Micropreparation nutmeg liver description. disorders of chromoprotein metabolism
MICROPREPARATIONS. Study, sketch and label the listed morphological characteristics.
1. Acute venous congestion (edema) of the lungs A) dilated, full-blooded blood vessels of the interalveolar septa, b) in the lumens of the alveoli there is eosinophilic content (protein transudate) with an admixture of macrophages and desquamated epithelium.
2. Brain hemorrhage. Hematoxylin and eosin staining. A) in the brain tissue there is an accumulation of hemolyzed and preserved red blood cells, b) there is no brain matter in the center of the hemorrhage (brain tissue dissection with blood), V) pericellular and perivascular edema.
3. Brown induration of the lungs. Perls reaction. In lung tissue in the background A) plethora and edema, b) deposits of hemosiderin, which gives a positive reaction to iron and its grains are colored bluish-green, growths of connective tissue are observed in the alveolar septa, around the bronchi and blood vessels.
4. Chronic venous congestion of the liver (“nutmeg liver”). Hematoxylin and eosin staining. In the center of the lobules are found A) dilation and congestion of veins and sinusoids, discomplexation of the hepatic beams, b) necrosis and atrophy of hepatocytes. At the periphery of the lobules, the blood supply to the sinusoids is normal, the structure of the hepatic beams is preserved, hepatocytes are able to V) fatty degeneration.
MACRO-PREPARATIONS.
1. Acute congestion of the membranes of the brain during influenza. The preparation contains the brain. The soft meninges are swollen, gelatinous with dilated full-blooded blood vessels, the convolutions are smoothed.
Reasons: flu.
Complications: cerebral edema due to serous meningitis. Outcomes: usually complete recovery.
2. Nutmeg liver. In the preparation, the liver is enlarged in size, dense in consistency, with a smooth surface and a rounded anterior edge. The cut surface of the organ is motley, gray-yellow (fatty degeneration of hepatocytes along the periphery of the lobules) with dark red specks (central stagnant parts of the lobules) and resembles nutmeg.
Reasons: chronic heart failure with the development of venous congestion in the systemic circulation: cardiosclerosis of various origins, tricuspid valve disease. Hypertension in the pulmonary circulation, chronic lung diseases resulting in pneumosclerosis.
Complications And outcomes: transition to congestive fibrosis (cirrhosis) of the liver, development of portal hypertension syndrome, ascites, splenomegaly, varicose dilatation of portocaval anastomoses, bleeding, anemia.
3. Brown induration of the lungs. The preparation contains lungs, increased in size, brown (“rusty”) color, dense consistency. Around the bronchi, vessels and diffusely in the lung tissue, layers of white dense tissue (pneumosclerosis) are visible. The changes are more pronounced in the lower and posterior parts of the lung.
Reasons: chronic heart failure.
Complications And outcomes: respiratory failure aggravates chronic heart failure - pulmonary heart failure progresses.
MACRO PREPARATION No. 1 FATTY LIVER
Sections of the liver are visible in the preparation.
The liver is small in size, as it is the liver of a child. But still, the size of the liver is increased, since its capsule is tense and the corners are rounded.
The color of the liver when cut is yellow.
The consistency of the liver is flabby.
When cutting such a liver with a knife, droplets of fat remain on its blade.
This is parenchymal fatty liver, or “goose” liver.
It can develop in people suffering from chronic cardiovascular diseases, chronic lung diseases, diseases of the blood system, and chronic alcoholism.
As a result of parenchymal fatty degeneration, portal, small-nodular cirrhosis of the liver may develop over time.
MACRO PREPARATION No. 2 HEMORRHAGE IN THE BRAIN
The preparation shows a horizontal section of brain tissue. The cerebellum is visible below and behind the brain.
In the right hemisphere of the brain, in the area of the subcortical nuclei, there is a dark brown focus due to the fact that in the focus of hemorrhage we see dried blood. This is a focus of hemorrhage into dead brain tissue, with fairly clear boundaries - a hematoma. In the center of the hematoma, under anaerobic conditions, the pigment hematoidin is formed, and along the periphery, at the border with healthy tissues, hemosiderin is formed. Blood from the hemorrhage center broke into the anterior horn of the right lateral ventricle, the third ventricle of the diencephalon, the Sylvian aqueduct of the midbrain and the fourth ventricle of the rhombencephalon.
Hematoma is one of the types of hemorrhagic stroke.
Clinically it was accompanied by the development of focal symptoms on the opposite side of the body - left-sided paresthesia, hemiplegia, hemiparesis, paralysis.
If the patient had not died, a cyst with walls rusty from hemosiderin would have formed at the site of the hemorrhage.
MACRO PREPARATION No. 3 CEPHALOHEMATOMA
The preparation presents the integumentary bone of the skull of a newborn. On the upper - lateral surface of the bone, under its periosteum, there is dried blood of a dark brown, almost black color - this is a subperiosteal hemorrhage. This is a birth injury to the skull, classified as an external cephalohematoma.
MACRO PREPARATION No. 4"Tamponade" of the Heart
The preparation shows a longitudinal section of the heart from the left ventricle, since the thickness of the ventricular myocardium is more than 1 cm. It is noteworthy that the cavity of the left ventricle is slit-like, that is, the heart is compressed from the outside by something. The subepicardial fat layer, epicardium, and pericardium are determined. Gray-brown blood clots are visible in the pericardial cavity. It was thanks to their presence in the pericardial cavity that the heart was compressed on all sides, and the cavity of the left ventricle became slit-like. This is bleeding into the pericardial cavity - hemopericardium, an example of internal bleeding, figuratively - “tamponade” of the heart. It is also noteworthy that in the region of the posterior - lower wall of the heart, the myocardial tissue is stained brown with hemosiderin, due to a rupture of the heart wall in this place and hemorrhage from the damaged vessel. A rupture of the heart wall occurred due to myomalacia in the area of transmural myocardial infarction.
Thus, hemorrhage into the cardiac membrane was a consequence of myomalacia and rupture of the heart wall in the area of transmural myocardial infarction.
MACRO PREPARATION No. 5 PURULAR MENINGITIS
The preparation shows the brain from its upper – lateral surfaces. Under the soft meninges, an accumulation of white-yellow exudate with the consistency of thick sour cream is detected. This is a purulent exudate. The exudate lies on the surface of the convolutions, enters the furrows, smoothing out the relief of the surface of the brain.
Inflammation of the soft meninges is meningitis.
Primary purulent meningitis can occur with meningococcal infection, and secondarily it can complicate infectious diseases during generalization of infection (with sepsis).
MACROPREPARES No. 6 BRAIN TUMOR
The preparation shows a horizontal section of the brain. In one of the hemispheres (in the left), in the white matter there is a focus of pathological growth of brain tissue with unclear contours and unclear boundaries of growth. The consistency of the node of pathological growth of brain tissue approaches the consistency of the brain itself. The color is variegated, as there are hemorrhages and necrosis in the lesion. This is a brain tumor. Since the boundaries of tumor growth are unclear, a malignant tumor occurs. It can be assumed that this is glioblastoma, the most common malignant tumor of adults.
MACRO PREPARATION No. 7 SARCOMA OF THE TIBIAL BONE
The preparation shows the bones that form the knee joint. In the area of the upper part of the diaphysis of the tibia there is a pathological growth of tissue that destroys the posterior surface of the bone and has unclear growth boundaries. This is a tumor. It is white, layered, and resembles fish meat. Unclear growth boundaries indicate the malignant nature of the tumor. A malignant tumor of bone tissue is osteosarcoma. Since the process of bone destruction prevails over the process of bone formation, this is osteolytic osteosarcoma.
MACRO PREPARATION No. 8 BRAIN ABSCESSES IN SEPTICOPYEMIA
The preparation contains sections of the brain. In each section there are multiple foci of irregular round shape, clearly delimited from the brain tissue by a thick wall. Filled with contents of white-yellowish or white-greenish color, the consistency of thick sour cream. This is a purulent exudate.
Focal accumulations of pus, delimited from the brain tissue by a wall, are abscesses.
The wall of an acute abscess consists of two layers: 1) the inner layer - the pyogenic membrane and 2) the outer layer - nonspecific granulation tissue.
There are three layers in the wall of a chronic abscess: 1) internal - pyogenic membrane, 2) middle - nonspecific granulation tissue and 3) external - coarse fibrous connective tissue.
Brain abscesses develop with the generalization of purulent inflammation in the lungs, intestines and other organs, that is, with sepsis, septicopyemia.
MACRO PREPARATION No. 9 MITRAL STENOSIS (RHEUMATIC HEART DISEASE)
The preparation shows a cross section of the heart, made above the level of the atrioventricular orifices, so that the leaflets of the bicuspid, mitral and tricuspid valves are clearly visible.
The mitral valve leaflets are deformed. They are sharply thickened, with a bumpy surface, opaque, rigid due to the growth of connective tissue in them. There is a gap between the closed valve leaflets, that is, mitral valve insufficiency has developed.
In addition, there is a narrowing of the left atrioventricular orifice.
Thus, in the area of the mitral valve there is a combined heart defect - insufficiency and stenosis of the mitral valve.
Such acquired heart defects most often form during rheumatic valvular endocarditis.
The described changes in the mitral valve correspond to the stage of fibroplastic endocarditis.
It can be assumed that the patient died from progressive chronic cardiovascular failure caused by decompensated rheumatic heart disease.
MACRO PREPARATION No. 10 CHORIONEPITHELIOMA OF THE UTERUS
The preparation contains a longitudinal section of the uterus with appendages.
The size of the uterus is increased (normally the height of the uterus is 6–8 cm, width – 3–4 cm and thickness – 2–3 cm). In the uterine cavity, the growth of tumor tissue is visualized, which grows into the myometrium, that is, invasive tumor growth takes place.
The consistency of the tumor is soft and porous, since the tumor contains absolutely no connective tissue.
The color of the tumor tissue in the preparation is gray with dark brown inclusions. In a fresh specimen, it is dark red and motley, since the tumor has cavities, lacunae, filled with blood.
Based on the nature of its growth, the tumor is malignant. It develops from the epithelium of the chorionic villi (placenta). This is chorionepithelioma.
It is an organ-specific tumor. Constructed of two types of cells - large mononuclear cells with light cytoplasm, or Langhans cells, derivatives of cytotrophoblast, and large ugly multinucleated cells, derivatives of syntiotrophoblast. The tumor is hormonally active. Tumor cells secrete the hormone gonadotropin, which is found in a woman’s urine; Thanks to the hormone, the uterus increases in size.
The tumor developed in connection with pregnancy. This is a differentiated tumor.
Metastasizes predominantly hematogenously to the liver, lungs, and vagina.
In this specimen, in the area of the vaginal portion of the cervix and in the vaginal wall, round lesions are visible in appearance similar to the primary tumor. These are tumor metastases.
MACRO PREPARATION No. 11 CHRONIC STOMACH ULCER WITH PENETRATION INTO THE PANCREAS
The preparation shows a fragment of the stomach wall from the mucous membrane side and the pancreas located behind the stomach.
There is an ulcerative defect in the wall of the stomach with raised, dense, calloused, callous edges and a flat bottom. One edge of the defect, facing the esophagus, the proximal one, is undermined, with an overhanging mucous membrane. The other edge, opposite, distal, is flat or terrace-like. The difference between the edges is due to the presence of a peristaltic wave.
A defect in the wall of the stomach is a chronic ulcer, since connective tissue has grown at its edges, causing a change in the edges of the defect.
At the bottom of the ulcer, it is not the tissue of the stomach wall that is determined, but the lobular, white tissue of the pancreas.
Thus, there is an ulcerative - destructive complication of a chronic gastric ulcer - penetration into the pancreas.
It can be assumed that the patient died from a spilled broth.
MACRO PREPARATION No. 12 Nutmeg liver
The preparation shows a frontal section of the liver.
The size of the liver is increased.
The color of the liver tissue on the section is variegated: areas of gray-black color (these are areas with dried blood) interspersed with areas of gray-brown color (the color of hepatocytes).
The areas are gray-black, and in the fresh specimen – red, due to the plethora and expansion of the central veins and the central 2/3 of the sinusoids of the liver lobules flowing into them.
Due to the similarity of the cross-sectional surface of the liver to the cross-sectional surface of nutmeg, the drug got its name.
Occurs with the development of chronic venous congestion in the body, which occurs in conditions of chronic cardiovascular failure, which is a complication of chronic diseases of the heart, such as mitral valve disease, myocarditis with outcome in cardiosclerosis, chronic ischemic heart disease.
MACRO PREPARATION No. 13 PROSTATE ADENOMA WITH URETEROHYDRONEPHROSIS
The preparation presents an organocomplex consisting of a longitudinal section of the kidney with the ureter, longitudinal sections of the bladder and prostate gland.
Changes in the structure of the prostate gland entailed compensatory and adaptive changes in the structure of the overlying organs.
The prostate gland is enlarged in size due to the growth in one of its lobes of a tumor node, round in shape, with clear boundaries of growth, delimited from the prostate tissue by a connective tissue capsule. This is a benign tumor - prostate adenoma.
Due to the presence of an adenoma, the prostatic part of the urethra sharply narrowed, which led to disruption of the outflow of urine.
