Grun




Microscopic: collagen fibers swollen with the illegible outlines, stained as fіbrin, eosinophilic



Microscopic: deposition of homogenous non structural substances, stained pink colour with кислими красителями








Mucoid swelling

Fibrinoid swelling

Hyalinosis

General Amyloidosis

Fatty Dystrophy - Obesity

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