mixed degenerations

MIXED ACCUMULATIONS MIXED ACCUMULATIONS (DEGENERATIONS)(DEGENERATIONS)

Morphological changes Morphological changes (accumulations) occur inside and (accumulations) occur inside and

outside cellsoutside cells

The group includes:The group includes:

- chromoproteins metabolism - chromoproteins metabolism disturbances;disturbances;- lipoproteins metabolism - lipoproteins metabolism disturbances;disturbances;- nucleoproteins metabolism - nucleoproteins metabolism disturbances;disturbances;- mineral metabolism - mineral metabolism disturbances.disturbances.

Chromoproteins Chromoproteins metabolism disturbancesmetabolism disturbances

Chromoproteins – are colored Chromoproteins – are colored proteins (or pigments)proteins (or pigments)

They can be:They can be:

- hemoglobinogenic;- hemoglobinogenic; - lipidogenic; - lipidogenic;

- proteinogenic- proteinogenic

Hemoglobinogenic pigmentsHemoglobinogenic pigments

““normal”normal”

- Hemosiderin;Hemosiderin;- Ferritin;Ferritin;- BilirubinBilirubin

““abnormal abnormal

(pathologic”)(pathologic”)

- Porphirin;Porphirin;- Hematoidin;Hematoidin;- HematinsHematins

Hemosiderin – hemosiderosis Hemosiderin – hemosiderosis (result of increased synthesis of (result of increased synthesis of

hemosiderin with its hemosiderin with its accumulation in organs and accumulation in organs and

tissues)tissues)

Hemosiderosis can be:Hemosiderosis can be:

- hereditary (tesaurismosis);- hereditary (tesaurismosis);- acquired (local or general)- acquired (local or general)

Acquired generalAcquired generalWhy?Why? – intravascular erythrocytes – intravascular erythrocytes hemolysis.hemolysis.

When?When? – blood diseases; poisoning by – blood diseases; poisoning by hemolytic poisons (eg. snakes venom); hemolytic poisons (eg. snakes venom); severe infections (such as malaria); severe infections (such as malaria); incompatible blood transfusions.incompatible blood transfusions.

Where?Where? – liver; spleen; lymphatic nodes; – liver; spleen; lymphatic nodes; bone marrow.bone marrow.

Outward appearance?Outward appearance? – enlarged, – enlarged, brownbrown

Micro? – accumulation of brown Micro? – accumulation of brown color pigment which there is in color pigment which there is in

specific cells - sideroblastsspecific cells - sideroblasts

Sideroblast – large cell with large nucleus, thin cytoplasm Sideroblast – large cell with large nucleus, thin cytoplasm and lot of siderosomes, containing hemosiderin. and lot of siderosomes, containing hemosiderin.

Hemosiderin’s grains consist of ferritin moleculesHemosiderin’s grains consist of ferritin molecules

Acquired localAcquired local

Why?Why? – extravascular erythrocytes – extravascular erythrocytes hemolysis.hemolysis.

When?When? – hemorrhages, diapedesis of – hemorrhages, diapedesis of erythrocytes in venous congestion.erythrocytes in venous congestion.

Where?Where? – everywhere – everywhere

Classic exampleClassic example – lung – lung hemosiderosis in chronic venous hemosiderosis in chronic venous congestion (brown induration of lung) congestion (brown induration of lung)

Brown induration of lung (Perls stain – Brown induration of lung (Perls stain – for iron)for iron)

Bilirubin metabolism Bilirubin metabolism disturbancesdisturbances

its increased containment in its increased containment in blood, tissues – jaundiceblood, tissues – jaundice

ManifestationsManifestations::

- - hyperbilirubinaemiahyperbilirubinaemia;;- yellow color of skin, scleras, - yellow color of skin, scleras, visible mucous membranes;visible mucous membranes;

- - only in obstructive only in obstructive jaundicejaundice there is intoxication there is intoxication due to cholalaemia (bile in blood)due to cholalaemia (bile in blood)

Types of jaundicesTypes of jaundices

- - prehepatic (hemolytic) - intravascular erythrocytes prehepatic (hemolytic) - intravascular erythrocytes hemolysis;hemolysis;

- hepatic (parenchimatous) – injury of hepatocytes – - hepatic (parenchimatous) – injury of hepatocytes – hepatoses, hepatitides, liver cirrhoses;hepatoses, hepatitides, liver cirrhoses;

- posthepatic (obstructive) – blockade or difficulties - posthepatic (obstructive) – blockade or difficulties of bile outflow – cholelythiasis, tumors of pancreas of bile outflow – cholelythiasis, tumors of pancreas

or bile ducts, destructive diseases of bile ducts, or bile ducts, destructive diseases of bile ducts, congenital defects of their structure, malignant congenital defects of their structure, malignant tumour metastases into hepatic lymph nodes.tumour metastases into hepatic lymph nodes.

