【基础医学】细胞和组织适应与损伤.ppt

Chapter 1 adaptation and injury of tissue and cell adaptation and injury of tissue and cell 1.what is adaptation?define:atrophy,hypertrophy,hyperplasia,metaplasia.department of pathology2.describe the mechanisms of damage of tissue and cell3.describe the main morphological change of degeneration department of pathology4.tissue necrosis:define;morphological change;describe the mechanisms of cell death and histological types of necrosis;the key difference between necrosis and apoptosis;outcome of tissue necrosis department of pathologyadaptation and injury of tissue and cell inside and/or outside stimulate the factortissue and cell adaptationinjury metabolism+function+morphologydepartment of pathologySection 1:adaptation1.Atrophy-2.Atrophy is the decrease in size of an organ or cell by reduction in cell size and/or reduction in cell number,often by a mechanism involving apoptosis.cell size and/or numberdepartment of pathologyAtrophy occurs physiological conditions pathologic conditionsdepartment of pathologynormalEndocrine atrophydepartment of pathologyAtrophy of brain department of pathologycardiac atrophyNormal department of pathologyatrophy of myocardial cellsdepartment of pathologyMuscular atrophydepartment of pathologydepartment of pathologyHypertrophy:cell size(physical volume )physiological hypertrophy pathological hypertrophy compensatory hypertrophy endocrine hypertrophydepartment of pathologyPhysiological hypertrophy1department of pathologyhypertrophynormalatrophydepartment of pathologycardiac hypertrophy(compensatory)endocrine hypertrophyhyperplasia:increase in cell number by mitosis increase tissue or organ sizethe stimuli for hypertrophy and hyperplasia are very similar department of pathologyhyperplasiahypertrophycombined hypertrophy and hyperplasiadepartment of pathologydepartment of pathologyIncreasing its size without cell replication(hypertrophy)Increasing its numbers by cell division(hyperplasia)department of pathologymetaplasia:is the transformation of one mature differentiated cell type into anotherusually in response to an irritating stimuluse.g.smoking bronchial epithelium metaplasiadepartment of pathologySquamous metaplasia of the bronchusdepartment of pathologyimportant types of metaplasia:Squamous metaplasia:bronchial epithelium cervical epitheliumintestinal metaplasia:gastric mucosal epitheliumtransformation to neoplasiamay bedepartment of pathologySquamous metaplasia of the cervixdepartment of pathologyintestinal metaplasiadepartment of pathologySection 2:tissue and cell injury1.causative agents of cell injury physical,chemical,The hypoxia is the most basic2.mechanisms of cell injurydepartment of pathologyDNA damage or loss Membrane damageMembrane pumps Na/K ATPaseDeficiency of metabolismOxygenGlucosehormonesIntracellularswellingMembrane pumpsCa/Mg ATPaseO2 .-Failure of membrane functionComplement-mediated cytolysisAlteration of membrane lipidsCross-linking of membrane proteinslysosomenecrosisCell injury reversible cell injury irreversible cell injury reversible-degeneration irreversible-necrosisdepartment of pathologyCell injury reversible cell injury irreversible cell injury reversible-degeneration irreversible-necrosisdepartment of pathology3.morphologic lesions of cell damage cause a variety of histological abnormalitieshydropic change and fatty change are two patterns commonlydepartment of pathologyMorphology-Reversible cell injuryUltrastructural change:plasma membrane alteration mitochondrial change dilation of the endoplasmic reticulumLight microscope:cellular swelling (the first manifestation of almost all forms of injury to cell)fatty changedepartment of pathology3-1.degeneration:are a variety of changes occurrence at intracellular or intercellular tissue normal or abnormaldepartment of pathology3-1-1 cellular swelling(hydropic degeneration)is the most familiar typeis applied to cells when the cytoplasm becomes pale and swollen due to the accumulation of fluidare called cloudy swelling department of pathologyCellular swellingdepartment of pathologyCellular swellingdepartment of pathology3-1-2 fatty changeaccumulation of lipid droplets(neutral fat)to intracellularmany small vacuoles to form one large vacuole filling the cell and displacing the nucleus department of pathologyGross appearance:becomes increasingly yellow transform into a bright yellow,soft,greasy organ fatty liver(heart)department of pathologyLight microscopy:clear vacuoles within parenchymal cellsfat solvents fat fusionfatty change is the most often seen the liver and heartdepartment of pathologyfatty metamorphosis(fatty change)of the liver fatty change of liverfatty heart 3-1-3.hyaline changeHyaline refers to any alteration within cells or in extracellular space,which gives a homogeneous,glassy,pink,any architecture appearance in routine histological sections stained with HE.department of pathologythree subtypes:1.vessels:important2.Extracellular:scar