Pathology
Department of Pathology
Long jie
1,What is Pathology:
1) Scientific study of disease
Causes (etiology)
mechanisms (pathogenesis)
2) manifestation
progress
sequels
Investigation
of
morphology
2,Status of Pathology,a bridge
? Anatomy
? Histology and
embryology
? Physiology
? Biochemistry
? Cytology
? microbiology
pathology Clinical medicine
3,Contents of pathology
pathology
General pathology Systemic pathology
Cell,tissue damage
repair
Disorders of
vascular flow
Inflammation
Neoplasm……
Cardiovascular
system
Respiratory system
Digestive system……
4,Methods in pathology
1) Autopsy
2) Biopsy
3) Cytology
4) Electron-microscopy
5) tissue and cell cultivation
6) Animal experiment
7) molecular biology
5,morphological observations:
1) Gross level
2) Light microscopy
Chapter 1
Cell injury and
adaptation
Introduction
? Cells maintain normal homeostasis
Physiologic
stresses
Pathologic
stimuli
cells
adaptation Atrophy hypertrophyhyperplasia metaplasia
injury
Degeneration (reversible)
Cell death (irreversible)
Adaptation（适应）
1,Atrophy (萎缩）
2,Hypertrophy (肥大 )
3,Hyperplasia (增生 )
4,Metaplasia (化生 )
Atrophy (萎缩）
?Shrinkage in the size of the normal cell,
tissue and organ by the loss of cell
substance.
?Decrease in Cell size or number
Causes and types
1,Aging (生理性 ~)
2,Inadequate nutrition/ diminished blood
supply (营养不良性 ~)
3,Pressure (压迫性 ~)
4,Reduced functional activity (废用性 ~)
5,Interrupted nerve supply (去神经性 ~)
6,Endocrine deficiency (内分泌性 ~)
Pathologic changes
Grossly:
The entire tissue or organ diminishes in
size,weight and function.
Microscopically:
1,Organelles degradation
2,Increased autophagic vacuoles
3,Residual bodies(e.g.,lipofuscin)
results
? Recover
? Cell death
? Increase in the size of cells and
consequently an increase in the
size of the organ.
? increase in cell size
Hypertrophy （肥大）
Causes and types
? Physiologic hypertrophy (生理性～）
? Pathologic hypertrophy （病理性～）
Hypertrophy of myocardium
Pathologic changes
Grossly:
Enlarged organ
Microscopically:
1,Increased in the size and number of
Organelles
2,Bigger cells
Physiologic hypertrophy of the uterus during pregnancy
?Increase in the number of cells and
consequently an increase in the size of
the organ or tissue.
?Increase in cell number
Hyperplasia （增生）
Causes and types
? Physiologic hyperplasia (生理性～）
? Pathologic hyperplasia （病理性～）
? Most forms of pathologic hyperplasia are
instances of excessive hormonal or growth
factor stimulation.
Pathologic changes
? Microscopically:
Increased cell mitosis
? Grossly:
Enlarged organ
results
? Recover
? Cancerous proliferation
? A reversible change in which one adult
cell type( epithelial or mesenchymal) is
replaced by another adult cell type.
? Change in cell type
Metaplasia （化生）
Causes and types
? Squamous metaplasia
? Intestinal epithelial ~
? Bone or cartilage ~
Pathologic changes
? Microscopically:
1.cell type change
2,Epithelium __ Epithelium ;
mesenchymal__ mesenchymal
3,Adult cells
results
? Recover
? Induce cancer transformation
? causes
? mechanisms
? morphology
Cell injury（损伤）
Causes
? Oxygen deprivation
? Chemical agents
? Infectious agents
? Immunologic reactions
? Genetic defects
? Nutritional imbalances
? Physical agents
? aging
Mechanisms (self-study)
? Defects in plasma membrane
? Hypoxia or generation of reactive
oxygen species
? Loss of calcium homeostasis
? Chemical injury
? Genetic variation
morphology
?Degeneration ( reversible )
?Cell death ( irreversible )
degeneration（变性）
The injuried cell accumulate abnormal
amounts of various substance in the cell
or mesenchyma, Degeneration is always
accompanied by diminishing in function.
types
1,Cellular swelling (细胞水肿）
2,Fatty change (脂肪变性 )
3,Hyaline change (玻璃样变 )
4,Amyloidosis (淀粉样变 )
5,Mucoid degeneration (黏液样变 )
6,Pathologic pigmentation (病理性色素沉着 )
7,Pathologic calcification (病理性钙化 )
Cellular swelling
Hydropic change (水变性 )
Vacuolar degeneration (空泡变性 )
morphology
? Microscopically:
1,swollen cells balloon degeneration
2,Small clear vacuoles in the cytoplasm
3,Coarse granules in the cytoplasm( swollen
organells),
? Grossly:
entire organ, pallor,turgor,increased weight.
