Practical class 3 Metabolic disease. Morphology of pathologic accumulation of endogenous and exogenous pigments. Morphology of mineral metabolism disease icon

Practical class 3 Metabolic disease. Morphology of pathologic accumulation of endogenous and exogenous pigments. Morphology of mineral metabolism disease




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Learn and describe orally macropreparations


1) Brown induration of the lungs. It is an example of local haemosiderosis. Haemosiderosis is always an evidence of haemoglobin destruction. In that case haemosiderin forms in alveolar and tissue macrophages of the stroma. Insufficiency of the lymphatic system of the lung stipulates accumulation of this pigment in stroma, that gives rusty tinge to the lung. Lymphostasis, presence of unnecessary protein, hypoxia stipulates activation of fibroblasts and development of pneumosclerosis. Accordingly to that organ becomes dense (induration). Lung is enlarged, densed, brown colour with numerous rusty disseminations owing to accumulation of haemosiderin. In venous plethora, conditioned by that that right ventricle of heart force blood to the basin of pulmonary artery (small circle of bloodcirculation) and left ventricle is not able to pump blood from lungs into aorta. Owing to defect of valves or affection of myocardium, blood congests in small circle of blood circulation. Vessels widen, permeability of their walls increase so, that not only fluid part of blood exudates into alveoli (oedema of lungs), but also erythrocytes the last are exogenous that’s why they are absorbed by macrophages in which haemoglobin turns into brown colour haemosiderin. Intensity of colouring depends on duration of venous plethora of lungs.

2) ^ Haemorrhage in brain. On the surface of the brain cut there is an area of tissue softening with blood infiltration, brown colour. Brown colouring is conditioned by accumulation of haemosiderin and haematoidin.

3) Hydrochloric acid haematin on the bottom of ulcer of stomach wall. There is deep defect of mucous, submucous and muscular layers of the stomach wall. Mucosa is hypertrophied, folds are protuberant around the ulcer. There is an ulcerated vessel and deposition of dark-brown colour pigment-hydrochloric acid haematin on the bottom of ulcer.

4) ^ Billiar cirrhosis of liver. Liver is dense with small-granulated surface. On cut parenchyma is greenish-brown colour with connective tissue net, which is well discerned. Bile ducts are widened, filled with stones. What is the mechanism of stones formation? Name morphogenesis of icterus

5) ^ Brown atrophy of heart. Heart is diminished in size, deposition of fat under epicardium is diminished, fat tinctures in brown colour. Such colour is conditioned by deposition of lipofuscin.

6) Gallstones. Gallbladder is enlarged, filled with stones of different sizes

7) ^ Stone of the kidney pelvis and hydronephrosis. Big stone with branches, which form reminds mould of the pelvis, is situated in kidney pelvis. Atrophy of kidney parenchyma is marked

8) Liming of heart valves. Deformed, sclerotic heart valves with grey colour deposition of lime salts are seen in the preparation.


^ Study micropreparations from a theme and be able to draw the essence of pathological process with proper designations

1) Liver at the mechanical icterus. Preparation is stained with hematoxilin-eosin. In bile capillaries and ducts there are yellow colour concrements. Bile capillaries are widened, hepatocytes are in condition of fatty dystrophy. Around the portal canal growing of connection tissue is marked. Determine type of icterus. Designate: 1- Bile fields in clearance of vessels; 2- Fatty dystrophy of hepatocytes; 3- Connective tissue growing.

^ 2)Brown induration of lung. Preparation is stained with hematoxilin-eosin and also according to Perls. Haemosiderin deposits in interalveolar septa, alveoli. Organ’s stroma is sclerotic. By what brown colouring and density of the organis conditioned? What is the origin of blue inclusions in staining of preparations according to Perls? Designate: 1- haemosiderin, 2 -sclerosis of interalveolar septa.

^ 3) Haemosiderosis of liver. Preparation is stained according to Perls. By what hystochemical method is ferrum indicated in tissues? Indicate character of its deposition. In what pathology are such changes in liver possible? Designate: 1 - hepatocytes, 2 - haemosiderin, 3 - widen vessels.

^ 4)Liming in fibromyoma. Preparation is stained with hematoxin-eosin. In fibromathous nodes deposition of calcium salts which are stained in dark-blue colour are seen. Designate: 1-calcium salt, 2- muscle fiber.

5) Melanoma of skin. Preparation is stained with hematoxilin – eosin. In areas of growing of atypical epithelial cells deposition of dark-brown pigment melanin is marked. To what pathology do such pathological changes in skin belong?

Designate: 1-atypical melanocyte, 2-deposition of melanin.


^ Situation tasks

1 At blood transfusion the patient has got low back pain and an arterial pressure decrease. Explain the mechanism of mentioned symptoms.

2 Calculous cholecystitic patient has got jaundice, low back pain, protein in urine. Define possible stone localization. What is the mechanism of jaundice and what changes are observed in kidneys?

3 Nidus of cerebral hemorrhage was discovered at the autopsy. The question has been raised concerning time of its appearance. How are you going to accomplish this task?

4 Skin hyper pigmentation, hypotonia, hypodynamia, hypoglucosemia are detected at consumptive patient. Define the mechanism of presentation of mentioned symptoms and give the name of the disease.