Working hypertrophy developed in the bladder wall. Along with wall hypertrophy, an expansion of the bladder cavity occurred, that is, eccentric decompensated hypertrophy of the bladder developed.
The ureter, pelvis and renal cups have dilated due to a violation of the outflow of urine - hydroureteronephrosis.
A type of local pathological atrophy has developed in the kidney parenchyma - pressure atrophy.
MACRO PREPARATION No. 14 CENTRAL LUNG CANCER
The specimen shows the trachea with cartilaginous semirings located on its anterior surface, the main bronchi, and part of the left lung adjacent to the left main bronchus.
The lumen of the left main bronchus is sharply narrowed due to the fact that around the bronchus in the lung tissue there is a pathological growth of tissue of a gray-beige color, dense consistency, in the form of a node with unclear growth boundaries. This is a malignant tumor growing from the epithelium of the main bronchus - lung cancer. Outside the main tumor node there are multiple foci of irregular round shape - cancer metastases to the lungs.
Since cancer grows from the main bronchus, its location is central.
Since tumor growth is represented by a node, the macroscopic form of cancer is nodular.
Most often, the histological form of central lung cancer is squamous cell, the development of which is preceded by metaplasia of the glandular epithelium of the bronchi into multilayered squamous non-keratinizing epithelium during chronic bronchitis.
In relation to surrounding tissues, cancer grows infiltratively.
In relation to the lumen of the main bronchus - into its wall, that is, endophytically, compressing the lumen of the bronchus.
Due to impaired bronchial patency due to compression by a tumor, complications such as atelectasis, abscess, pneumonia, and bronchiectasis may develop in the lung tissue adjacent to the bronchus.
Lung cancer is an epithelial organ-nonspecific tumor.
Metastasizes predominantly by lymphogenous route. The first lymphogenous metastases are found in regional lymph nodes - peribronchial, paratracheal, bifurcation.
MACRO PREPARATION No. 15 POLYPOSUS – ULCERATIVE ENDOCARDITIS OF THE AORTIC VALVE
We see a preparation of the heart in a longitudinal section from the side of the left ventricle, since its myocardium has a thickness of more than 1 cm. The cavity of the left ventricle is expanded. There is eccentric decompensated working hypertrophy of the myocardium of the left ventricle of the heart and tonogenic dilatation.
The crescents of the aortic valve are changed, they are thickened, tuberous, rigid, and opaque. On two of the three crescents, an ulcerative defect is clearly visible, on the surface of which thrombotic deposits in the form of polyps have formed. Such changes in the crescents of the aortic valve are called polyposis-ulcerative endocarditis, which is one of the clinical and morphological forms of sepsis.
Microscopically, colonies of microbes and deposits of lime salts can be detected in the thickness of these thrombotic deposits.
Complications of this process may include thrombobacterial embolism and the formation of aortic heart disease.
Since polyposis-ulcerative endocarditis developed on already altered crescents of the aortic valve, this is secondary endocarditis.
MACRO PREPARATION No. 16 STOMACH CANCER (SAUCER-SHAPED)
The preparation shows a fragment of the stomach from the mucous membrane side. The stomach is cut along the greater curvature.
In the area of the lesser curvature of the body of the stomach, there is a pathological growth of tumor tissue into the lumen of the stomach with loose, raised edges and a flat bottom. The boundaries of tumor growth are unclear in places. At the bottom of the tumor growth there are foci of white necrosis.
Fuzzy boundaries of tumor growth and the presence of secondary changes in it in the form of foci of necrosis indicate the malignancy of the tumor.
A malignant tumor growing from the epithelium of the stomach is gastric cancer.
By localization it is cancer of the body of the stomach.
According to the nature of growth, it is an ecophytic-expansive cancer.
In macroscopic appearance, it is a saucer-shaped cancer.
Microscopically, it will most often be presented as a differentiated form of cancer - adenocarcinoma.
Since gastric cancer, according to the international classification of tumors, belongs to the group of epithelial organ-nonspecific tumors, the predominant route of metastasis will be lymphogenous. The first lymph node metastases may appear in the regional lymph nodes - four lymph node collectors located along the lesser and greater curvature of the stomach.
Since the stomach is an unpaired organ of the abdominal cavity, the first hematogenous metastases are found in the liver.
MACRO PREPARATION No. 17 ABSCEDING PNEUMONIA WITH SEPTICOPYEMIA
We see a cross section of the right lung, since it contains three lobes.
In each lobe, against the background of airy tissue of a light beige color, there are multiple foci of round and irregular shape, the size of a match head, in places merging with each other, of dense consistency, airless or low-air, with a smooth cut surface, white-gray in color. These are foci of inflammation in the lung tissue - foci of pneumonia.
A white wall forms around some lesions, and the contents of the lesions become the consistency of thick sour cream. A complication of pneumonia develops – abscess formation.
Abscess pneumonia can develop with septicopyemia, one of the clinical and morphological forms of sepsis.
MACRO PREPARATION No. 18 LOUPIC PNEUMONIA (WITH ABSCEDING)
The preparation shows a longitudinal section of the right lung, as three lobes are visible.
The lower lobe is entirely gray and airless. Its cut surface is fine-grained.
The consistency of the lung lobe corresponds to the liver density.
The interlobar pleura is thickened with membranous overlays of gray-beige color.
This is lobar pneumonia, the hepatic stage, a variant of gray hepatization.
In the lower segments of the lobe, cavities are defined, delimited from the lung tissue by a wall. These are abscess cavities.
One of the pulmonary complications of pneumonia occurs - abscess formation. Its cause is the addition of a secondary purulent infection due to decreased immunity and increased fibrinolytic activity of neutrophilic leukocytes.
MACRO PREPARATION No. 19 SMALL NODULA CIRRHOSIS OF THE LIVER
The preparation shows a section of the liver.
The liver is reduced in size, as its corners are sharpened and the capsule is wrinkled.
On the outer surface of the liver, multiple regenerated nodes are identified, up to 1 cm in size, making the surface of the liver non-smooth.
On the cut surface, the boundaries of the false lobules are clearly visible (whereas normally the boundaries of the hepatic lobules are not visualized) due to the proliferation of fibrous tissue in the area of the portal tracts.
This is cirrhosis of the liver.
In macroscopic appearance it is finely nodular. In microscopic appearance it is monolobular, since the size of the false lobules corresponds to the size of the regenerated nodes.
According to pathogenesis, this is portal cirrhosis, in which portal hypertension develops primarily, and hepatic cellular failure develops secondarily.
Such cirrhosis can develop as a result of fatty hepatosis, the chronic form of viral hepatitis B and the chronic course of alcoholic hepatitis.
MACRO PREPARATION No. 20 CANCER OF THE UTERUS BODY
A longitudinal section of the uterus is presented.
The uterus is increased in size. It can be seen that in the uterine cavity there is a pathological growth of tissue with a non-smooth, papillary surface, in places with ulcerations, with unclear boundaries of growth. This is a tumor growth.
The tumor develops from the endometrium and is seen to grow into the wall of the uterus. This is a malignant tumor of the epithelium - cancer of the uterine body.
Histologically, it is represented by a differentiated form of cancer – adenocarcinoma.
The nature of tumor growth in relation to the lumen of the uterus is exophytic, in relation to surrounding tissues – infiltrating.
May develop as a result of atypical glandular endometrial hyperplasia.
It is an epithelial organ-nonspecific tumor. Metastasizes predominantly by lymphogenous route. The first lymphogenous metastases are found in regional lymph nodes.
MACRO PREPARATION No. 21 PURULAR - FIBRINOUS ENDOMYOMETRITIS
A longitudinal section of the uterus with appendages is visible.
The uterus is sharply increased in size, its cavity is sharply expanded, the wall is thickened.
The endometrium is dirty gray in color, dull, covered with filmy beige deposits, in places hanging into the uterine cavity. There is an inflammatory process in the endometrium - purulent-fibrinous endometritis.
In addition, the inflammation has spread to the muscular lining of the uterus, since the myometrium is dull and dirty-gray.
Thus, the presented preparation contains purulent-fibrinous endomyometritis, which could arise as a result of a criminal abortion and cause uterine sepsis.
MACRO PREPARATION No. 22 MULTIPLE UTERINE FIBROMYOMAS
A cross section of the uterus is presented.
In the wall of the uterus one can see the growth of tumor tissue in the form of nodes of different sizes, round and oval, with clear growth boundaries, surrounded by a thick-walled capsule, which is a reflection of the expansive growth of the tumor.
Nodes located inside the uterine wall are intramural, those lying under the endometrium are submucosal, those lying under the serous membrane are subserous.
The nodes are built from two types of fibrous structures: some beige fibers are smooth muscle fibers, the other gray-white fibers are connective tissue fibers. The fibrous structures have different thicknesses and go in different directions, which are manifestations of tissue atypia.
Since tumor nodes contain a large number of connective tissue fibers, their consistency is dense.
Due to the fact that the tumor grows expansively and has only signs of tissue atypia, it is benign. A benign tumor of smooth muscle mixed with fibrous tissue is called fibromyoma.
Based on the international classification of tumors, it belongs to mesenchymal tumors.
MACRO PREPARATION No. 23 BUBBY SLIFT
The drug is represented by a cluster-shaped cluster of thin-walled bubbles, linked to each other, and filled with a clear liquid. This is a hydatidiform mole, a benign organ-specific tumor that develops during and after pregnancy from the epithelium of the chorionic villi.
The development of hydatidiform mole is based on hydropic degeneration of epithelial cells.
A hydatidiform mole is benign until it begins to grow into the wall of the uterus, into the veins. After this, it becomes malignant, or destructive. Against the background of a malignant hydatidiform mole, a malignant organ-specific tumor, chorionepithelioma, can develop.
MACRO PREPARATION No. 24 THROMBOEMBOLISM OF THE PULMONARY ARTERY TRUNK
The drug is represented by an organocomplex: the heart and fragments of both lungs.
The heart is cut from the side of the right ventricle, since the thickness of its myocardium is approximately 0.2 cm. The pulmonary trunk emerges from the right ventricle, which is divided into two pulmonary arteries, respectively, the right and left lungs.
In the lumen of the pulmonary trunk and its bifurcation there are massive strandy, dense, crumbling masses with a corrugated surface, not attached to the walls of the vessels. These are thromboemboluses. The source of such massive thromboemboli could most likely be the veins of the lower extremities.
The thromboembolus located in the lumen of the pulmonary artery trunk and its bifurcation irritates the receptors of the reflexogenic zone located in the intima of the above vessels and causes the development of the pulmonary-coronary reflex, consisting of an instant spasm of the small bronchi and bronchioles and coronary arteries of the heart, with the development of acute cardiovascular failure and the onset of instant death.
MACRO PREPARATION No. 25 ATHEROSCLEROSIS OF THE AORTA WITH ATHEROMATOSIS AND WALL THROMBOSIS
The abdominal aorta is presented in a longitudinal section and the area of bifurcation of the aorta into the common iliac arteries.
The intima of the aorta is changed. It reveals multiple round-longitudinal white-yellow spots, which represent lipid deposits and overgrowth of fibrous tissue. These are atherosclerotic plaques. They bulge into the lumen of the aorta, making it narrower. Below the opening of the inferior mesenteric artery, the plaques are ulcerated, atheromatous (necrotic) masses have formed on their surface and hemorrhages have occurred.
The appearance of atherosclerotic plaques in the intima of the aorta indicates the presence of atherosclerosis, a clinical and morphological form of aortic atherosclerosis.
The described plaque changes correspond to the macroscopic stage of complicated lesions.
Damage to the intima of the aorta was one of the local prerequisites for thrombus formation. In the lumen of the abdominal aorta and in the lumens of the iliac arteries, parietal and even occlusive thrombi have formed, disrupting the passage of blood through the aorta to the lower extremities.
MACRO PREPARATION No. 26 SMALL INTESTINE DAMAGE IN TYPHUS
The preparation shows the small intestine in a longitudinal section from the side of the mucous membrane.
On the mucous membrane, longitudinal oval-shaped formations are visible, bulging above the surface of the mucous membrane and having on their surface a kind of grooves and convolutions, as in the brain. These formations are pathognomonic for typhoid fever. They arose as a result of acute productive inflammation in the area of lymphatic follicles located in the submucosal layer of the intestine. Due to the proliferation of macrophage and histiocytic elements, the follicles increased in volume, size and began to rise above the surface of the mucosa.
Due to the presence of grooves and convolutions on the surface of the follicles, the first stage of typhoid fever is called cerebral swelling.
MACRO PREPARATION No. 27 FIBROUS-CAVERNOUS PULMONARY TUBERCULOSIS
The specimen is presented by a longitudinal section of the right lung, since it has 3 lobes. In each of the lobes there are cavities, large cavities with thick, non-collapsing walls. Since the walls of the cavities do not collapse, these are old, chronic cavities inherent in fibrous-cavernous pulmonary tuberculosis, one of the phases of the forms of secondary pulmonary tuberculosis.
The wall of the old cavity consists of 3 layers: 1) internal - caseous necrosis; 2) medium – specific granulation tissue; 3) external – fibrous tissue.
The patient develops cor pulmonale, chronic pulmonary heart failure, tuberculosis intoxication and cachexia, from which he dies.
MACRO PREPARATION No. 28 LYMPHOGRANULOMATOSIS OF PARA-AORTAL LYMPH NODES
The preparation shows the aorta in a longitudinal section.