Cellular swelling of liver
胞浆疏松化
气球样变性
Fatty change
Fatty degeneration (脂肪变性 )
Refer to any abnormal accumulation of triglycerides
within parenchymal cells.
? Fatty change may caused by toxins,
protein malnutrition,diabetes mellitus,
obesity and anoxia.
? Alcohol abuse
morphology
? Microscopically:
Clear lipid vacuoles / small droplets in the
cytoplasm of parenchymal cells.
? Grossly:
liver ----- enlarge,become yellow,soft and
greasy.
heart ----- tigered effect 虎斑心
Fatty change of liver
Hyaline change
Hyaline degeneration (透明变性 )
morphology
? Microscopically:
1,Homogeneous,pink,refractile(折光）,
hyaline protein accumulation
2,Occure in the cytoplasm,connective tissue,
and walls of arteriole,the mechanisms are different.
amyloidosis
Amyloid deposition
Amyloid degeneration
morphology
? Microscopically:
1,Homogeneous,pink,protein-
glycosaminoglycan accumulation;
2,Occur in the extracellular tissue,
basement membrane of blood vessels.
E.M.:
closely packed interlacing fibrils
Pathological
pigmentation
Colored substances that are either
exogenous or endogenous
accumulate in /out the cell.
types
1,Hemosiderin (含铁血黄素）
2,lipofuscin (脂褐素 )
3,melanin (黑色素 )
……
hemosiderin
? hemoglobin-derived
? granular pigment
? golden-yellow to brown
? Accumulates in tissues when there is
local or systemic excess of iron.
lipofuscin
? wear-and-tear pigment
? insoluble,brownish-yellow,granular
? Accumulates in variety of tissues
(heart,liver and brain) as a function of
age or atrophy.
melanin
? Endogenous,brown-black pigment
? formed by melanocyte
? occur when the enzyme tyrosinase
catalyzes the oxidation of tyrosine to
dihydroxyphenylalanine
Pathological
calcification
The abnormal deposition of
calcium salts in a wide variety of
tissues except bone and teeth.
types
1,Dystrophic calcification
(营养不良性钙化）
2,Metastatic calcification
(转移性钙化 )
morph olo gymorph olo gy
? Microscop ica ll y,
Intr ace ll u lar and /or ext racellula r
baso ph il ic depo s it s,
? G rossl y,
w hite granules or clum ps,f elt as grit ty
dep osits,
Cell death（细胞死亡）
when the nuclear is severly injuried,the
cell show irreversible changes
including cell cessation of metabolic
versatility,damage of structure and
loss of function.
types
1,necrosis (坏死 )
2,apoptosis (凋亡 )
necrosis
A sequence of morphologic changes
that follow partial cells death in
living tissue.
microscopically:
? Increased eosinophilia,more glassy
homogeneous
? Cytoplasm becomes vacuolated and
appears moth-eaten
?Nuclear changes:
pyknosis （ 核固缩 ）
karyorrhexis（ 核碎裂 ）
karyolysis (核溶解 ）
types
Caseous necrosis
(干酪样坏死 )
gangrene
(坏疽 )
Dry~(干性坏疽 )
Moist ~(湿性坏疽 )
Gas ~(气性坏疽 )
Coagulative ~
(凝固性坏死）
Liquefactive ~
(液化性坏死 )
Fibrinoid ~
(纤维素样坏死 )
Coagulative
necrosis
Preservation of the basic structural outline
of the cell or tissue by denaturation of
proteins in the dead cell.
grossly:
The necrosis area become swollen,
firm,dull,and lustreless,yellowish.
