pigments and accumulations. normal cellular constituent vs. abnormal substance transient vs....
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Pigments and accumulations
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• Normal cellular constituent vs. abnormal substance
• Transient vs. permanent• Harmless vs. toxic• Cytoplasm vs. nucleus• Cell produced vs. produced other place in body
Intracellular Accumulations
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Met
abol
ic F
unct
ions
of L
iver
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Lipids
• Triglycerides• Cholesterol
http://health-7.com/imgs/15/939.jpg
http://academic.brooklyn.cuny.edu/biology/bio4fv/page/cholesterol.JPG
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Fatty Change
Intracellular accumulations of a variety of materials can occur in response to cellular injury. Here is fatty metamorphosis (fatty change) of the liver in which deranged lipoprotein transport from injury (most often alcoholism) leads to accumulation of lipid in the cytoplasm of hepatocytes.
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http://www.ijp-online.com/articles/2012/44/3/images/Indian%20J%20Pharmacol_2012_44_3_299_96297_f1.jpg
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Cholesterol
• Athersclerosis• Xanthomas• Cholesterolosis• Niemann-Pick disease, type C
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http://www.lab.anhb.uwa.edu.au/mb140/corepages/vascular/Images/aty10he.jpg
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http://dermatology-s10.cdlib.org/123/case_presentations/xanthoma/1.jpg
Xanthoma
http://www.ajronline.org/content/188/5/1380/F19.large.jpg
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Proteins
• Pink in H&E staining
• Proteins may accumulate as aggregates in vacuoles or in extracellular spaces
• Protein droplets may stain brightly in proximal tubules
• Secretory granules budded from ER may stain brightly as Russell bodies
• Misfolded proteins aggregate, such as 1-antitrypsin in hepatocytes
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Russell Body
http://www.atlasbloodcells.es/imagenes_atlas/thumbm_11263233826_4.jpg
http://imagebank.hematology.org/Content%5C10939%5C10939_full.JPG
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Hyaline
• Histologic appearance of pale, glassy,diffuse pink in H&E staining
• Eosine binds free amino groups– N-ends, Lys, Arg– May indicate protein breakdown or influx of
plasma proteins• Accumulation of staining, not itself a pigment
http://library.med.utah.edu/WebPath/jpeg4/LIVER015.jpg
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Amyloid
• Amyl = starch
• Misfolded proteins in B-pleated sheet formation that resist digestion and accumulate as inclusions
• Amyloid accumulations in glomeruli stain brown with iodine, similar to the iodine reaction with glycogen
• Amyloid and glycogen stain pink under white light with Congo red, but polarized light bounces off amyloid and looks green
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http://www.pathology.vcu.edu/education/PathLab/pages/renalpath/rpsr/images/amyloid_sr/image03.jpg
http://gsm.utmck.edu/research/HICP/images/apple_green.gif
http://www.anaspec.com/images/b-amyloid%201-40.gif
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Glycogen• Glycogen is a readily available energy source stored in
the cytoplasm of healthy cells. • Excessive intracellular deposits of glycogen are seen in
patients with an abnormality in either glucose or glycogen metabolism.
• Glycogen dissolves in aqueous fixatives; for its localization, tissues are best fixed in absolute alcohol.