tissue3.Intracellular:4.kidney,plasma cells,5.viral infection,liver cellsdepartment of pathologythree subtypes:1.vessels:important2.Extracellular:scar tissue3.Intracellular:4.kidney,plasma cells,5.viral infection,liver cellsdepartment of pathologyarteriolosclerosisarteriolosclerosisdepartment of pathologyhyaline changearteriolosclerosisthree subtypes:1.vessels:important2.Extracellular:scar tissue3.Intracellular:4.kidney,plasma cells,5.viral infection,liver cellsdepartment of pathologydepartment of pathology3-1-4.Amyloidosis:With light microscope,amyloid appears as an amorphous,eosinophilic,hyaline,extracellular substance accumulation Iodine solution dilute sulfuric acidAmyloid yellow-red blue Congo red Amyloid pink or redamyloidosisdepartment of pathology3-1-5.Mucoid degeneration mucus polysaccharide accumulation in extracellular department of pathologyMucoid degenerationdepartment of pathology3-1-6.Pathologic pigmentation Pigments accumulated normally at intracellular or extracellular.hemosiderin lipofuscin melanin department of pathology3-1-6.Pathologic pigmentation Pigments accumulated normally at intracellular or extracellular.hemosiderin lipofuscin melanin department of pathologyHE stainingHemosiderin stainingdepartment of pathologyiron stain of the liverdemonstrate of hemosiderin 3-1-6.Pathologic pigmentation Pigments accumulated normally at intracellular or extracellular.hemosiderin lipofuscin melanin department of pathologyLipofuscin inmyocardial cellElectro microscopydepartment of pathologylipochrome in the hepatocytes3-1-6.Pathologic pigmentation Pigments accumulated normally at intracellular or extracellular.hemosiderin lipofuscin melanin department of pathologyanthracotic pigment in macrophages in a lymph node department of pathologyMelanin body3-1-7.Pathologic calcificationCalcium salts are normally found only in bone and teeth.In disease states,however,tissue can become hardened by deposits of calcium salts,this process is called calcification.Calcification may be:dystrophic:abnormal tissue metastatic:normal tissueCalcium saltsDystrophic calcificationAtheromatous plaqueOld tuberculous lesionsFat necrosisBreast lesions department of pathologyDystrophic calcificationdepartment of pathologydystrophic calcification of stomachMetastatic calcificationHyperparathyriodismHypercalcaemia of malignancymetastatic calcification Cell injury reversible cell injury irreversible cell injury reversible-degeneration irreversible-necrosisdepartment of pathology3-2.necrosis Cell death:Cells can be recognized as dead with metabolism stopped,morphologic pattern changed,function disappeared.Cell death may be two types:necrosis and apoptosis department of pathology3-2-1.What is“necrosis”?Necrosis is the death of cells or tissues which are still part of the living organism.department of pathology living organismdiffer from autolysis after death difference between necrosis and autolysis?part of differ from whole or systemic difference between necrosis and death?department of pathology3-2-2.Base lesion normalpyknosiskaryorrhexiskaryolysis important histological marking of necrosisdepartment of pathologykaryolysisdepartment of pathologyPyknosis and karorrhexis and karyolysis Nuclear change (pyknosis,karyolysis,karyorrhexis)cell membrane broken swelling and lysis of cells eosinophilic,thin granular,lacks any structure3-2-3.histological types coagulative necrosis caseous necrosis gangrene(dry,moist,gas)liquefactive necrosis(colliquative necrosis)fat necrosis fibrinoid necrosis gangrene.coagulative necrosis:That is the most common form of necrosis and occurs in almost all organ.occurring in the heart,kidney and spleen,but occurring in most tissuesdepartment of pathologygross appearance:depend upon its size swollen and firm later become soft as a result?microscopic examination:occurring loss of nucleus but preservation of the basic cellular shape,permitting recognition of the cell outlines and tissues architecture department of pathologyCoagulative necrosisdepartment of pathologydepartment of pathologyCoagulative necrosisCoagulative necrosiscoagulative necrosis coagulative necrosis of adrenal cortex Caseous necrosis:commonly seen in TB gross section:“caseous”histologically:The complete loss of normal tissue architecture is replaced by amorphous,granular and eosinophilic tissue.department of pathologyCaseous necrosis of the tuberculosis.Liquefactive necrosis:commonly seen in brain because of its lack of any substantial supporting stroma,its lack of protein and full of phospholipids.hydrolytic enzyme autolysis or heterolysis liquefactiondepartment of pathologyLiquefactive necrosis of the brain tissueBrain malaciadepartment of pathologyLiquefactive necrosis of the brain tissuedepartment of pathologyFat necrosis:direct trauma:release of triglycerides following trauma elicits a rapid inflammatory response.enzymatic lipolysis:lipase liberated from damaged acini act on