坏
死
区
microscopically:
? Nuclei change
? Cytoplasm is granular,take up more
eosin than normal
? Outline of necrosis cells can be
recognised
Caseous necrosis
? tuberculous infection;
? Cheesy,white gross appearance;
? Microscopially,structureless,
amorphous granular debris; the tissue
architecture is completely obliterated.
gangrene
? Necrotic lesion + infected by
organisms which cause putrefaction;
? grossly,brown,green or black
discolouration of the tissue;
Dry gangrene:
? skin surface
? Following arterial obstruction
? Liable to affect the limbs (e.g,toes脚趾）
? dry
? Mild infection
? Clear borderline
moist gangrene:
? Splanchnic organs
? Venous congestion + arterial obstruction
? Liable to affect bowel,gall bladder,
uterus,lung e.t,
? moist
? severe infection
? unclear borderline
gas gangrene:
? Deep,open wound
? Infected with clostridial organisms.
? gas
? Alveolate tissue
? toxicosis
liquefactive
necrosis
The enzymes decompose the necrosis
tissue into fluid.
grossly:
The necrosis area become sofen,and
turns into turbid fluid.
(brain,spinal cord)
microscopically:
? Profound loss of the previous
histological architecture.
Types (self-study):
? Fat necrosis (脂肪坏死 )
? Purulence (化脓 )
? Lytic necrosis (溶解性坏死 )
Fibrinoid
necrosis
Commen feature of collagen or
connective tissue diseases and
accelerated hypertention.
microscopically:
? The necrosis tissue is filamentous or
granule,brightly eosinophilic fibrinoid
substance,
? Collagen
? Immunoglobulin
? fibrin
Sequels of necrosis
? Autolyze (自溶 )
? Dissolved and absorbed (溶解吸收 )
? Expelled (分离排出 )
? Organization (机化 )
? Encapisulation (包裹 )
? Undergo dystrophic calcification (钙化 )
? Erosion (糜烂 )
? Ulcer (溃疡 )
? Sinus (窦道 )
? Fistula (瘘管 )
? Cavity (空腔 )
Terms:
apoptosis
? Programmed cell death
? dying cell,Shrink and compact
? Affect single cell
? form apoptotic bodies
? no inflammatory reaction
凋亡小体
Department of Pathology
Long jie
1,What is Pathology:
1) Scientific study of disease
Causes (etiology)
mechanisms (pathogenesis)
2) manifestation
progress
sequels
Investigation
of
morphology
2,Status of Pathology,a bridge
? Anatomy
? Histology and
embryology
? Physiology
? Biochemistry
? Cytology
? microbiology
pathology Clinical medicine
3,Contents of pathology
pathology
General pathology Systemic pathology
Cell,tissue damage
repair
Disorders of
vascular flow
Inflammation
Neoplasm……
Cardiovascular
system
Respiratory system
Digestive system……
4,Methods in pathology
1) Autopsy
2) Biopsy
3) Cytology
4) Electron-microscopy
5) tissue and cell cultivation
6) Animal experiment
7) molecular biology
5,morphological observations:
1) Gross level
2) Light microscopy
Chapter 1
Cell injury and
adaptation
Introduction
? Cells maintain normal homeostasis
Physiologic
stresses
Pathologic
stimuli
cells
adaptation Atrophy hypertrophyhyperplasia metaplasia
injury
Degeneration (reversible)
Cell death (irreversible)
Adaptation（适应）
1,Atrophy (萎缩）
2,Hypertrophy (肥大 )
3,Hyperplasia (增生 )
4,Metaplasia (化生 )
Atrophy (萎缩）
?Shrinkage in the size of the normal cell,
tissue and organ by the loss of cell
substance.
?Decrease in Cell size or number
Causes and types
1,Aging (生理性 ~)
2,Inadequate nutrition/ diminished blood
supply (营养不良性 ~)
3,Pressure (压迫性 ~)
4,Reduced functional activity (废用性 ~)
5,Interrupted nerve supply (去神经性 ~)
6,Endocrine deficiency (内分泌性 ~)
Pathologic changes
Grossly:
The entire tissue or organ diminishes in
size,weight and function.
Microscopically:
1,Organelles degradation
2,Increased autophagic vacuoles
3,Residual bodies(e.g.,lipofuscin)
results
? Recover
? Cell death
? Increase in the size of cells and
consequently an increase in the
size of the organ.