Atherosclerotic plaques are detected in the intima of the aorta.
On both sides of the abdominal aorta, above the bifurcation, lymph nodes that are sharply enlarged and therefore fused to each other, forming “packets” of lymph nodes, are determined.
The consistency of the lymph nodes is dense-elastic, the surface is smooth, and the color when cut is gray-pink.
Lymph nodes lying on the sides of the aorta are called para-aortic.
Enlargement of the para-aortic lymph nodes and their fusion into packets occurs with lymphogranulomatosis, malignant Hodgkin's lymphoma.
MACRO PREPARATION No. 29 ARTERIOLOSCLEROTIC NEPHROSCLEROSIS
Two intact kidneys are visible in the preparation.
Their size and weight are sharply reduced (both kidneys in a person weigh 300 - 350 g). The surface of the buds is wrinkled and fine-grained. The consistency of the buds is very dense.
This is the appearance of a primarily wrinkled kidney due to the benign course of primary arterial hypertension. The basis of wrinkling is hyalinosis and sclerosis of the capillaries of the renal glomeruli - arteriolosclerotic nephrosclerosis.
The same appearance is secondary - a wrinkled kidney that develops as a result of chronic glomerulonephritis.
Clinically, against the background of primary and secondary wrinkled kidneys, chronic renal failure develops, accompanied by the development of azotemic uremia, which can be treated with chronic hemodialysis or kidney transplantation.
MACRO PREPARATION No. 30 MILIARY PULMONARY TUBERCULOSIS
A longitudinal section of an enlarged lung is presented.
It is clearly visible that the entire surface of the lung tissue is diffusely dotted with small, millet grain-sized, dense tubercles, light yellow in color.
This type of lung occurs in miliary tuberculosis, which develops in hematogenous generalized and hematogenous tuberculosis with predominant damage to the lungs.
Each tubercle has the following structure: in the center there is a focus of caseous necrosis, the severity of which depends on the state of the patient’s immunity; it is surrounded by a cell shaft of epithelioid cells, lymphocytes, plasmacytes and single multinucleated Pirogov-Langhans cells.
According to the classification of granulomas, tuberculous granulomas are infectious and specific. The specific cells of tuberculous granuloma are epithelioid cells of hematogenous, monocytic origin, which are most abundant in the granuloma.
MACRO PREPARATION No. 31 NODUAL GOITTER
The preparation shows the thyroid gland on a section.
Its dimensions are sharply increased (normally it weighs 25 g).
The outer surface is lumpy.
On the cut surface, the lobular structure of the gland is distinguished, and in the lobules there are follicles of different sizes, filled with brown colloid.
A persistent increase in the size of the thyroid gland, not associated with inflammation, tumor or circulatory disorders in it, is called goiter.
In appearance it is a nodular goiter.
The internal structure is colloid goiter.
Most often it occurs with endemic goiter, the occurrence of which is associated with a deficiency of exogenous iodine.
Despite the compensatory increase in the size of the gland, its function is reduced.
MACRO PREPARATION No. 32 TUBAL PREGNANCY
The fallopian tube is visible in a cross section.
The pipe is sharply expanded. Its wall is thinned in places and thickened in others. In places where the tube wall is thickened, the tissue is dark brown due to hemorrhage. In the center of the tube there is a human embryo, in which the head, torso, and arms with fingers are clearly visible. The embryo is surrounded by membranes.
This is an ectopic, tubal pregnancy, complicated by an incomplete tubal abortion.
The fertilized egg separated from the walls of the fallopian tube, as evidenced by hemorrhage, but remained in the tube.
MACRO PREPARATION No. 33 RENAL CELL CANCER
It is represented by a section of the kidney, in the upper pole of which tumor tissue grows in the form of a node with clear growth boundaries, forming a pseudocapsule around itself, which indicates expansive growth of the tumor.
The tumor node is light yellow in color, since the tumor cells contain a large amount of lipids; mottled, since the tumor is characterized by the development of necrosis and hemorrhages; soft consistency, since the tumor contains little fibrous tissue.
Despite the growth pattern, the tumor is malignant, differentiated, epithelial, organ-specific, developing from the epithelium of the kidney tubules.
Occurs in adults.
MACRO PREPARATION No. 34 DRY GANGRENE OF THE FOOT
The foot of the right lower limb is visible in the preparation.
In the area of the dorsal surface of the metatarsus, at the base of the toes, there is no skin, and the soft tissues are dry, mummified, gray-black.
This is dry gangrene of the foot, one of the clinical and morphological forms of necrosis.
Gangrene is called necrosis of tissues in contact with the external environment.
During gangrene, soft tissues are colored gray-black with the pigment pseudomelanin, or iron sulfide.
Gangrene of the foot can develop as a result of atherosclerotic damage to the vessels of the lower extremities, occurring primarily or as a result of diabetes mellitus due to the development of macroangiopathy.
MACRO PREPARATION No. 35 EMBRYONIC KIDNEY CANCER
Represented by a kidney in a longitudinal section.
In the upper pole of the kidney there is a proliferation of tumor tissue, large in size, with clear growth boundaries, forming a pseudocapsule around itself. In the center of the tumor node there is a large cavity due to necrosis of the tumor tissue.
The lower pole of the kidney is small, which indicates that the kidney belongs to a small child.
Despite the nature of tumor growth - expansive and taking into account the presence of secondary changes in the tumor - it is a malignant, undifferentiated tumor that develops from metanephrogenic tissue and affects children from two to six years of age.
Expansive growth gives way to invasive growth over time.
The tumor is epithelial organ-specific.
Metastasizes predominantly hematogenously to the opposite kidney, lungs, bones, and brain.
MACRO PREPARATION No. 36 BREAST CANCER
The drug is presented in the mammary gland.
In one of the quadrants of the mammary gland, a pathological proliferation of tumor tissue occurred, emanating from the epithelium of the mammary gland ducts and growing onto the surface of the skin, which indicates invasive tumor growth.
This is a malignant, epithelial organ-specific tumor - breast cancer.
The human body is a reasonable and fairly balanced mechanism.
Among all infectious diseases known to science, infectious mononucleosis has a special place...
The world has known about the disease, which official medicine calls “angina pectoris,” for quite a long time.
Mumps (scientific name: mumps) is an infectious disease...
Hepatic colic is a typical manifestation of cholelithiasis.
Brain edema is a consequence of excessive stress on the body.
There are no people in the world who have never had ARVI (acute respiratory viral diseases)...
A healthy human body is able to absorb so many salts obtained from water and food...
Knee bursitis is a widespread disease among athletes...
Kidney amyloidosis microslide
Micropreparations for classes
Topic: Parenchymal dystrophies.
Microslide No. 17
Granular dystrophy of the epithelium of the convoluted tubules of the kidneys (stained with hematoxylin-eosin).
1. Protein inclusions in the cytoplasm of the epithelium of convoluted tubules of the kidneys.
Microslide No. 25 Microslide No. 26
Fatty liver degeneration Fatty liver degeneration
(stained with hematoxylin-eosin). (environment Sudan III).
1. Inclusion of cytoplasmic fat in hepatocytes.
Topic: Stromal-vascular dystrophies.
Microslide No. 19
Amyloidosis of the kidneys (environment Congo red).
1. Deposition of amyloid in the renal glomerulus.
2. Amyloid deposition in the kidney stroma.
3. Deposition of amyloid in the vessel wall.
4. Deposition of amyloid under the basement membrane of the tubules.
Microslide No. 27
Obesity of the heart (environment of hematoxylin-eosin).
1. Fat deposition under the epicardium.
2. Fat deposition between cardiomyocytes.
3. Atrophy of cardiomyocytes.
Topic: Mixed dystrophies.
Microslide No. 111
Brown induration of the lungs (environed by hematoxylin-eosin).
1. 2. 3. 1. 2. 3.
1. Clusters of siderophages.
2. Sclerosis of the interalveolar septa.
3. Congestion of blood vessels and perivascular hemorrhages.
Microslide No. 100
Liver with obstructive jaundice (biliary cirrhosis) (stained with hematoxylin-eosin).
1. Bile blood clots in the bile ducts.
2. Accumulation of bilirubin granules in hepatocytes.
Topic: Plethora. Bleeding.
Microslide No. 1
Nutmeg liver (stained with hematoxylin-eosin).
1. 2. 3. 4. 1. 2. 3. 4.
1. Congestion of the central veins and hemorrhages in the central parts of the lobules.
2. Fatty degeneration of hepatocytes in the peripheral parts of the lobules.
3. Sclerosis of the periportal zone.
4. Dystrophic changes and focal necrosis of hepatocytes in the central parts of the lobules.
Microslide No. 11
Bleeding in the brain (hemorrhagic infiltration) (hematoxylin-eosin staining).
1. Infiltration of brain tissue by erythrocytes.
2. Preserved structural elements of the brain in the area of hemorrhage.
Microslide No. 153
Pulmonary edema (environment of hematoxylin-eosin).
1. Accumulation of edematous fluid in the lumens of the alveoli.
Topic: Thrombosis. Embolism. Heart attack.
Microslide No. 6
Hemorrhagic pulmonary infarction (surrounded by hematoxylin-eosin).
1. Infiltration of erythrocytes into lung tissue with necrosis.
Microslide No. 7
Ischemic renal infarction (surrounded by hematoxylin-eosin).
1. Zone of necrosis.
2. Hemorrhagic corolla (paretic dilated vessels and hemorrhages).
3. Zone of unchanged renal tissue.
Microslide No. 5
Mixed thrombus in a vessel (stained with hematoxylin-eosin).
1. Area of damaged vascular endothelium.
2. Elements of a mixed thrombus in the lumen of the vessel.
Topic: Necrosis.
Microslide No. 9
Necrosis of the epithelium of the convoluted tubules of the kidneys (stained with hematoxylin-eosin).
1. Necrotic convoluted tubule epithelial cells.
Topic: Inflammation. Exudative inflammation.
Microslide No. 76
Fibrinous pericarditis (surrounded by hematoxylin-eosin).
1. Myocardium.
2. Cellular infiltration of the epicardium.
3. Applying fibrin to the epicardium.
Microslide No. 173
Purulent leptomeningitis (surrounded by hematoxylin-eosin).
1. Infiltration of neutrophilic leukocytes of the pia mater.
2. Congestion of the vessels of the pia mater.
3. Edema of the brain substance.
Microslide No. 114
Diphtheritic colitis (stained with hematoxylin-eosin).
1. Intestinal epithelium.
2. Cellular infiltration and focal necrosis of the intestinal mucosa.
3. Fibrin application.
Topic: Productive and specific inflammation.
Microslide No. 131
Tuberculous granulomas in the lung (surrounded by hematoxylin-eosin).
1. Cellular shaft of lymphocytes and epithelioid cells.
2. Site of caseous necrosis.
3. Giant multinucleated Pirogov-Langhans cells.
Topic: Compensatory-adaptive reactions.
Microslide No. 40
Glandular cystic hyperplasia of the endometrium (hematoxylin-eosin staining).
1. Proliferation of endometrial stromal cells.
2. Proliferation and cystic changes in the glands.
3. “Tangles” of spiral arteries.
Microslide No. 43
Granulation tissue (stained with hematoxylin-eosin).
1. Newly formed vessels.
2. Cellular infiltration.
3. Connective tissue fibers.
Topic: Immunopathological processes.
Microslide No. 23
Autoimmune thyroiditis (Hashimoto's goiter) (hematoxylin-eosin staining).
1. Lymphocytic infiltration with the formation of lymphoid follicles.
2. Atrophy of the thyroid follicles.
Topic: Tumors. Epithelial tumors.
Microslide No. 62
Squamous cell keratinizing skin cancer (stained with hematoxylin-eosin).
1. Accumulation of atypical tumor cells with the formation of cancer “pearls”.
Microslide No. 64
Adenocarcinoma of the rectum (stained with hematoxylin-eosin).
1. Unchanged glands of the mucous membrane.
2. Complexes of tumor glandular structures.
Microslide No. 58
Skin papilloma (stained with hematoxylin-eosin).
1. 2. 3. 1. 2. 3.
1. Acanthotic cords.
2. Vascular pedicle.
3. Violation of stratification of stratified squamous epithelium.
Microslide No. 61
Papillary cystadenoma of the ovary (stained with hematoxylin-eosin).
1. Papillary processes of the epithelium.
2. Stromal-vascular legs.
Topic: Mesenchymal tumors.
Microslide No. 41
Skin fibroma (stained with hematoxylin-eosin).
1. Chaotic arrangement of connective tissue fibers.
Microslide No. 51
Cavernous hemangioma (surrounded by hematoxylin-eosin).
1. Cavities with endothelial lining filled with blood.
Microslide No. 49
Chondroma (stained with hematoxylin-eosin).
1. Chaotic arrangement of chondrocytes.
Microslide No. 51
Uterine fibroids (environed by picrofuchsin according to Van Gieson).
1. Connective tissue fibers.
2. Smooth muscle fibers.
Microslide No. 79
Pleomorphic liposarcoma (hematoxylin-eosin stained).
1. Adipose tissue cells with cellular atypia.
Microslide No. 55
Polymorphic cell sarcoma (hematoxylin-eosin-stained).
1. Cells with cellular atypia.
Topic: Cancers of individual localizations.