Liver in obstructive jaundice – enlarged, Liver in obstructive jaundice – enlarged, green-yellowgreen-yellow

Liver in obstructive jaundice – accumulation Liver in obstructive jaundice – accumulation of bilirubin into hepatocytes cytoplasmof bilirubin into hepatocytes cytoplasm

Porphyrin containment disturbances Porphyrin containment disturbances – porphyria– porphyriacongenital disease due to congenital disease due to insufficiency of enzymes in insufficiency of enzymes in hemoglobin metabolismhemoglobin metabolism

Very rareVery rareHypersensitivity to sunlight realizes Hypersensitivity to sunlight realizes as necrosis of skin and other as necrosis of skin and other membranes. “Moonlight child”membranes. “Moonlight child”

Hematoidin – form of Hematoidin – form of hemosiderin which is hemosiderin which is

synthesizing in hypoxia/synthesizing in hypoxia/Usually is observed in old Usually is observed in old

hemorrhageshemorrhages

Hematins – group of pathological Hematins – group of pathological hemoglobinogenic pigments hemoglobinogenic pigments

appearing in different specific appearing in different specific pathological situationspathological situations

Hemomelanin – malaria pigment.Hemomelanin – malaria pigment.Hydrochloric acid hematin – Hydrochloric acid hematin –

peptic ulcers.peptic ulcers.Formaldehyde pigment.Formaldehyde pigment.

Lipidogenic pigments:Lipidogenic pigments:

- lipofuscin;- lipofuscin;- ceroid;- ceroid;

- pigment of vitamin E - pigment of vitamin E insufficiencyinsufficiency;;

-- lipochromine lipochromine..

LipofuscinosisLipofuscinosis- primary (as rule hereditary)- primary (as rule hereditary)- secondary (cachexias, - secondary (cachexias, atrophies, some vitamins atrophies, some vitamins deficiency, chronic intoxications deficiency, chronic intoxications by hydrocarbons, over-by hydrocarbons, over-indulgence in analgetics indulgence in analgetics (especially methamysolum)(especially methamysolum)

Most perfect examples are brown Most perfect examples are brown atrophy of liver and myocardium atrophy of liver and myocardium (often in elderly persons): (often in elderly persons): the organs are decreased in sizes the organs are decreased in sizes and brown; and brown; at the histological examination – at the histological examination – yellowish or light-brown small yellowish or light-brown small grains of lipofuscin there in grains of lipofuscin there in cellular cytoplasm are observed.cellular cytoplasm are observed.

Proteinogenic pigments:Proteinogenic pigments:

- melanin;- melanin;- adrenochromine;- adrenochromine;

- pigments of APUD-system cells - pigments of APUD-system cells grains.grains.

Disturbance of melanin Disturbance of melanin containment - melanosiscontainment - melanosis

Melanosis can be:Melanosis can be:

- hypermelanosis and hypomelanosis;- hypermelanosis and hypomelanosis;- hereditary and acquired;- hereditary and acquired;- local and general.- local and general.

General acquired hypermelanosis General acquired hypermelanosis

General hereditary hypermelanosis General hereditary hypermelanosis

Addison's diseaseAddison's disease bilateral destruction of adrenal glands bilateral destruction of adrenal glands hypogonadismhypogonadismpellagrapellagrascurvyscurvycachexiacachexia

pigmentpigment xerodermiaxerodermia

Pigment xerodermiaPigment xerodermia

Local acquired hypermelanosis Local acquired hypermelanosis

melanosis of the large intestine in elderly people melanosis of the large intestine in elderly people suffering from chronic constipation;suffering from chronic constipation;

black acanthosis (skin areas with increased black acanthosis (skin areas with increased pigmentation) in hypophyseal adenoma, pigmentation) in hypophyseal adenoma, hyperthyroidism, diabetes mellitus.hyperthyroidism, diabetes mellitus.

Increased local formation of melanin is Increased local formation of melanin is observed in observed in nevusnevus, which may turn in , which may turn in malignant tumors – malignant tumors – melanomamelanoma..

Nevus (mole, birthmark)Nevus (mole, birthmark)

Melanoma Melanoma

HypomelanosisHypomelanosis

generalgeneral (albinism)(albinism)

locallocal (vitiligo)(vitiligo)

albinismalbinism

Nucleoproteins metabolism Nucleoproteins metabolism disturbancesdisturbances

- Urolithiasis;Urolithiasis;

- Uric acid infarction of - Uric acid infarction of kidneys in newborns;kidneys in newborns;

- Gout.- Gout.

Gout – chronic disease is Gout – chronic disease is characterized by sedimentation of characterized by sedimentation of

uric acid salts (urates) in organs and uric acid salts (urates) in organs and tissues and accompanied with tissues and accompanied with

hyperuricaemia and hyperuricuria.hyperuricaemia and hyperuricuria.