? increase in cell size
Hypertrophy （肥大）
Causes and types
? Physiologic hypertrophy (生理性～）
? Pathologic hypertrophy （病理性～）
Hypertrophy of myocardium
Pathologic changes
Grossly:
Enlarged organ
Microscopically:
1,Increased in the size and number of
Organelles
2,Bigger cells
Physiologic hypertrophy of the uterus during pregnancy
?Increase in the number of cells and
consequently an increase in the size of
the organ or tissue.
?Increase in cell number
Hyperplasia （增生）
Causes and types
? Physiologic hyperplasia (生理性～）
? Pathologic hyperplasia （病理性～）
? Most forms of pathologic hyperplasia are
instances of excessive hormonal or growth
factor stimulation.
Pathologic changes
? Microscopically:
Increased cell mitosis
? Grossly:
Enlarged organ
results
? Recover
? Cancerous proliferation
? A reversible change in which one adult
cell type( epithelial or mesenchymal) is
replaced by another adult cell type.
? Change in cell type
Metaplasia （化生）
Causes and types
? Squamous metaplasia
? Intestinal epithelial ~
? Bone or cartilage ~
Pathologic changes
? Microscopically:
1.cell type change
2,Epithelium __ Epithelium ;
mesenchymal__ mesenchymal
3,Adult cells
results
? Recover
? Induce cancer transformation
? causes
? mechanisms
? morphology
Cell injury（损伤）
Causes
? Oxygen deprivation
? Chemical agents
? Infectious agents
? Immunologic reactions
? Genetic defects
? Nutritional imbalances
? Physical agents
? aging
Mechanisms (self-study)
? Defects in plasma membrane
? Hypoxia or generation of reactive
oxygen species
? Loss of calcium homeostasis
? Chemical injury
? Genetic variation
morphology
?Degeneration ( reversible )
?Cell death ( irreversible )
degeneration（变性）
The injuried cell accumulate abnormal
amounts of various substance in the cell
or mesenchyma, Degeneration is always
accompanied by diminishing in function.
types
1,Cellular swelling (细胞水肿）
2,Fatty change (脂肪变性 )
3,Hyaline change (玻璃样变 )
4,Amyloidosis (淀粉样变 )
5,Mucoid degeneration (黏液样变 )
6,Pathologic pigmentation (病理性色素沉着 )
7,Pathologic calcification (病理性钙化 )
Cellular swelling
Hydropic change (水变性 )
Vacuolar degeneration (空泡变性 )
morphology
? Microscopically:
1,swollen cells balloon degeneration
2,Small clear vacuoles in the cytoplasm
3,Coarse granules in the cytoplasm( swollen
organells),
? Grossly:
entire organ, pallor,turgor,increased weight.
Cellular swelling of liver
胞浆疏松化
气球样变性
Fatty change
Fatty degeneration (脂肪变性 )
Refer to any abnormal accumulation of triglycerides
within parenchymal cells.
? Fatty change may caused by toxins,
protein malnutrition,diabetes mellitus,
obesity and anoxia.
? Alcohol abuse
morphology
? Microscopically:
Clear lipid vacuoles / small droplets in the
cytoplasm of parenchymal cells.
? Grossly:
liver ----- enlarge,become yellow,soft and
greasy.
heart ----- tigered effect 虎斑心
Fatty change of liver
Hyaline change
Hyaline degeneration (透明变性 )
morphology
? Microscopically:
1,Homogeneous,pink,refractile(折光）,
hyaline protein accumulation
2,Occure in the cytoplasm,connective tissue,
and walls of arteriole,the mechanisms are different.
amyloidosis
Amyloid deposition
Amyloid degeneration
morphology
? Microscopically:
1,Homogeneous,pink,protein-
glycosaminoglycan accumulation;
2,Occur in the extracellular tissue,
basement membrane of blood vessels.