Microslide No. 66
Fibroadenoma of the mammary gland (stained with hematoxylin-eosin).
1. Proliferation of the glandular component of the tumor.
2. Proliferation of the stromal component of the tumor.
Microslide No. 104
Cancer metastasis to the lymph node (hematoxylin-eosin staining).
1. Complexes of glandular tumor structures.
2. Lymph node tissue.
Topic: Tumors of the blood system.
Microslide No. 118
Lymph node with lymphogranulomatosis (stained with hematoxylin-eosin).
1. Reed-Berezovsky-Sternberg cells.
2. Large Hodgkin cells.
Microslide No. 120
Leukemic infiltrates in the kidney in acute undifferentiated leukemia
(environment with hematoxylin-eosin).
1. Infiltration of the kidney by undifferentiated leukemic cells.
Topic: Atherosclerosis. IHD. GB.
Microslide No. 201
Atherosclerosis of the artery (stained with hematoxylin-eosin).
1. Vessel lumen.
2. Petrificates.
3.Atheromatous masses.
Microslide No. 143
Acute myocardial infarction (environment with hematoxylin-eosin).
1. Necrotic myocardium.
2. Demarcation zone.
3. Unchanged myocardium.
Microslide No. 97
Post-infarction large-focal cardiosclerosis (surrounded by hematoxylin-eosin).
1. Connective tissue.
2. Hypertrophied cardiomyocytes.
Microslide No. 140
Arteriolosclerotic nephrosclerosis (primarily shriveled kidney) (surrounded by hematoxylin-eosin).
1. Hyalinosis of arterioles.
2. Sclerosis and hyalinosis of the glomeruli.
3. Sclerosis and lymphocytic infiltration of the stroma.
Topic: Rheumatic diseases.
Microslide No. 133
Acute warty endocarditis (surrounded by hematoxylin-eosin).
1. Thrombotic overlays.
Microslide No. 134
Recurrent warty endocarditis (surrounded by hematoxylin-eosin).
1. Thrombotic overlays.
2. Lymphomacrophage infiltration of the valve.
3. Mucoid swelling and fibrinoid changes in the valve.
4. Sclerosis and neovascularization of the valve.
5. Petrificates.
Topic: Acute inflammatory diseases of the lungs.
Microslide No. 75
Lobar pneumonia (environment of hematoxylin-eosin).
1. Exudate consisting of neutrophils and alveolar macrophages.
2. Fibrin threads.
Microslide No. 72
Focal pneumonia (surrounded by hematoxylin-eosin).
1. Leukocyte infiltrate in the bronchial lumen.
2. Serous-leukocyte infiltrate in the alveoli.
Topic: Chronic nonspecific lung diseases.
Microslide No. 92
Chronic bronchitis with bronchiectasis (surrounded by hematoxylin-eosin).
1. Squamous metaplasia of the bronchial epithelium.
2. Cystic transformation of the bronchus with purulent contents.
3. Sclerosis of lung tissue.
Topic: Diseases of the gastrointestinal tract.
Microslide No. 144
Chronic gastric ulcer with exacerbation (environment of hematoxylin-eosin).
1. Fibrinous-purulent exudate.
2. Granulation tissue and sclerosis at the bottom of the ulcerative defect.
3. Preserved mucous membrane.
Microslide No. 146
Acute phlegmonous appendicitis (surrounded by hematoxylin-eosin).
1. Neutrophilic infiltration of all layers.
2. Paretic dilation and congestion of blood vessels.
Topic: Liver diseases.
Microslide No. 171
Toxic liver dystrophy (stained with hematoxylin-eosin).
1. Necrosis of the central parts of the lobules.
2. Fatty degeneration of the peripheral parts of the lobules.
Microslide No. 77
Portal cirrhosis of the liver (stained with hematoxylin-eosin).
1. Fatty degeneration of hepatocytes.
2. Narrow septal layers.
Microslide No. 189
Post-necrotic cirrhosis of the liver (stained with hematoxylin-eosin).
1. Protein dystrophy of hepatocytes.
2. Wide septal layers.
Topic: Kidney diseases.
Microslide No. 184
Subacute extracapillary glomerulonephritis (hematoxylin-eosin staining).
1. Proliferation of extracapillary epithelium with the formation of “crescents”.
2. Dystrophic and atrophic changes in the tubular epithelium
Microslide No. 185
Chronic glomerulonephritis resulting in wrinkling (hematoxylin-eosin staining).
1. Hyalinosis and glomerular sclerosis.
studfiles.net
Kryuchkov - description of microslides according to Patan
Department of Pathological Anatomy, State Educational Institution of Higher Professional Education "PGMA of the Ministry of Health of Russia"
A.N. Kryuchkov, A.V. Retz
MATERIALS FOR PRACTICAL LESSONS
ON PATHOLOGICAL ANATOMY FOR STUDENTS OF THE MEDICAL AND MEDICAL-PREVENTIVE FACULTIES
A.N. Kryuchkov, A.V. Rec. Materials for practical classes in pathological anatomy for students of medical and preventive medical faculties. – Perm, 2003. – 32 p. (published by the Department of Pathological Anatomy of the State Educational Institution of Higher Professional Education “PGMA of the Ministry of Health of Russia”).
The publication contains descriptions of drugs, the study of which is mandatory at the Department of Pathological Anatomy of the Perm State Medical Academy and is intended for third-year students of the medical and preventive medicine faculties. The “Introduction” provides the general principles of the descriptive method, widely used in practical medicine.
In practical classes in pathological anatomy, students become familiar with the basics of the descriptive method (method of description).
The method of describing macro-objects is used by almost all doctors of clinical specialties, which determines the need for medical students to study this method. Most often, the method of describing macro-objects is used when a doctor detects changes in superficial tissues (skin and visible mucous membranes) during an examination of a patient. During surgical interventions, the surgeon reflects visible changes in internal organs, primarily those that are removed, in the operation report.
In pathological anatomy, the study and description of macroscopic objects is the first stage of morphological analysis of autopsy and surgical material, which is then supplemented by microscopic examination.
The concept of morphological methods. Especially-
sity of morphological research methods in biology
and medicine is the use of empirical information obtained directly from the study of the object. In contrast, it is possible to study the properties of an object without directly perceiving it, but based on the nature of secondary changes in the environment caused by the very existence of the object (such research methods are widely used in pathological physiology
in clinical medicine). The morphological method is based on the direct perception of the object being studied, primarily its visual characteristics (the result of observation).
Morphological methods, like any other scientific methods, are implemented in three stages:
1. empirical stage – obtaining primary information about an object from the senses. In pathological morphology, in addition to visual, tactile information is of great importance.
2. theoretical stage – the stage of understanding the obtained empirical data and their systematization. This requires broad erudition of the researcher, since the effectiveness of perception of empirical information directly depends on the completeness of theoretical knowledge, which you
expressed in the formula “We see what we know.”
3.stage of practical implementation – use of research results in practical activities. The results of morphological research in medicine are the basis for diagnosis, which determines the important practical significance of the method.
Basic morphological methods include:
1.macromorphological method - a method for studying biological structures without significantly enlarging the object. Examination using a magnifying glass with low magnification refers to the macromorphological method. The macromorphological method should not be called a macroscopic study, since the information obtained is not only visual.
study).
Descriptive method. Among the morphological methods at the empirical stage, of particular importance is the
scriptive method (method of description) – a method of recording perceived information using verbal symbols (means of language as a sign system). A correct description of pathological changes is a kind of information copy of the research object. That is why it is necessary to strive to ensure that it is as accurate as possible.
Macromorphological parameters. Description pa-
tological changes in organs are carried out using the following basic parameters:
1. localization of the pathological process in the organ
(if not the entire organ is affected, but part of it);
2.size of an organ, part of it or pathologically caused
changed area (dimensional parameter, volumetric characteristics);
3.color characteristics of the fabric from the surface and on the cut;
4. consistency of pathologically altered tissue;
5.configuration (outline, shape) of a pathologically altered organ or part of it;
6.degree of homogeneity of pathologically altered tissue in color and consistency.
If a parameter has not been changed, it is usually not reflected in the object description.
Micromorphological method. Tissue sections for conventional light-optical examination are prepared using special instruments (microtomes) and stained using various methods. The optimal thickness of such sections is 5-7 microns. The histological preparation is a stained tissue section, enclosed between a slide and cover glass in a transparent medium (balsam, polystyrene, etc.). There are overview and special (differential) painting methods. Special methods are used to identify certain tissue structures, for example, certain substances (histochemical and immunohistochemical studies).
The most commonly used staining of tissue sections is hematoxylin and eosin. Hematoxylin - a natural dye, extract of the bark of a tropical logwood tree - stains blue the nuclei of cells ("nuclear dye"), deposits of calcium salts, colonies of gram-positive microorganisms and fibrous tissue in a state of mucoid edema. Hematoxylin is a basic (alkaline) dye, therefore the ability of tissue to perceive it is called basophilia (from the Latin basis - base). Eosin is a synthetic pink dye, a dye the color of dawn (named after the Greek goddess of dawn Eos). Eosin is an acidic dye, so the ability of tissue structures to perceive it is called acidophilia or ilioxyphilia.
2.micromorphological (microscopic) method Eosin stains the cytoplasm of most cells
-a method of morphological research that uses ("cytoplasmic dye") and intercellular material uses devices (microscopes), significantly increased.
depicting the image of the object. Many variants of the microscopic method have been proposed, but the most widely used is light microscopy (light-optical
Other methods of staining tissue sections, including histochemical ones, will be given in the description of the corresponding micropreparations.
DEATH OF AN ORGANISM. NECROSIS
Macropreparations
No. 1. Dry gangrene of the foot. Black areas are visible on the skin of the foot; their sizes and shapes vary in different preparations. The altered tissues are compacted (due to dehydration of detritus). The boundaries of the lesions are clear. In the unfixed material, the skin surrounding the area of dry necrosis is preserved and is bright red in color. The presence of a halo of hyperemia around the blackened tissue creates the impression of “burning” and subsequent “charring” of the skin, which determined the old Russian name Antonov fire, which designated dry gangrene of the distal extremities. The term γάγγραινα (“gággraina”, transformed in Russian into the word gangrene) was introduced into the European medical tradition by Hippocrates and derived from the verb γραίνω - to gnaw, i.e. “Gangrene” literally translated from ancient Greek means “something gnawing [the body]”, “something devouring [flesh]”.
No. 2. Wet gangrene of the intestine. The tissues of the intestinal wall are dirty gray, almost black, moist, and tear easily. The relief of the mucous membrane (normally present folds) is smoothed. The peritoneum covering the altered segment of the intestine is dull in fresh, unfixed preparations (normally, the serous membranes are moist and shiny).
No. 3. White splenic infarction. In the tissue of the spleen, an irregular or cone-shaped area is visible, whiteish-gray in color, with clear boundaries. In some preparations, several infarcts are found in the spleen. The apex of the cone-shaped areas of necrosis faces the hilum of the spleen, and their bases touch
scapsule (in such cases, the infarction zone is visible from the surface of the organ).
No. 4. Caseous necrosis of lymph nodes in tuberculosis (caseous tuberculous lymphadenitis). Lymph nodes are enlarged, dense, fused together and form a conglomerate. When cut, their tissue is homogeneous, whitish-gray.
No. 5. A focus of white (gray) softening in the brain. In the section of the brain, a rounded area of whitish-gray color is visible, formed by loose, moist detritus. The size of the encephalomalacia lesion and its location
in the brain are different in different preparations.
Microspecimens
No. 2. Caseous necrosis of spleen tissue with tuberculosis
kulose. Hematoxylin and eosin staining. In the spleen,
Mostly in place of the white pulp structures, compact accumulations of hypereosinophilic amorphous masses (caseous detritus) are visible. Around the foci of necrosis, remnants of the organ's lymphoid tissue are noticeable. In addition to detritus, changes characteristic of tuberculosis develop in the tissue (their detailed characteristics will be given in the corresponding practical lesson). In a number of preparations, detritus is saturated with fragments of decaying cell nuclei (karyorrhexis), giving the necrotic masses a basophilic hue.
No. 4. A focus of white softening in the brain.
Hematoxylin and eosin staining. The area of necrosis in the brain tissue is formed by loose eosinophilic amorphous masses, in which numerous round-shaped macrophages with abundant, often granular, cytoplasm (“granular balls”) are visible.
No. 5. Demarcation inflammation in the kidney. Staining with hematoxylin and eosin. In the preserved kidney tissue
the circle of the focus of necrosis, small vessels are dilated and full of blood (inflammatory hyperemia), neutrophil granulocytes and macrophages are visible in the perivascular tissue (inflammatory cell infiltration), partially penetrating into the detritus (scavenger cells).
PARANCHYMATOUS DYSTROPHY
Macropreparations
No. 37. Dull (cloudy) swelling of the kidney. The kidney is slightly enlarged, its tissue is flabby, slightly edematous. The cut surface of the organ is not shiny (dull); a small amount of cloudy liquid drains from it. Such changes in the kidney are reversible and are detected only in native (fresh) material. Microscopic examination reveals granular degeneration of the epithelium of the renal tubules.