fat cells in the peritoneal cavity thus:lipases Ca+triglycerides fatty acids insoluble soapsdepartment of pathologyfat necrosis of the pancreas fat necrosis of the pancreas.Fibrinoid necrosis:This occurs in malignant hypertension,where increased arterial pressure results in necrosis of the smooth muscle wall.This allows seepage of plasma into the media with consequent deposition of fibrin.The appearance is termed fibrinoid necrosis.department of pathologydepartment of pathology.Gangrene:necrosis+secondary infectionas a result of action of certain bacteria,notably clostridia.The affected tissue appear black,because of the deposition of iron sulphide from degraded haemoglobin.three subtypes:dry,wet,gas.department of pathologyDry gangrene department of pathologydry gangrene department of pathologyDry gangrenedepartment of pathologydry gangrene department of pathologyWet(moist)gangrenedepartment of pathology3-2-4.Outcome of necrosis.Autolysis or heterolysis acute inflammation.are removed by phagocytes or blood vessel and lymph vessel.abruption and exclusion.organization.encapsulation and calcificationdepartment of pathologyOutcome of necrosisdepartment of pathology3-3.apoptosisApoptosis is energy dependent mechanism of cell death for the deletion of unwanted individual cell,it is also known as programmed cell death.department of pathologyInhibition of apoptosis cell accumulation e.g.neoplasia(tumour)Increase of apoptosis cell loss e.g.atrophy(brain)department of pathologyA 14-years-old boy shows the signs of accelerated agingAbnormal apoptosisagingdepartment of pathologyApoptosis can be either physiological or pathologicalPhysiological:maintenance of organ size in adults organ development remodelling in embryoPathological:response to irreparable DNA damage preventing the perpetuation of a genetically abnormal cell department of pathologyStages of apoptosis:The process of apoptosis occurs the following four stages.1.priming 2.enzyme activation 3.fragmentation of the cell 4.phagocytosis department of pathology1.Priming:Synthesis of enzymes e.g.proteases and nucleasesNo structural cellular changesdepartment of pathology 2.Enzyme activation:endonucleases chromatin DNA fragmentation proteases cytoskeleton shrinkage plasma membrane organelles remain intactdepartment of pathology3.fragmentation of the cell:fragmentation into apoptotic bodiesapoptotic bodies contains intact plasma membranesabsence of any inflammation department of pathologydepartment of pathologydepartment of pathologydepartment of pathologyApoptotic bodiesdepartment of pathology4.phagocytosisApoptotic fragments are phagocytosed and destroyed by adjacent cells.Surrounding cells then move together to fill vacant space.department of pathologydepartment of pathologyApoptotic bodiesphagocytephagocytosisdepartment of pathologynecrosisapoptosisnormalinflammationphagocytosisdepartment of pathologyinjuryrecoverynormal cellnormal celldeathnecrosisapoptosisdepartment of pathologyApoptosis department of pathologynecrosisdepartment of pathologythe key difference between necrosis and apoptosisFeatureNecrosisApoptosisoccurrencePathological conditionsPhysiological or pathological conditionsNumber of cells involvedMore than one cell in the groupSingle cellsCellular statusCell membrane brokenCell membrane remains wholeappearancesSwelling and lysis of cellShrinkage and fragmentation of cellSurrounding responseInflammatory cell present NoneDestiny of dead cellsPhagocytosed by inflammatory cellsPhagocytosed by adjacent cells in the same tissuedepartment of pathology 2002 2002年度诺贝尔生理学或医学奖年度诺贝尔生理学或医学奖授予三位在授予三位在凋亡研究领域凋亡研究领域作出重大贡作出重大贡献的科学家。献的科学家。Sydney Brenner,(1927)英国科学家，英国科学家，Salk生物生物研究所研究所John Sulston,(1942),英国科学家英国科学家,剑桥大学剑桥大学Sanger中心中心Robert Horvitz,(1947),美国科学家，美国科学家，麻省理工学院麻省理工学院3-2.necrosis Cell death:Cells can be recognized as dead with metabolism stopped,morphologic pattern changed,function disappeared.Cell death may be two types:necrosis and apoptosis department of pathology3-2-1.What is“necrosis”?Necrosis is the death of cells or tissues which are still part of the living organism.department of pathology3-2-2.Base lesion normalpyknosiskaryorrhexiskaryolysis3-2-3.histological types coagulative necrosis caseous necrosis gangrene(dry,moist,gas)liquefactive necrosis (colliquative necrosis)fat necrosis fibrinoid necrosis gangrenedepartment of pathology3-2-4.Outcome of necrosis.Autolysis or heterolysis acute inflammation.are removed by phagocytes or blood vessel and lymph vessel.abruption and exclusion.organization.encapsulation and calcificationdepartment of pathology3-3.apoptosisApoptosis is energy dependent mechanism of cell death for the deletion of unwanted individual cell,it is also known as programmed cell death.department of pathology tissue necrosis:define morphological change histological types outcome necrosis and apoptosis department of pathologydepartment of 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