E.M.:
closely packed interlacing fibrils
Pathological
pigmentation
Colored substances that are either
exogenous or endogenous
accumulate in /out the cell.
types
1,Hemosiderin (含铁血黄素）
2,lipofuscin (脂褐素 )
3,melanin (黑色素 )
……
hemosiderin
? hemoglobin-derived
? granular pigment
? golden-yellow to brown
? Accumulates in tissues when there is
local or systemic excess of iron.
lipofuscin
? wear-and-tear pigment
? insoluble,brownish-yellow,granular
? Accumulates in variety of tissues
(heart,liver and brain) as a function of
age or atrophy.
melanin
? Endogenous,brown-black pigment
? formed by melanocyte
? occur when the enzyme tyrosinase
catalyzes the oxidation of tyrosine to
dihydroxyphenylalanine
Pathological
calcification
The abnormal deposition of
calcium salts in a wide variety of
tissues except bone and teeth.
types
1,Dystrophic calcification
(营养不良性钙化）
2,Metastatic calcification
(转移性钙化 )
morph olo gymorph olo gy
? Microscop ica ll y,
Intr ace ll u lar and /or ext racellula r
baso ph il ic depo s it s,
? G rossl y,
w hite granules or clum ps,f elt as grit ty
dep osits,
Cell death（细胞死亡）
when the nuclear is severly injuried,the
cell show irreversible changes
including cell cessation of metabolic
versatility,damage of structure and
loss of function.
types
1,necrosis (坏死 )
2,apoptosis (凋亡 )
necrosis
A sequence of morphologic changes
that follow partial cells death in
living tissue.
microscopically:
? Increased eosinophilia,more glassy
homogeneous
? Cytoplasm becomes vacuolated and
appears moth-eaten
?Nuclear changes:
pyknosis （ 核固缩 ）
karyorrhexis（ 核碎裂 ）
karyolysis (核溶解 ）
types
Caseous necrosis
(干酪样坏死 )
gangrene
(坏疽 )
Dry~(干性坏疽 )
Moist ~(湿性坏疽 )
Gas ~(气性坏疽 )
Coagulative ~
(凝固性坏死）
Liquefactive ~
(液化性坏死 )
Fibrinoid ~
(纤维素样坏死 )
Coagulative
necrosis
Preservation of the basic structural outline
of the cell or tissue by denaturation of
proteins in the dead cell.
grossly:
The necrosis area become swollen,
firm,dull,and lustreless,yellowish.
坏
死
区
microscopically:
? Nuclei change
? Cytoplasm is granular,take up more
eosin than normal
? Outline of necrosis cells can be
recognised
Caseous necrosis
? tuberculous infection;
? Cheesy,white gross appearance;
? Microscopially,structureless,
amorphous granular debris; the tissue
architecture is completely obliterated.
gangrene
? Necrotic lesion + infected by
organisms which cause putrefaction;
? grossly,brown,green or black
discolouration of the tissue;
Dry gangrene:
? skin surface
? Following arterial obstruction
? Liable to affect the limbs (e.g,toes脚趾）
? dry
? Mild infection
? Clear borderline
moist gangrene:
? Splanchnic organs
? Venous congestion + arterial obstruction
? Liable to affect bowel,gall bladder,
uterus,lung e.t,
? moist
? severe infection
? unclear borderline
gas gangrene:
? Deep,open wound
? Infected with clostridial organisms.
? gas
? Alveolate tissue
? toxicosis
liquefactive
necrosis
The enzymes decompose the necrosis
tissue into fluid.
grossly:
The necrosis area become sofen,and
turns into turbid fluid.
(brain,spinal cord)
microscopically:
? Profound loss of the previous
histological architecture.
Types (self-study):
? Fat necrosis (脂肪坏死 )
? Purulence (化脓 )
? Lytic necrosis (溶解性坏死 )
Fibrinoid
necrosis
Commen feature of collagen or
connective tissue diseases and
accelerated hypertention.
microscopically:
? The necrosis tissue is filamentous or
granule,brightly eosinophilic fibrinoid
substance,
? Collagen
? Immunoglobulin
? fibrin
Sequels of necrosis
? Autolyze (自溶 )
? Dissolved and absorbed (溶解吸收 )
? Expelled (分离排出 )
? Organization (机化 )
? Encapisulation (包裹 )
? Undergo dystrophic calcification (钙化 )
? Erosion (糜烂 )
? Ulcer (溃疡 )
? Sinus (窦道 )
? Fistula (瘘管 )
? Cavity (空腔 )
Terms:
apoptosis
? Programmed cell death
? dying cell,Shrink and compact
? Affect single cell
? form apoptotic bodies
? no inflammatory reaction
凋亡小体