No. 47. Fatty parenchymal degeneration of the myocardium (“tiger heart”). This condition develops with de-
compensation of cardiac activity (in a “worn out heart”) in the outcome of severe heart lesions of various origins. The heart is enlarged due to expansion (dilatation) of the cavities, its walls are thinned (compared to the compensated state); the myocardium is flabby, yellowish-gray in color. On the side of the endocardium, numerous small, sometimes merging yellowish spots and stripes are visible. Sometimes yellowish stripes are located parallel to each other, forming a characteristic “tiger skin” pattern (in such cases, the heart with fatty parenchymal myocardial degeneration is called “tiger”).
No. 49. Fatty parenchymal degeneration of the liver (liver steatosis, fatty hepatosis, “goose liver”).
The liver is enlarged, its tissue is flabby, from a yellowish-brown to grayish-yellow color (normally, the liver tissue is dark brown). With pronounced steatosis, the liver becomes very light and is called “goose” (this type of liver in waterfowl is not a sign of a pathological process ).
Microspecimens
No. 18. Hydropic dystrophy of the renal epithelium
ny tubules. Hematoxylin and eosin staining.
The epithelial cells of some renal tubules are enlarged, their cytoplasm is light (optically empty). Normally, the cytoplasm of tubular nephroepithelial cells is eosinophilic (stained pink with eosin). The tinctorial properties of the cytoplasm of cells in a state of hydropic degeneration are caused by edema (hydration); in this case, the water entering the cell dilutes the cytosol, making it unable to fix the dye.
No. 31. Fatty parenchymal degeneration of the liver
neither. Staining with hematoxylin and Sudan III (or only Sudan III). In the cytoplasm of hepatocytes of all parts of the hepatic lobule, numerous round inclusions of various sizes are visible, stained orange with Sudan III.
MESENCHYMAL (STROMAL-VASCULAR) DYSTROPHIES
Macropreparations
No. 41. Hyalinosis of the spleen capsule (“glazed spleen”). The splenic capsule is focally or completely thickened,
compacted, whitish-gray. Most often, such changes are formed as a result of fibrinous perisplenitis.
No. 42. Sago amyloidosis of the spleen (“sago spleen”). The spleen is slightly enlarged, slightly condensed; on a section in its tissue, numerous small translucent rounded lesions are visible, reminiscent of grains of boiled sago (sago is starch pressed in the form of grains, which, when boiled, takes on the appearance of translucent balls). “Sago spleen” is the initial morphologically verified stage of spleen amyloidosis; In this case, amyloid is deposited mainly in the structures of the white pulp, so the lesions have a round shape.
No. 43. Sebaceous spleen amyloidosis (“sebaceous spleen”). The organ is enlarged, dense, the tissue in the section is grey.
The pores are uniform, pale red, shiny (“greasy sheen of the cut surface”). “Sebaceous spleen” is the name given to late changes in the organ during amyloidosis with pronounced damage to both the white and red pulp. Some authors use the term “ham spleen” to refer to such changes in the organ.
No. 44. Amyloidosis of the kidney (large white amyloid kidney). The kidney is enlarged, dense, the cortex is expanded, light gray with a yellowish tint; the cut surface is shiny (“greasy shine of the cut surface”). The yellowish tint of the kidney tissue is due to fatty parenchymal degeneration. This type of kidney is characteristic of the stage of advanced clinical manifestations of nephropathic amyloidosis (nephrotic stage of renal amyloidosis). With advanced amyloidosis, parenchymal atrophy develops and the kidneys decrease in size.
No. 46. Obesity of the heart. The heart is enlarged due to a significant proliferation of subepicardial adipose tissue (normally, adipose tissue under the epicardium is located only along the neurovascular bundles). Obesity of the heart may be accompanied by myocardial lipomatosis (the proliferation of white adipose tissue in the myocardium).
Microspecimens
No. 21. Amyloidosis of the spleen. Hematoxyl staining
nom and congo red. Focal accumulations of compact acellular masses stained Congo red are visible in the spleen tissue. Amyloid is predominantly located in the structures of the white pulp, displacing and replacing cells of lymphoid tissue.
No. 23. Kidney amyloidosis. Staining with hematoxylin and Congo red. In various structures of the kidney (glomeruli, walls of tubules and vessels), red-stained (Congophilic) compact acellular masses (amyloid) are found. Amyloid is predominantly located in the renal glomeruli. – nephron tubules.
No. 26. Hyalinosis of the renal glomeruli and vessel walls
Dov. Van Gieson staining. Some glomeruli are reduced in size, replaced by coarse fibrous connective tissue, partially or completely hyalinized, stained red with acid fuchsin. Hyaline is a homogeneous hyperoxyphilic (i.e., intensely stained with acidic dyes such as acid fuchsin and eosin) masses. The walls of individual vessels are also hyalinized. – normal glomerulus, – nephron tubules.
MIXED DYSTROPHIES
Macropreparations
No. 53. Calcified tuberculosis focus in the lung (Gon's focus). In the lung tissue there is a focus of whitish
cottony gray in color, round in shape, up to 1 cm in diameter, rocky in density, with fairly clear boundaries.
No. 54. Kidney stone (nephrolithiasis). The pelvis, large and small calyces of the kidney are occupied by a large coral-shaped calculus.
No. 56. Gallstones (cholelithiasis). Numerous stones are visible in the gall bladder. The color, size and shape of the stones vary in different preparations.
No. 60. Hemosiderosis of the spleen. The spleen tissue on the section is brown in color due to the deposition of a large amount of hemosiderin in its tissue (the “rusty appearance” of the cut surface). Hemosiderosis of the spleen is a manifestation of generalized (systemic) hemosiderosis, in which hemosiderin accumulates and stains the tissue of the bone marrow, liver, spleen and lymph nodes brown.
No. 61. Hemomelanosis of the spleen (malarial pigmentation of the spleen). The spleen is slightly enlarged, thickened
On the cut, its fabric is gray-black (slate gray) in color. Hemomelanin refers to hematins - hemoglobinogenic pigments containing ferric iron. Hematins, unlike pigments containing ferrous iron (ferritin and hemosiderin), color the tissue black.
Microspecimens
No. 40. Deposition of calcium salts in the kidney (nephro-
calcinosis). Staining with hematoxylin and eosin. In pro-
in the light of some renal tubules there are calcium salts stained hyperbasophilically (hematoxylin
dark blue color). The nephroepithelial cells of these areas are in a state of severe hydropic degeneration or destroyed.
No. 42. Hemosiderosis of the liver. Perls reaction (stained with yellow blood salt). Numerous hemosiderin granules are visible in the cytoplasm of hepatocytes, stained
blue color (“Prussian blue”).
The Perls reaction detects only ferritin and its polymerization product, hemosiderin, i.e. hemoglobinogenic pigments containing divalent iron. To detect all iron-containing hemoglobinogenic pigments (including hematins) in tissue, the Thierman reaction is used (treatment of tissue sections with reducing agents followed by staining with red blood salt).
No. 45. Liver with obstructive jaundice. Staining with hematoxylin. The interlobular bile ducts and bile capillaries are dilated and filled with brown-green masses (bile); the walls of some ducts are thinned. Dark green granules of bile are located in the cytoplasm of hepatocytes (intracellular cholestasis). The tissue of individual portal tracts and lobules is stained with bile (“biliary necrosis”).
CIRCULATION DISORDERS (1 lesson)
Macropreparations
No. 7. "Nutmeg" liver. The liver is somewhat enlarged and thickened; On a section, the tissue of the organ has a variegated appearance (numerous evenly spaced small foci of red color are visible on the yellowish-serophone), reminiscent of a nutmeg kernel with a characteristic alternation of lighter and darker areas. Red lesions correspond to the central sections of the lobules, the vessels of which are sharply congested; the yellowish-gray background is due to fatty degeneration of hepatocytes in the peripheral sections of the lobules.
No. 8. “Nutmeg” liver fibrosis (congestive compaction of the liver). The liver is slightly enlarged, dense,
its surface is smooth. The tissue on the section is variegated: multiple whitish-gray small foci (“nutmeg in reverse”) are visible on a red background. Light gray foci correspond to the central sections of the lobules, where fibrous tissue grows; The sinusoidal capillaries of the peripheral parts of the lobules and the vessels of the portal tracts are full of blood, which gives a red color to other parts of the liver tissue.
No. 9. Brown induration of the lungs. The lungs are somewhat enlarged, compacted, their cut surface is brown (due to the high content of hemosiderin in the tissue).
No. 13. Fresh hemorrhage in the brain. In the brain tissue there is a cavity filled with clotted blood (hematoma). In some preparations, blood is found in the lateral ventricles (hemocephaly).
No. 27 (169). Hydrocephalus (water on the brain). The ventricles of the brain are stretched by an increased amount of cerebrospinal fluid. The volume of brain tissue is reduced due to prolonged compression by cerebrospinal fluid (atrophic changes).
Microspecimens
No. 51. "Nutmeg" liver. Hematoxylin staining
eosin. The lobular structure of the liver is preserved. The central venule and adjacent sections of the sinusoidal capillaries are dilated and sharply plethoric (plethora of the central sections of the lobule). Centrilobular hepatocytes are reduced in size, their number is reduced (atrophy of parenchymal cells in the central sections of the lobules). The cytoplasm of hepatocytes in the peripheral parts of the lobules contains fatty inclusions (rounded voids with clear contours).
No. 53. Brown induration of the lungs. Hematoxy staining
lin and eosin. The interalveolar septa are thickened due to congestion of capillaries and fibrosis. In the lung tissue, especially in the lumen of the alveoli, numerous sideroblasts (alveolar macrophages with hemosiderin granules in the cytoplasm) are visible.
No. 54. Fresh hemorrhage in the brain. Ok-
staining with hematoxylin and eosin. In brain tissue
ha outside the vessels there are numerous red blood cells. In some areas of the brain, small cavities are formed without clear boundaries, filled with blood (microhematomas); in others, the brain tissue is more or less evenly saturated with blood (hemorrhagic infiltration).
CIRCULATION DISORDERS (lesson 2)
Macropreparations
No. 11. White kidney infarction. In the cortex of the kidney, a whitish-gray area with clear boundaries is visible, adjacent to the fibrous capsule of the organ. There may be several foci of necrosis (infarctions).
No. 14. Hemorrhagic pulmonary infarction. In the lung, under the pleura, an area of dark red color, dense consistency, with fairly clear boundaries is visible. The tissue in the lesion is airless. There may be several heart attacks in a preparation. Hemorrhagic infarction is the result of thromboembolism of the branches of the pulmonary artery.
No. 16. White thrombus in the aorta. A light gray thrombus with an uneven (rough) surface is attached to the inner surface of the abdominal aorta. Sometimes the surface of the thrombus is wavy (“corrugated”). In some drugs, the thrombus completely blocks the lumen of the vessel (obstructive thrombus), in others - partially (parietal, or parietal, thrombus). Unlike a thrombus, a post-mortem blood clot is not attached to the wall of the vessel, it is soft-elastic (jelly-like), its surface is smooth, moist, and shiny.
No. 20. Massive pulmonary embolism. In the pulmonary trunk and both pulmonary arteries there are thromboemboli coiled into a ball, completely blocking the lumen of the vessels. Massive pulmonary embolism usually results in death.
No. 21. Purulent metastases in the kidney during sepsis (septicopyemia). Under the kidney capsule there are small cavities filled with purulent exudate (abscesses).
No. 22. Cysticercosis of the brain. Brain tissue contains numerous vesicles with a diameter of 2-3
No. 23. Metastases of stomach cancer to the liver. In the liver, round whitish-gray nodules of various sizes are visible, with fairly clear boundaries.
Microspecimens
No. 57. Hemorrhagic pulmonary infarction. Staining with hematoxylin and eosin. The infarcted area is formed by amorphous eosinophilic masses (detritus) with numerous red blood cells. In the intact tissue adjacent to the necrosis zone, the microvessels are dilated and full of blood; In the interalveolar septa and fibrous stroma, an inflammatory cellular infiltration of macrophages and neutrophilic granulocytes is formed, and the cavities of the alveoli are filled with exudate rich in cells
(signs of demarcation inflammation).
No. 61. Organization of a blood clot. Van Gieson staining.
The lumen of the vessel is filled with a thrombus, colored yellow with picric acid. Fibrous tissue grows into the thrombus from the vessel wall (thrombus organization), the collagen fibers of which are colored red with acid fuchsin. Small vessels are formed in the thrombus, some of which do not contain blood cells (endothelialization of the blood clot); in other vessels of the thrombus, signs of restoration of blood flow are revealed - the presence of blood cells in the lumen (vascularization
tion of a thrombus).
No. 63. Microbial emboli (bacterial meta-
stasis) in the kidney. Hematoxylin and eosin staining.B
In the lumen of the small vessels of the kidney, including the glomerular capillaries, there are colonies of gram-positive bacteria (staphylococci), stained dark blue with hematoxylin.
EXUDATIVE INFLAMMATION
Macropreparations
No. 66. Vesicular exanthema in smallpox. The skin contains numerous vesicles (bubbles) filled with clear or cloudy liquid (serous exudate). Elements of the rash (a rash on the skin is called an exanthema) up to 0.5 cm in size with a characteristic central retraction of the vesicle cover.
No. 68. Brain abscess. In the brain tissue, a cavity with a diameter of 1.0-2.5 cm is visible (the diameter of the cavity varies in different preparations), containing purulent exudate.