More often urates is accumulated in More often urates is accumulated in skin, joints, kidney, blood vessels.skin, joints, kidney, blood vessels.

Necrosis, chronic inflammation, Necrosis, chronic inflammation, sclerosis – results of urates sclerosis – results of urates sedimentations in a tissue.sedimentations in a tissue.Irreversible deformation of joint.Irreversible deformation of joint.Chronic renal failure (gout kidney Chronic renal failure (gout kidney – tubulopathia).– tubulopathia).

Mineral metabolism disturbancesMineral metabolism disturbances

ССalcium metabolism alcium metabolism disturbances disturbances

– – pathological calcificationpathological calcification – –

sedimentation of calcium salts into sedimentation of calcium salts into organs and tissuesorgans and tissues

Pathological calcification can be:Pathological calcification can be:

According to the locationAccording to the location:: intracellular, intracellular, extracellular and mixt.extracellular and mixt.

According to propagation: systemic and According to propagation: systemic and local.local.

According to the mechanism of its According to the mechanism of its development: metastatic, metabolic, development: metastatic, metabolic, degenerative.degenerative.

Metastatic calcificationMetastatic calcification (as rule general, (as rule general, widespraed) – always there is hypercalcaemia.widespraed) – always there is hypercalcaemia.

It is possible in:It is possible in:- thyroid gland adenomas;- thyroid gland adenomas;- parathyroid glands adenomas;- parathyroid glands adenomas;- massive destruction of calcium depot (bones);- massive destruction of calcium depot (bones);- increased vitamin D containment; - increased vitamin D containment; - kydneys diseases;- kydneys diseases;- gastriontestinal tract disease.- gastriontestinal tract disease.

Usually calcium salts in metastatic calcification Usually calcium salts in metastatic calcification deposit in GIT mucosa, lungs, skin, blood vessels, deposit in GIT mucosa, lungs, skin, blood vessels, myocardium, kidneymyocardium, kidney

Metabolic calcification Metabolic calcification

causes are unknown;causes are unknown;

result of acid-basic condition result of acid-basic condition disorder in a tissue;disorder in a tissue;

can be local and generalcan be local and general

Degenerative calcification or Degenerative calcification or

petrifactionpetrifactionit is always localizedit is always localized

there is not hypercalcaemiathere is not hypercalcaemia

calcium salts deposit in calcium salts deposit in necrotic foci or zones of necrotic foci or zones of tissues with sharply decreased tissues with sharply decreased vital functionsvital functions..

Examples:Examples:- petrifaction in thrombi;- petrifaction in thrombi;- petrifaction in atherosclerotic plaques;- petrifaction in atherosclerotic plaques;- petrifaction in tumor’s stroma;- petrifaction in tumor’s stroma;- petrifaction in cusps in defective valvular heart - petrifaction in cusps in defective valvular heart diseases;diseases;- petrifaction of purulent exudate in chronic purulent - petrifaction of purulent exudate in chronic purulent inflammation;inflammation;- petrifaction of caseous necrosis in tuberculosis;- petrifaction of caseous necrosis in tuberculosis;- petrifaction in syphilitic gummas;- petrifaction in syphilitic gummas;- petrifaction in place of dead parasites - petrifaction in place of dead parasites (echinococci);(echinococci);- petrifaction in place of dead fetus (lythopedion).- petrifaction in place of dead fetus (lythopedion).

Petrifaction of tuberculosis foci in lungPetrifaction of tuberculosis foci in lung

Petrifaction in myocardiumPetrifaction in myocardium

StoneformationStoneformation

Stones – pathological hard Stones – pathological hard formations freely lying in a ducts formations freely lying in a ducts

or an organ’s cavityor an organ’s cavity

Predisposing factors of Predisposing factors of stoneformation:stoneformation:

A) general – disturbances of A) general – disturbances of general metabolism;general metabolism;

B) local – chronic inflammation, B) local – chronic inflammation, slowing of outflow, changes of slowing of outflow, changes of

secretion chemical composition secretion chemical composition and its physics features.and its physics features.

Stones from urinary bladderStones from urinary bladder

Stones from kidney pelvisStones from kidney pelvis

Stones in gallbladderStones in gallbladder

Stones from gallbladderStones from gallbladder

Stone in bronchusStone in bronchus

Every stone has inorganic matrix Every stone has inorganic matrix and organic part.and organic part.

Complications of stoneformationComplications of stoneformation

- difficulties or total blockade of - difficulties or total blockade of outflow;outflow;

- supporting of chronic - supporting of chronic inflammation;inflammation;

- necrosis, fistula, bedsore in tissue - necrosis, fistula, bedsore in tissue under stone.under stone.

Thank You!Thank You!