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http://geneticpeople.com/wp-content/uploads/2011/03/1048885-1116574-1840.jpg
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Pigments• Exogenous• Endogenous
http://www.mda-sy.com/pathology/JPEG3/SKIN063.JPG
Tattoo
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Exogenous Pigments
• Lipofuscin• Melanin• Hemosiderin
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Lipofuscin• Fuscus = brown• Inclusions of lipid peroxides, phosphates,
proteins • Not harmful• Accumulates in liver, heart from normal “wear
and tear”• Sign of free radical damage• Pigment accumulates near nucleus • Indicative of age, oxidative damage• Does not stain blue with Prussian blue or Perl’s
iron
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Lipofuscin
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Melanin
• Melas = black• Synthesized from tyrosine by tyrosinase• Reaction confined to melanosome compartment
of melanocytes in dermis• Whole melanosome is transferred to
keratinocytes in epidermis• Blocks UV radiation• Benign accumulations (freckles, moles) are
called nevi (pl., singular: nevus or naevus = from birth; birthmark)
• Alternative name, lentigo, like a lentil or pea
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• Hemochromatosis• Bilirubin
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http://ahdc.vet.cornell.edu/clinpath/modules/chem/images/iron%20metabolism.jpg
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RE System Liver Marrow
Destruction of Senescent
RBCs
Destruction ofMaturing
RBCs
Turnover ofHeme and
Heme Products
Hemoglobin
Heme
Biliverdin
Bilirubin
Bilirubin Glucuronide
Urobilinogens
Fecal Excretion
Globin
Heme Oxygenase
Biliverdin Reductase
Glucuronosyl Transferase
15-20%80-85%
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Hemoglobin
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Oxyhemoglobin• Oxygen-bound hemoglobin, Hb or HbO2, is red• Mucous membranes and nail beds look pink
http://medsci.indiana.edu/a215/virtualscope/images/blood4_b.jpg
Deoxyhemoglobin• Reduced hemoglobin, HHb is
dark purple-red• Mucous membranes and nail
beds look blue (cyan)
http://easypediatrics.com/wp-content/uploads/2012/08/cyanosis.jpg
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Hemolysis and Hemoglobinuria
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Colors of bruising• Initial hemorrhage of RBCs into tissue is cleared by
macrophages, which process Hb Oxyhemoglobin and Deoxyhemoglobin Deoxyhemoglobin and Biliverdin Biliverdin and Bilirubin Bilirubin and Hemosiderin Hemosiderin
• When iron is completely cleared, tissue resumes normal color
• Accumulation of hemosiderin is hemosiderosis• Hemochromatosis is severe, chronic accumulation
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Colors of bruising
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Bilirubin Metabolism
Bilirubin (B) B-L B +UDP-GU
B-GU
B-(GU)2
Ligandin (L)
GlucuronylTransferase (GT)
GlucuronylTransferase (GT)
Sinusoid Hepatocyte Cannaliculus
UDP-Gu = Uridine diphosphoglucuronic acid 80+
% e
xcre
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, 20-%
reab
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Hepatic bile ducts
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Jaundice, icterus
• Bilirubin build-up in tissues Prehepatic or hemolytic: due to excessive
hemolysis• build-up of unconjugated bilirubin
Hepatic or hepatocellular: due to failure of at least 80% of liver function
• both conjugated and unconjugated bilirubin accumulates
Posthepatic or obstructive: due to failure of bile to drain into GI
• Conjugated bilirubin accumulates
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Excessive accumulation of iron• Accumulation of hemosiderin is hemosiderosis• Hemosiderin is normally found in marrow, spleen,
liver• Hemosiderosis in tissues is secondary to:
iron intake oveload (enteral or parenteral), long-term hemodialysis or transfusions, blood disorders
• Hemochromatosis is severe, chronic accumulation in liver, pancreas, myocardium Primary, genetic hemochromatosis most frequent in men
of northern European descent
• Hemochromatosis results in oxidative damage and inflammation
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Hemosiderosis, hemochromatosis
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Pathologic Calcification
• Dystrophic Calcification
• Metastatic Calcification
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Dystrophic calcification
• Associated with necrosis, aging or damaged heart valves
• Precipitated calcium salts look white
• Basophilic when stained with H&E
• Blue granular crystals
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Calcified bicuspidhttp://ars.els-cdn.com/content/image/1-s2.0-S105488071100007X-gr2.jpg
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Psammoma body
Histologically, with the usual hematoxylin and eosin stain, calcium salts have a basophilic, amorphous granular, sometimes clumped appearance.
On occasion single necrotic cells may constitute seed crystals that become encrusted by the mineral deposits.
The progressive acquisition of outer layers may create lamellated configurations, called psammoma bodies because of their resemblance to grains of sand.
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Metastatic calcification
• Associated with imbalances in phosphorous equilibrium or hypercalcemia Hyperparathyroidism stimulates resorption of Ca from
bone Accelerated bone turnover due to immobility,
metastatic cancer, leukemia, Paget disease Vitamin-D intoxication, sarcoidosis Renal failure
• Phosphate retention• Hyperparathyroidism
• Principally affects acid secreting cellls Gastric mucosa, kidneys, lungs, systemic arteries,
pulmonary veins
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Sarcoidosis
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Cellular Aging
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