No. 70. Purulent leptomeningitis with meningococcal infection. The soft meninges, primarily the convexital surface of the brain, are whitish-gray, thickened due to edema, pronounced congestion of the vessels and the presence of purulent exudate in their tissue.
No. 73. Fibrinous pericarditis (“hairy heart”). The epicardium is covered with a layer of soft yellowish-gray mass (fibrinous exudate), forming hair-like outgrowths.
No. 78. Diphtheritic endometritis. The mucous membrane of the uterus is covered with thin, gray, spontaneously exfoliating films of fibrinous exudate.
Microspecimens
No. 76. Fibrinous pericarditis. Staining according to van Gie-
zone. The epicardium is covered with amorphous picrinophilic (yellow-stained with picric acid) masses of fibrinous exudate. In the submesothelial tissue, the microvessels are dilated and full-blooded (inflammatory hyperemia), around them there are numerous cells of the inflammatory infiltrate (primarily macrophages and neutrophil granulocytes). – subepicardial adipose tissue; – myocardium.
No. 80. Cellulitis of soft tissues. Hematoxy staining
lin and eosin. Numerous neutrophil granulocytes are located around the fibers of striated muscle tissue and fat cells. Disintegrating neutrophilic granulocytes that form purulent exudate are called purulent bodies in classical pathology. – skeletal muscle tissue, – white adipose tissue cells.
No. 131. Fibrinous laryngitis. Hematoxy staining
lin and eosin. The mucous membrane of the larynx is in a state of necrosis. Detritus and fibrinous exudate form a film (fibrinous-necrotic film) covering the underlying preserved tissues, the small vessels of which are dilated and full of blood (inflammatory hyperemia), and cells of the inflammatory infiltrate are visible in the perivascular tissue. The inflammatory cell infiltrate consists mainly of histiocytes (macrophages) and neutrophilic granulocytes.
studfiles.net
description
DESCRIPTIONS AND SYMBOLS
TRAINING MICROPREPARATIONS
ON THE COURSE OF GENERAL AND PRIVATE
PATHOLOGICAL ANATOMY
TOPIC: Parenchymal dystrophies
Microslide
Turbid swelling of the epithelium of the kidney tubules.
Even at low magnification, it is noticeable that the boundaries of the epithelial cells of the convoluted tubules are unclear, their cytoplasm is dim, and not all cells have visible nuclei. In the tubules of the intercalary part, the epithelial cells, on the contrary, do not show any changes, the nuclei and outlines of the cells are clearly visible, the cytoplasm of the cells is transparent. The glomeruli are also unchanged.
At high magnification, it is easy to establish that cells with dull cytoplasm are enlarged in size and the cytoplasm is fine-grained. The lumens of the tubules are narrowed or have a characteristic star-shaped appearance, due to the fact that the apical ends of the dystrophic cells seem to be broken off. In the lumen of some tubules a fine-grained or homogeneous protein mass (so-called cylinders) is visible.
Designations
1) unchanged glomeruli;
2) enlarged convoluted tubule epithelial cells with dull, fine-grained cytoplasm;
3) pale colored nuclei of these cells;
4) narrowed lumen of convoluted tubules;
5) stellate lumen of convoluted tubules;
6) tubules of the intercalary region (collecting ducts) with unchanged cells;
7) protein masses in the lumen of the tubules.
Microslide X
Cloudy liver swelling
Even at low magnification, it is clear that in the center and along the periphery of the lobules the trabecular structure of the trabecular beams is disturbed, the cells are arranged randomly (the so-called discomplexation of the hepatic beams).
At high magnification, it is clearly noticeable that the cells are increased in size. The granularity of the cytoplasm is completely optional; it may or may not be present. Along the periphery, in most cells the nuclei are preserved, in the center only their shadows are visible (karyolysis) - the outcome is necrosis.
Designations
1) normal liver cells along the periphery of the lobules;
2) discomplexation of the hepatic beams;
3) enlarged liver cells with granular and homogeneous cytoplasm;
4) pale colored kernels.
Microslide
Mucous dystrophy of the epithelium
Staining: a) mucicarmine; b) CHIC reaction; c) according to Hale
Nasal discharge with symptoms of inflammation, which is expressed in the impregnation of the stroma with inflammatory exudate, rich in segmented leukocytes. The epithelium covering the polyp is partially in a state of mucous degeneration:
swollen, the entire cytoplasm is filled with mucus. Pay attention to the colorful reactions to mucus: mucicarmine - pink, according to Hale - turquoise, positive CHIC reaction - crimson. Draw separately the epithelial cells stained using different methods. In those areas where there is no mucous degeneration, mucus is retained only in the apical sections and on the surface of the epithelium.
Designations
1) mucous degeneration of the epithelium (with various staining methods);
2) normal epithelium.
Microslide
Fatty degeneration of the myocardium (tiger heart)
Staining - hematoxylin-eosin
In contrast to “simple” obesity of the heart, with dystrophic obesity of the myocardium, the muscle fibers themselves become fat, and not the small layers of connective tissue between them. Fat deposits in the form of small droplets that do not merge with each other are found mainly near blood vessels, and it is not individual muscle fibers that become fat, but groups of them. The peculiar spotting that occurs explains the name - tiger heart. In some cases, there may be a breakdown of the muscle fiber, its transformation into a fine-grained mass; dystrophic changes in the nuclei, if any, are much less pronounced than changes in the muscle fibers.
Designations
1) blood vessels
2) small drops of fat in muscle fibers located near blood vessels
3) muscle fibers without fat drops
Microslide
Fatty liver
Staining - hematoxylin-sudan
Not only different drugs, but also different parts of the same
drugs may differ significantly from each other in the degree of obesity. IN
In severe cases, the entire lobule becomes obese. Hepatic nuclei. cells
are pushed away by drops of fat to the periphery and there is a significant resemblance to
normal fat fiber. In other cases, not the entire lobule becomes obese, but part of it, peripheral or central. Drops of fat can be both small and large. Based on the size of fat drops and their location in the center or along the periphery of the lobule, it is impossible to distinguish physiological obesity from dystrophic obesity. The only convincing criterion is dystrophic changes in the nuclei of liver cells, but these changes are observed in advanced cases.
Designations
1) hepatic beams;
2) large (small) drops of fat in the liver cells along the periphery (in the center) of the lobules;
H) whole, fatty liver lobule.
TOPIC: Stromal-vascular dystrophies
Microslide 3
Hyalinosis of the spleen capsule
Staining: pierofuchsin
The spleen capsule is sharply thickened in some areas. At low magnification, it is clear that in the thickest places the collagen fibers are swollen, merged with each other, there are few connective tissue cells, they are compressed by homogeneous masses, colored red. In a normal capsule, collagen fibers are thin, each fiber is clearly contoured, and a significant number of cells are visible between them. This is an example of hyaline connective tissue dystrophy.
Designations
1) hyalinized area of the capsule (the fibers are thickened, swollen, fused with each other)
2) normal capsule with well-defined fibrous structures
H) spleen tissue:
a) lymphatic follicle
b) trabecula
c) red pulp
Microslide
Hyalinosis of kidney arterioles in hypertension
At low magnification, small vessels are visible in the renal cortex. In cross section, they look like uniform rings of pink or slightly bluish color (the chemical structure of hyaline is not the same). Their clearance is narrow. Accordingly, such vessels undergo desolation of the glomeruli with their subsequent scarring, as well as atrophy of the tubules with the proliferation of connective tissue. Scar tissue has the appearance of homogeneous, pale-colored, rounded formations with single nuclei. There are tubules with an expanded lumen containing homogeneous masses of protein, the so-called. hyaline casts (hyalinosis of dead masses).
Designations
1) hyalinized arteriole
2) sclerotic (scarred) glomerulus
3) atrophying tubules and proliferation of connective tissue
4) dilated tubules with hyaline cylinders
Microslide
Kidney amyloidosis
Staining - Congo mouth + hematoxylin
Amyloid masses, clearly visible in the preparation due to selective staining in brick-red color, are found in the greatest quantities in the glomeruli. Some glomeruli are so rich in amyloid that only a few endothelial cells remain. In smaller quantities, amyloid deposits are found along the small vessels of the cortex and medulla, as well as in the lining of the tubules.
Designations
1) amyloid deposits under the endothelium of the glomerular capillaries
2) deposits of amyloid under the endothelium of the capillaries of the cortex and medulla
3) amyloid deposits in the tubular lining
Microslide X
Sago spleen
Staining: Congo mouth + hematoxylin
Amyloid is selectively deposited in follicles. They are easily detected in the form of rounded formations of brick-red color. Only a few lymphocytes remained in the follicle. The rest suffered atrophy and death from compression by amyloid masses. There is no amyloid in the red pulp. The venous sinuses between the enlarged follicles containing amyloid masses are compressed.
Designations
1) enlarged, amyloid-containing follicles
2) single lymphoid cells preserved in follicles
3) compressed venous sinuses between follicles
Microslide 3
Heart in general obesity
Staining - hematoxylin-eosin
The epicardium is sharply thickened, representing a strip of adipose tissue with passing. Between groups of fat cells and blood vessels. The boundary between the epicardium and myocardium is not clearly expressed due to the fact that adipose tissue seems to penetrate deep into the myocardium in the form of strands of fat cells. In those places where obesity of the connective tissue layers between muscle fibers is most pronounced, the latter are thinned (pressure atrophy). In the deeper parts of the myocardium, where there is no adipose tissue, muscle fibers without significant changes have normal thickness.
Designations
1) thickened fatty layer of the epicardium
2) fat cells between worn out muscle fibers
H) muscle fibers of normal thickness
Microslide
Intermediate obesity of the intima of the vessel (artery)
Color - Sudan
At low magnification, focal intimal thickening is visible. At the site of thickening, the intima is diffusely stained with Sudan - this is obesity of the interstitial substance. As lipids accumulate in the interstitial substance, macrophages appear that capture droplets of fat (resorptive obesity); such cells are called xanthoma cells. Xanthoma cells in the preparation look like orange spots of various shapes containing a nucleus.
Designations
1) thickening of the intima
2) obesity of the interstitial substance
H) xanthoma cells
TOPIC: Blood and lymph circulation disorders -1
(hyperemia, ischemia, bleeding, hemorrhage).
Microslide
Brown induration of the lungs
The small vessels of the lung are dilated and filled with blood. The interalveolar septa are thickened due to the growth of connective tissue in them. In the alveoli and septa, large cells, macrophages, containing the pigment hemosiderin (brown) are visible - the so-called cardiac defect cells. Such changes in the lungs are observed most often with heart defects, less often with chronic heart failure of another origin.
Designations
1) thickened interalveolar septum
2) dilated capillaries
H) cardiac defect cells
Microslide
Congestive congestion of the liver
The central veins are sharply dilated. In the centers of the lobules, the capillaries are dilated and filled with blood. The hepatic beams located between them, on the contrary, are narrowed (pressure atrophy), and in some places are not defined at all. Along the periphery of the lobules, stagnation is much less pronounced, the hepatic beams and capillaries have a normal appearance.
Designations
1) dilated central veins
2) dilated capillaries in the center, lobules
H) compressed liver beams in the center of the lobules
4) unchanged hepatic beams and capillaries along the periphery of the lobules
Microslide
Old cerebral hemorrhage
Under low magnification, an old focus of hemorrhage is visible, surrounded by a demarcation line. In the demarcation zone there are many macrophages containing hemosiderin (granular yellow-brown pigment). The pigment is formed in macrophages. When macrophages are destroyed, the pigment lies free in the tissue. Considering the accumulation of hemosiderophages in the tissue around the shed blood, the hemorrhage should be considered old.
Designations
1) large focus of hemorrhage
2) demarcation line
a) macrophages with hemosiderin
b) free hemosiderin grains
H) brain tissue
TOPIC: Disorders of blood and lymph circulation-2
(thrombosis, embolism, heart attack).
Microslide
Obstructive thrombus with organization
When examining the drug with the naked eye, it is easy to determine the stenosis of the artery and the red-pink color of the mass of the blood clot, completely blocking the lumen. Using low magnification, they study the composition of the blood clot, noting the presence of varying thicknesses of fibrin threads and numerous red blood cells, as well as hemosiderophages. In places where the thrombus comes into contact with the arterial wall, thin-walled vessels and accompanying granulation tissue cells growing into the thrombus are visible.
Designations
1) artery wall
2) capillaries and accompanying cells, mainly macrophages and fibroblasts, growing into a blood clot (organization of a blood clot)
H) fibrin threads and red blood cells of the thrombus
Microslide
Fat embolism of the lung
Staining: Sudan + hematoxylin
Drops of fat are visible in the vessels of the interalveolar septa. Such changes can occur with fractures of tubular bones, with crushing of adipose tissue, with convulsions.
Designations
1) interalveolar septum
2) drops of fat in the vessels of the interalveolar septum (colored yellow with Sudan)
Microslide
Hemorrhagic pulmonary infarction
In the preparation one can distinguish three areas not sharply demarcated from each other: necrosis, reactive inflammation, congestive plethora. The area of necrosis is completely saturated with blood. Nuclear detritus is located along the interalveolar septa. Only the outlines of the walls have been preserved from the vessels. On the pleura, corresponding to the area of the infarction, fibrin is deposited. The zone of reactive inflammation is a strip of lung tissue with sharply dilated vessels, small hemorrhages, leukocytes and red blood cells in the lumen of the alveoli. The pulmonary tissue surrounding the area of necrosis shows signs of venous stagnation: the capillaries of the interalveolar septa are dilated and filled with blood. In the lumen of the alveoli there are many alveolar macrophages with grains of coal and hemosiderin in the cytoplasm, as well as erythrocytes (diapedesis).