^ Answers to situational tasks

1 Low back pain is explained by development of hemoglobinuric nephrosis. The mechanism of presentation of mentioned symptoms is as follows: hemolysis of erythrocytes (its cause is unknown) has appeared at blood transfusion, the accumulation of unconjugated hemoglobin has caused toxic affection of kidney. An arterial pressure decrease could be explained by appearance of significant quantity of active reduced ferritin which is an adrenalin antagonist.

2 The stone has obstructed a biliary tract. The obstructive jaundice appeared. Bilirubin concentration in blood increased and its extraction from kidneys started. As a result toxic affection of kidney parenchyma was developed, that’s why low back pain and protein in urine appeared.

3 Time of appearance of cerebral hemorrhage should be defined according to coloring of hemorrhage nidus. At hemorrhage area the hemolysis of erythrocytes occurs and hemoglobinuric pigments (ferritin, hemosiderin, bilirubin, hematoidin) are accumulated which provide corresponding coloring.

4 The affection of adrenal glands with necrotic changes of gland parenchyma is often observed at tuberculosis. As a result the synthesis of corresponding hormones, catecholamines, is distorted. That’s why intermediate products of their synthesis (tyrosine, tryptophan acid) are used for excess synthesis of melanin, it explains skin hyperpigmentation. The name of the disease is Addison’s disease.


^ Test tasks

1 Brown-black pigment was detected at the bottom of stomach ulcer during gastroscopy. What is the name of this pigment?

А. Bilirubin; B Ferritin; C. Porphyrin; D. Hemosiderin; E. Muriatic hematin.

2 The patient with stomach cancer vomited coffee-like mass. Which pigment provided such color of gastric contents?

А. Hemosiderin; B. Bilirubin; C. Ferritin; D. Muriatic hematin; E. Porphyrin.

3 Deformation of aortal valve, its ulceration, petrified induration are discovered at necropsy of the 38 years old patient who died of acute cardiac insufficiency, there is a crunch defined at incision. Which pathologic process determined petrified induration of valves?

А. Hyalinosis; B. Amyloidosis; C. Metabolic calcification; D. Metastatic calcification; E. Dystrophic calcification.

4 The patient who has been ailing for a long time from rheumatism with development of mitral valvular disease got cough, rusty sputum. Which pigment provided such colour of sputum?

А. Мelanin; B. Hemoglobin; C. Hemosiderin; D. Malarial pigment; E. ferrous sulfate.

5 Induration and calcium salts deposits are developed at area of incarnation after tuberculosis inflammation. What is the name of this process?

^ А. Calcification metastases; B. Dystrophic calcification; C. Morphology of hypercalcemia; D. Metabolic calcification; E. Restricted calcinosis.

6 The patient is complaining of pain in articulations of toes. The patient likes beer. There is a suspicion of podagra. Increase of which substance in his blood should be discovered in order to confirm diagnosis?

А. Bilirubin; B. Urea; C. Uric acid; D. Ketone bodies;

E. Lactate.

7 As it is known from anamnesis the patient has tuberculosis of adrenal glands. An arterial pressure decrease, adynamy, decrease of 17-oxycorticosteroids in urine and plasma are defined. Skin has brown coloring. Metabolic disorder of which pigment does the patient have?

А. Lipochrome; B. Bilirubin; C. Lipofuscin; D. Мelanin; E. Hemosiderin.


Answers to test tasks

1. E; 2. D; 3. E; 4. C; 5. B; 6. C; 7. D.


Illustrations to theme.


Figure 1 – Cerebral hemorrhage. On cerebellum slice surface hemorrhage region is observed. Brown coloration is absent on periphery. Say if it is fresh or old hemorrhage.





Figure 2 – ^ Muriatic hematin on the bottom is stomach wall ulcer. There are deep defects of mucus tunic in stomach wall. On ulcers bottom there are dark brown pigment – muriatic hematin deposits.


Figure 3 – ^ Biliary cirrhosis. Liver is of green-brown color on section. Bile ducts are dilated, filled with stones. What is the mechanism of stones formation? Name jaundice morphogenesis


Figure 4 – ^ Brown atrophy of heart. Heart size is decreased, fat is diminished under epicardium,

Fat is colored in brown. This color is caused by lipofuscin deposit.


Figure 5 – Obstructive (mechanical) jaundice. Specimen is colored with hematoxylin and eosin There are concrements of yellow color in bile capillaries and bile ductules. Bile capillaries lumen is dilated, hepathocytes are in fatty degeneration condition. Conjunctive tissue excrescence is observed around portal tracts. Define jaundice type.


Figure 6 – Brown (pigment) induration of lungs. Specimen is colored with hematoxylin and eosin as well as by Pearls. Hemosiderin deposits in alveolar septums, alveoli. Organ stroma is sclerosed. What caused brown coloration of organ and its hardness? What is the origin of blue inclusions in case specimens are colored by Pearls?


Figure 7 – ^ Hepatic hemosiderosis. Specimen is colored by Pearls. What histochemical method is used to reveal iron in tissues? Define the character of its deposit. At what pathology named changes in liver are possible?


Figure 8 – ^ Petrificating (calcificating) myositis. Specimen is colored with hematoxylin and eosin Petrificated myositises are of blue color. Name existing types of pertification.
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