Designations
1) site of infarction
a) red blood cells permeating the entire area of necrosis
b) nuclear detritus along the interalveolar septa
c) necrotic vessels that have retained only their general outlines
2) zone of reactive inflammation
a) dilated capillaries filled with blood b) small hemorrhages and leukocytes
H) pulmonary tissue surrounding necrosis with symptoms of venous stagnation
a) dilated interalveolar septa rich in blood
b) cells of heart defects
c) red blood cells in the lumen of the alveoli
Microslide
Ischemic myocardial infarction with the onset of organization
In the myocardium, over a large area, there are no nuclei in the muscle fibers, but the contours of the fibers are preserved - this is a heart attack. Along its periphery grows young connective tissue, rich in blood vessels, macrophages, fibroblasts - this is an organization.
Designations
1) necrotic muscle fibers
2) connective tissue growing into the area of necrosis
3) normal muscle fibers
TOPIC: Necrosis.
Microslide
Ischemic renal infarction
The kidney has a large, approximately triangular-shaped area of necrosis. The glomeruli and tubules of this area are devoid of nuclei and are structureless formations that retain only general contours. The nuclei of the connective tissue layers are in a state of pyknosis and rhexis. Fragments of nuclei are mixed into the total mass of detritus. Along the periphery of the necrotic area, sharply dilated, full-blooded vessels and small hemorrhages are noticeable. Behind the hemorrhagic belt there is tissue with a well-defined cellular structure of glomeruli and tubules.
Designations
1) area of necrosis
a) necrotic glomeruli (nuclei are not stained)
b) necrotic tubules
c) nuclear detritus
2) hemorrhagic belt formed by small hemorrhages and dilated vessels filled with blood
3) normal kidney tissue
a) glomerulus with stained nuclei b) tubule with stained nuclei
Microslide
Necrosis of the convoluted tubule epithelium of the kidney (necrotizing nephrosis)
The convoluted tubule epithelium is sharply swollen, filling the lumen of the tubules. Nuclei are absent in most cells, and the boundaries are poorly defined. Necrotic cells are in places saturated with lime salts. The cellular structure of glomeruli and straight tubules, in contrast to convoluted tubules, is well expressed.
Designations
1) necrotic epithelium of convoluted tubules (nuclei are not stained)
2) normal glomerulus
H) normal straight tubules
Microslide
Focus of caseous necrosis in the lung with encapsulation
There are areas in the lung tissue in which the alveoli are filled with exudate and the border of the alveoli is poorly distinguishable, however, the nuclei in the septa and exudate cells are colored, therefore, the tissue is not yet necrotic. Against this background, foci of necrosis are visible, in which the nuclei are not colored, and the tissue structure is not distinguishable. Fibrous connective tissue grows around such lesions (encapsulation). Near the capsule there are clumps of decaying nuclei in necrosis (karyorrhexis).
Designations
1) area of necrosis with karyorrhexis
2) connective tissue capsules
H) normal lung tissue
TOPIC: Inflammation -1. Exudative inflammation.
Microslide 3
Necrotizing tonsillitis
Staining - hematoxylin-eosin
In the depths of the tonsil crypts, the epithelium is necrotic and lacks nuclei. On the surface of foci of necrosis there is a protein exudate with fibrin filaments and accumulations of microbes in the form of microcolonies (painted blue with hematoxylin). Proliferation is weakly expressed.
Designations
1) tonsil tissue
a) follicles
b) crypts
2) necrosis of the epithelium in the crypt wall
Microslide
Croupous tracheitis
Staining - hematoxylin-eosin
The epithelial lining of the trachea is almost universally absent. On the surface of the mucous membrane there are deposits of fibrin in the form of thin, intertwined threads, among which are leukocytes, which mostly disintegrate. There is pronounced edema in the submucosa, it is sharply thickened, infiltrated with many lymphoid cells and leukocytes with a predominance of the latter, and contains dilated vessels filled with formed elements.
Designations
1) mucous membrane of the trachea
2) superficially located fibrinous deposits in the form of thin intertwined threads
H) disintegrating leukocytes among fibrin threads
4) thickened, edematous submucosa, and in it a) dilated vessels
b) infiltrate consisting predominantly of leukocytes
Microspecimen of intestinal phlegmon
Staining - hematoxylin-eosin
The intestinal wall is sharply thickened. All its layers (mucosal, submucosal, muscular) are diffusely infiltrated with exudate consisting of leukocytes (purulent exudate). Purulent exudate is especially clearly visible in the intermuscular layers and in the submucosa.
Designations
1) layers of the intestinal wall
2) purulent infiltrate of all layers of the wall
H) inflammatory vascular hyperemia
Microslide
Metastatic abscess in the myocardium
Staining - hematoxylin-eosin
In the muscle tissue of the heart, limited foci of purulent inflammation are visible, according to which the muscle tissue is melted - these are abscesses. In the center of some of them microbial emboli are visible; they are stained with hematoxylin in an intense blue color. Such abscesses are called metastatic, because. they arise due to the transfer of microbes from some other source.
Designations
1) myocardium
2) abscess
H) microbial embolus
Microslide
Diphtheritic pharyngitis
Staining - hematoxylin-eosin
A thick fibrinous film replaces the stratified squamous epithelium over a large area and penetrates deep into the epithelium (diphtheritic inflammation). The film is permeated with leukocytes, and accumulations of microbes can be seen on the surface of the film. The pharynx tissue is swollen, infiltrated with leukocytes, lymphoid cells, histiocytes, and the blood vessels are dilated.
Designations
1) fibrinous film penetrating into the thickness of the epithelium
2) edematous tissue of the pharynx with dilated vessels
H) cellular infiltration
TOPIC: Inflammation -2. Productive and specific inflammation,
Microslide
Granulation tissue
The basis of ordinary granulation tissue is made up of many thin-walled blood vessels, around which various types of cells are located. Macrophages and fibroblasts are the most common. Macrophages are large cells, mostly irregular in shape. The nuclei of macrophages can differ significantly from each other in shape, size and chromatin content; what these cells have in common is a large amount of cytoplasm. Fibroblasts are elongated and resemble a spindle. Their elongated nuclei are poor in chromatin and often contain two or three large nucleoli. In addition to macrophages and fibroblasts, leukocytes with segmented nuclei are found in varying quantities, then lymphocytes, plasma cells with a characteristic nuclear structure in the form of wheel spokes, giant cells of foreign bodies and others can be found. Depending on the degree of maturity of the granulation tissue, single or, on the contrary, numerous collagen fibers lie between the cells.
Designations
1) thin-walled blood vessels
2) macrophages
H) fibroblasts
4) leukocytes
5) lymphocytes
Microslide 3
Fibrinous pericarditis in the organizing stage
Fibrinous deposits on the epicardium appear in the form of threads and lumps of varying thickness. Between the fibrin threads there are gaps into which granulation tissue grows from the epicardial side. Granulation tissue consists of vessels and accompanying cells, mainly macrophages and fibroblasts. In places where macrophages come into contact with fibrin, small cavities are found in the latter (lacunar resorption of fibrin by macrophages). Sometimes it is possible to see phagocytosed fibrin particles and nuclear fragments in the cytoplasm of macrophages. In those places where fibroblasts predominate in the granulation tissue, fibrin destruction is less pronounced. Among fibroblasts there are thin collagen fibers. -
Designations
1) application of fibrin in the form of threads and lumps
2) granulation tissue growing into fibrinous deposits:
a) vessels
b) macrophages
c) fibroblasts
3) lacunar resorption of fibrin by macrophages
4) epicardial fat cells
Microslide
Cirrhosis
Staining with picrofuchsin according to Van Gieson
When stained with picrofuchsin, strands of connective tissue in the form of rings covering groups of hepatic lobules are clearly visible. Dystrophic changes in the liver parenchyma are expressed primarily in fatty degeneration of liver cells. The exudative factor is represented by lymphoid
infiltration, productive - the formation of the above
connective tissue cords and so-called false passages in the form of small epithelial tubes. Areas of progressive inflammation are characterized by a significant lymphoid infiltrate and relatively numerous false bile ducts. In those places where the inflammatory process has ended or subsides, the connective tissue layers are represented by coarser bundles of fibers.
Designations
1) fibrous connective tissue in the form of rings covering groups of hepatic lobules
2) lymphoid infiltrate in fibrous connective tissue
3) fatty degeneration of liver cells
Microslide X
Metaplasia of multirow ciliated epithelium of the bronchi into stratified squamous epithelium
Longitudinal section of the bronchus. Its lumen is expanded with sawtooth outgrowths due to chronic inflammation of the wall (bronchiectasis, the epithelial lining is heterogeneous; in some places it retains the appearance of multirow ciliated epithelium, and in others of stratified squamous epithelium). The transformation of multilayered epithelium into multilayered squamous epithelium is called metaplasia.
Designations
1) bronchial wall
a) stratified ciliated epithelium b) stratified squamous epithelium
Microslide
Epithelioid tubercles in the lung
Already with the naked eye you can see tubercles in the preparation with a shape and size reminiscent of a pinhead. Microscopic examination reveals that the bulk of the tubercle consists of epithelioid cells, large and light. Among the epithelioid cells, there are Langhans giant cells with a characteristic arrangement of nuclei in the form of a palisade. A cluster of epithelioid cells is surrounded by a rim of lymphocytes. The tubercles merge with each other in places. By moving the specimen, you can detect different stages of development of the tubercles. There are often tubercles with caseous necrosis in the center. Epithelioid cells, having turned into fibroblasts, are located around the necrosis, forming a capsule, or grow into the necrosis, organizing it.
Designations
1) epithelioid tubercle
2) epithelioid tubercle with caseous necrosis in the center
Microslide X
Caseous pneumonia
At low magnification, it is clear that almost all of the lung tissue is airless. In some areas, the lung tissue is necrotic and has the appearance of a pink, fine-grained mass with fragments of chromatin with poorly visible contours of the alveoli. Along the periphery of these necrotic foci, the structure of the interalveolar septa is still preserved, the lumen of the alveoli is filled with protein exudate with an admixture of alveolar macrophages and single leukocytes.
Designations
1) caseous pneumonia (cells of exudate and interalveolar septa are necrotic)
2) exudate consisting of protein fluid, alveolar macrophages and leukocytes
In a preparation stained with fuchsilin for elastic fibers, it is clear that the elastic framework of the septa in areas of caseous necrosis is mostly preserved.
Microslide
Syphilitic aortitis
The main changes are found in the middle shell. A gummous infiltrate, consisting of lymphoid cells with an admixture of plasma cells, is located along the vessels. In places where cells accumulate, elastic fibers are destroyed. Lymphoid infiltrates are also found, although in smaller quantities, in the adventitia and inner membrane. In the inner shell there are characteristic retractions in places where scar tissue forms
Look at the preparation stained with hemotoxylin-eosin, and then compare it with the preparation stained according to Weigert for elastic fibers:
Designations
1) gummous infiltrate of lymphoid cells along the vessels in the tunica media
2) intimal retractions in places where scar tissue develops
H) destroyed elastic structures in the middle shell
Microslide I4
Actinomycosis
Granuloma in actinomycosis consists of lymphoid, epithelioid and xanthoma cells. In places where drusen are located, granuloma undergoes purulent transformation. Along with this, there is the development of connective tissue, which, depending on the stage of the process, has different maturity, but more often scar tissue predominates. The further away from the drusen, the less pronounced the purulent melting is; the inflammatory infiltrate is gradually lost in the surrounding tissue of the organ.
Designations
1) drusen of radiata fungus
2) accumulations of leukocytes surrounding the drusen
H) xanthoma cells
4) epithelioid cells
5) lymphocytes
TOPIC: Compensatory and adaptive processes.
Microslide
Emphysema
The lumens of the alveoli and alveolar ducts are expanded. The interalveolar septa are significantly thinned and poor in capillaries. In some places, the interalveolar septa are not only atrophied, but also torn. Due to the rupture of the interalveolar septa, common cavities are formed from a number of alveoli adjacent to each other.
studfiles.net
Description of drugs in Lesson No. 09
Description of drugs in Pathological Anatomy in Lesson No. 9
(This is an indicative description, not a cathedral one, some drugs may be missing, like the description of previous years)
LESSON No. 9 PATHOLOGY OF THE IMMUNE SYSTEM
ELECTRONOGRAM MUCOID Swelling
Tissue swelling, accumulation of acidic aminoglycans in the stroma. Collagen fibers are preserved.
ELECTRONOGRAM FIBRINOID NECROSIS
Collagen fibers are destroyed, their cross-striations are not determined. The spaces between the preserved collagen fibers are expanded (this is preceded by plasmorrhagia).
ELECTROGRAM CELL CYTOLYSIS IN CHRONIC ACTIVE HEPATITIS B (DEMONSTRATION)
MICROPREPARATION No. 149 BIOPTATE OF BRONCHUS FOR BRONCHIAL ASTHMA (HEM.-EOS.)
In the lumen of the bronchus, a layered secretion is determined, consisting of eosinophates and flattened epithelium (cylindrical epithelium). The basement membrane of the mucous membrane is thickened. The lamina propria is infiltrated by mast cells, lymphocytes, macrophages, and plasma cells. Note hypersecretion of mucous glands (enlarged, secreted). The vessels are full-blooded, dilated, and perivascular edema is noted. Sclerosis of the submucosal membrane. Note hypertrophy of muscle fibers. Additional staining: tuloidine blue: mast cells are lilac-colored.
MICROPREPARATION No. 81 EXTRACAP. PRODUCTIVE GLOMERULONEPHRITIS (HEM.-EOS.)
Antibodies damage the glomeruli. The main percent is extracapillary (Shumlyansky capsule - outer leaf => in the form of crescents). The glomeruli are increased in volume, proliferation is noted. Noting fibrinoid necrosis of individual loops. Deposition of fibrin in the glomerulus. In the epithelium of the proximal tubules – hyaline-droplet degeneration, edema.
MICROPREPARATION No. 222 LUPUS NEPHRITIS (HEM.-EOS.)
The glomeruli are enlarged, the bases of the capillary membranes are exposed, thickened, and have the appearance of “wire loops.” Fiber necrosis of individual loops and karyorrhexis are characteristic; the presence of hematoxylin bodies (hyalinosis at the site of fibrinoid necrosis). In the epithelium of the proximal tubules there is hydropic dystrophy. Blood clots are visible in the capillaries.
MICROPREPARATION No. 228(B) CHRONIC VIRAL ACTIVE HEPATITIS B (HEM.-EOZ.)
Sclerosis, abundantly infiltrated by leukocytes and macrophages. Hepatocytes undergo necrosis and apoptosis. Note hydropic degeneration of hepatocytes.
MICROPREPARATION No. 150 THYMUS FOR MYASTHENIAS
There is an increase in the number of lymphocytes and hyperplasia of Hassal's bodies (increased in volume).
MICROPREPARATION No. 153 HASHIMOTO GOITTER (HEM.-EOZ.)
The parenchyma of the gland secretes an infiltrate consisting of macrophages and lymphocytes. In places there are follicles with reproductive centers. The intact follicles of the thyroid gland are lined with cells with eosin and granular cytoplasm
MICROPREPARATION No. 20 SAG SLEEN (HEM.-EOZ.)
Amyloid is present in the intima of arteries and follicles. Amyloid appears as shapeless eosinophils, hyaline-like masses.
MICROPREPARATION No. 20 (B) CONGO-ROT staining
Amyloid is brick-red in color. Mark the glow in the form of a green apple
MICROPREPARATION No. 19 SEBIOUS SLEEN
Amyloid overlay is noted in the red and white pulp. Cellular elements are displaced
MACROPREPARATION LARGE MOTIFIED KIDNEY
Increased in volume
Flabby
Surface smooth, mottled
In cross-section, motley, yellow with red speckles
MACRO PREPARATION FOR HASHIMOTO'S GITTER
The thyroid gland is asymmetrical
Dense
The surface is finely to coarsely lumpy
Brownish in section, composed of many nodes of various diameters (bur-ser), separated by layers of whitish tissue
There are fine-grained areas with pale gray inclusions
Rubber consistency
MACRO PREPARATION SAG SLEEN
Increased in size
On cross-section, brownish-bluish with diff splashes of whitish-gray color, in the form of sago grains
MACRO PREPARATION SEIQUE SLEEN
Increased in size (much larger than sago)
Dense
Surface smooth
On the cut, brownish with a greasy sheen
Nutmeg liver is a consequence of chronic congestive venous congestion of the internal organs. This condition affects not only the digestive system, but also the heart, lungs, kidneys and brain.
Classification
Morphologically, there are three stages of changes occurring in the liver as the disease progresses:
- Nutmeg liver: against the background of fatty degeneration of cells (yellow color), dilated vessels (dark red color) are visible.
- Congestive fibrosis: the tissue is denser due to the overgrowth of connective tissue. Blood permeates the parenchyma of the organ, and foci of sclerosis appear.
- Cardiac cirrhosis: the surface of the organ takes on a lumpy appearance.
Etiology
Violation of the outflow of blood from the portal vein system leads to the formation of such a phenomenon as nutmeg liver. The causes of stagnation are impaired ventricular function and decreased venous return. These are manifestations of heart failure, and often accompany coronary heart disease. Increased pressure in the venous system, as well as accumulation and stagnation of blood in the vessels, prevent effective blood flow to the organs.
Epidemiology
The disease is not associated with gender or age. But statistically, senile and elderly men most often suffer from it. Most often, only at autopsy can it be determined that the patient had nutmeg liver. Pathological anatomy can provide answers to questions that interest the attending physician. To do this, the organs are not only visually assessed, but also sent for
Risk factors for the development of liver pathology are physical inactivity, unhealthy diet, bad habits, a history of heart disease, as well as an elderly person.
Clinic
In most cases, symptoms of heart failure dominate the clinical picture of the disease, so the patient may not suspect that he has liver problems. Nutmeg liver, like any other cirrhosis, is manifested by pain in the right hypochondrium, yellowness of the skin and mucous membranes, swelling in the legs at the end of the day, ascites (accumulation of fluid in the abdominal cavity). But these are all indirect signs. A definitive diagnosis can only be made after an autopsy, because none of the modern imaging methods can show whether an organ resembles a nutmeg. On palpation, the liver will be dense, its edge is rounded and protrudes from under the costal arch.
Diagnostics
In order to make a diagnosis of “chronic passive venous congestion”, it is necessary:
1. Confirm the presence of heart failure (instrumental or physical examination):
- chest x-ray (indicates changes in the heart, lungs, or effusion);
- Doppler examination of the heart and inferior vena cava (to identify the causes of heart disease);
- CT or MRI;
2. Conduct laboratory tests, such as biochemical blood tests and:
- bilirubin in the blood increases;
- Transaminases (ALT, AST) increase moderately;
- increased alkaline phosphatase levels;
- decrease in albumin and prolongation of blood clotting time.
3. Resort to instrumental diagnostics to morphologically establish the fact of liver degeneration. Such studies include:
- laparocentesis (aspiration of free fluid from the abdominal cavity) to determine the causes of ascites;
- puncture biopsy (to confirm the diagnosis of “nutmeg liver”, a microspecimen can be made during the patient’s lifetime).
Complications
Nutmeg liver and the cardiac cirrhosis that causes it have no effect on the outcome of heart failure. Cases where acute liver failure became the cause of death are rare and cannot be considered indicative. Bleeding disorders are also quite rare, although not unprecedented. Some experts suspect that there is a connection between cirrhosis of the liver and the occurrence of malignant neoplasms, but this theory has not yet been proven.
Treatment
Drug therapy should be aimed at eliminating the underlying disease, that is, heart failure. Cirrhosis itself has no specific therapy. In addition, the patient is recommended to follow a diet with limited salt and change his daily routine in order to get enough sleep, be in the fresh air and get enough exercise. These simple manipulations will help reduce blood pressure in the great vessels, including
Symptomatic therapy consists of taking diuretics (to reduce the amount), as well as beta blockers and ACE inhibitors (to normalize heart function).
Surgical treatment is usually not performed. This involves a great risk for the patient and is not worth it. Sometimes the doctor may decide to bypass the intrahepatic part of the portal vein, but this can lead to serious heart failure of the right ventricular type and pulmonary edema due to a sharply increased venous return.
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Rice. 5.1. Macropreparations. Chronic venous congestion of the liver (nutmeg liver). The liver is enlarged in volume, dense in consistency, the capsule is tense, smooth, the anterior edge of the liver is rounded. On a section, the liver tissue appears variegated due to the alternation of small foci of red, dark burgundy and yellow, resembling a nutmeg pattern on a section. The liver veins are dilated and full of blood. Insert - nutmeg
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Rice. 5.2. Microspecimens. Chronic venous congestion of the liver (nutmeg liver): a - pronounced congestion of the central sections of the lobules (up to the appearance of “lakes of blood” in the center of the lobules with necrosis of hepatocytes around the central veins), normal blood supply in the outer third. Blood stagnation does not extend to the periphery of the lobules, since at the border of the outer and middle third of the lobules, blood flows into the sinusoids from the branches of the hepatic artery. Arterial blood pressure interferes with the retrograde spread of venous blood. Fatty degeneration of hepatocytes of the outer third of the liver lobules; b - fatty degeneration of hepatocytes of the outer third of the liver lobules, vacuoles with lipids are colored orange-yellow with Sudan III, stained with Sudan III; a - ×120, b - ×400
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Rice. 5.3. Electron diffraction pattern. Nutmeg (congestive, cardiac) liver fibrosis; 1 - newly formed collagen fibers, the appearance of a basement membrane in the perisinusoidal space (space of Disse) near lipofibroblasts (capillarization of sinusoids) with signs of synthetic activity. From
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Rice. 5.4. Macropreparation. Pulmonary edema. Lungs with reduced airiness, full of blood, a large amount of light, sometimes pinkish, foamy fluid flows from the cut surface due to the admixture of blood. The same foamy liquid fills the lumens of the bronchi
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Rice. 5.5. Macropreparations. Cerebral edema with dislocation syndrome: a - the brain is enlarged, the gyri are flattened, the furrows are smoothed, the soft meninges are cyanotic, with full-blooded vessels; b - on the cerebellar tonsils and brain stem there is a depression from a herniation into the foramen magnum, petechial hemorrhages along the line of the herniation - dislocation syndrome
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Rice. 5.6. Macropreparation. Brown induration of the lungs. The lungs are enlarged in size, have a dense consistency; on a section in the lung tissue there are multiple small inclusions of brown hemosiderin, gray layers of connective tissue in the form of a diffuse mesh, proliferation of connective tissue around the bronchi and vessels (chronic venous congestion, local hemosiderosis and pulmonary sclerosis). Foci of black color are also visible - anthracose
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Rice. 5.7. Microspecimens. Brown induration of the lungs; a - when stained with hematoxylin and eosin, loose granules of the brown pigment hemosiderin are visible, the same granules in cells (sideroblasts and siderophages) in the alveoli, interalveolar septa, peribronchial tissue, lymphatic vessels (also in the lymph nodes of the lungs). Congestion of the interalveolar capillaries, thickening of the interalveolar septa and peribronchial tissue due to sclerosis; drug N.O. Kryukova; b - when stained according to Perls (Perls reaction), the granules of the hemosiderin pigment turn bluish-green (Prussian blue); ×100
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Rice. 5.8. Macropreparation. Cyanotic induration of the kidneys. The kidneys are enlarged in size, dense in consistency (induration), with a smooth surface, in section the cortex and medulla are wide, uniformly plethoric, bluish in appearance (cyanotic)
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Rice. 5.9. Macropreparation. Cyanotic induration of the spleen. The spleen is enlarged in size, of dense consistency (induration), with a smooth surface, the capsule is tense (weakly expressed hyalinosis of the spleen capsule is also visible - “glazed” spleen). On a section, the spleen tissue is bluish (cyanotic) with narrow grayish-white layers
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Rice. 5.10. Acute and chronic (stasis dermatitis) venous congestion of the lower extremities; a - the lower limb is enlarged in volume, edematous, cyanotic (cyanotic), with petechial hemorrhages - acute venous congestion in acute thrombophlebitis of the veins of the lower extremities; b - the lower limb is enlarged in volume, edematous, bluish (cyanotic), the skin is thickened with pronounced hyperkeratosis - trophic disorders - congestive dermatitis in chronic venous congestion caused by chronic heart failure (b - photo by E.V. Fedotov)
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Rice. 5.11. Macropreparation. Bleeding in the brain (intracerebral non-traumatic hematoma). In the area of the subcortical nuclei, parietal and temporal lobes of the left hemisphere, in place of destroyed brain tissue, there are cavities filled with blood clots; due to the destruction of the walls of the left lateral stomach - a breakthrough of blood into its anterior and posterior horns. Throughout the rest of the brain, the architectonics of the brain is preserved, its tissue is swollen, the furrows are smoothed, the convolutions are flattened, the ventricles are dilated, and there is an admixture of blood in the cerebrospinal fluid. Intracerebral hematoma can be non-traumatic (for cerebrovascular diseases) or traumatic (for traumatic brain injury)
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Rice. 5.12. Microslide. Hemorrhage in the brain (intracerebral non-traumatic hematoma). At the site of hemorrhage, brain tissue is destroyed, structureless, replaced by blood elements, primarily erythrocytes, partially lysed. Around the foci of hemorrhage - perivascular and pericellular edema, dystrophic changes in neurons, accumulation of sideroblasts and siderophages, proliferation of glial cells; ×120
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Rice. 5.13. Macropreparation. Acute erosions and stomach ulcers. In the gastric mucosa there are multiple small, superficial (erosions) and deeper, involving the submucosal and muscular layers of the stomach wall (acute ulcers), round defects with soft, smooth edges and a brownish-black or gray-black bottom (due to hydrochloric acid hematin, which is formed from hemoglobin of erythrocytes under the influence of hydrochloric acid and gastric juice enzymes). At the bottom of some acute erosions and ulcers there are blood clots (current gastric bleeding)
