ZHOU REN周 韧
Prof., M.D., Ph.D.
Institute of Pathology & Forensic MedicineDepartment of Pathology & Patho-physiology
Zhenjiang University Judicial Evidence & Evaluation Center
Zhejiang University School of Medicine
General Curriculum
Cell injury and AdaptationPart III
Chapter 1. Cell injury and AdaptationPart III
Course of Basic Medical Sciences Chapter 1
2. Cell DeathI. Necrosis
Def. Necrosis may be defined as the morphology of cell death in living body.
AutolysisHeterolysis
Course of Basic Medical Sciences Chapter 1
Fundamental changes①Nuclear changes: Pyknosis, karyorrhexis, Karyolysis.
②Cytoplasmic changes: acidophilic, granular, opaque mass.
Course of Basic Medical Sciences Chapter 1
Gross appearances of necrosis in earlier stage
Course of Basic Medical Sciences Chapter 1
Classification of necrosisDifferent classifications of necrosis type
①Coagulative necrosis②Caseous necrosis③Liquefactive necrosis④ Fat necrosis
Fibrinoid necrosis (Fibrinoid change )Gangrene
a)Dry gangreneb)Moist gangrenec)Gas gangrene
Course of Basic Medical Sciences Chapter 1
① Coagulative necrosis② Liquefactive necrosis③ Types of Special necrosis
Caseous necrosisGangrene
a) Dry gangreneb) Moist gangrenec) Gas gangrene
Fat necrosisFibrinoid necrosis (Fibrinoid change )
Course of Basic Medical Sciences Chapter 1
Types of necrosis.①Coagulative necrosisConception: Coagulative necrosis implies preservation of the basic outline of the coagulated cell for some days with the disappearance of fine structures (cellular details) within cell.
Course of Basic Medical Sciences Chapter 1
Course of Basic Medical Sciences Chapter 1
Mechanism: Intracellular acidosis denatures not only structural proteins but also enzymic proteins and so blocks the proteolysis of the cell.
Course of Basic Medical Sciences Chapter 1
Morphology:②Caseous necrosis
Conception: A distinctive form of coagulative necrosis, most often occurs in tuberculosis. The term “caseous” is derived from the gross appearance of the necrotic area. i.e. white and cheesy. Characteristic morphology: disappearance of both basic outline and fine structures (cellular details) within cell of the affected cell.
Course of Basic Medical Sciences Chapter 1
Course of Basic Medical Sciences Chapter 1
③Liquefactive necrosisConception: The damaged cells are lysed by autolysis or heterolysis leaving amorphous, fluid or semifluid material.Morphology:
Course of Basic Medical Sciences Chapter 1
④ Fat necrosisa)Enzymatic fat necrosis: In acute pancreatitis, activated pancreatic enzymes are released from pancreas resulting in destruction of fat tissue.b)Traumatic fat necrosis: Trauma induce rupture of fat cells. The released fat causes chronic inflammation and foreign body reaction.
Course of Basic Medical Sciences Chapter 1
Course of Basic Medical Sciences Chapter 1
Fibrinoid necrosis(Fibrinoid change) Conception: Accumulation of pink staining homogenous masses of fibrin, immunoglobulins, and other plasma proteins within the vascular wall, connetive tissue is known as fibrinoid change.
Course of Basic Medical Sciences Chapter 1
GangreneDef. Massive necrosis of body surface or organs with a passage to the body surface with putrefaction superadded is known as gangrene.
Course of Basic Medical Sciences Chapter 1
Classification:a)Dry gangrene
Conception: Dry gangrene occurs in the extremities due to occlusion of large artery with intact venous returns. The necrotic area is well dermacated black and mummification.
Course of Basic Medical Sciences Chapter 1
Morphology:Course of Basic Medical Sciences Chapter 1
b)Moist gangreneConception: Blockage of venous return and artery supply→massive necrosis followed by liquefaction caused by bacterial enzyme→purplish black color with fouelsmelling.
Course of Basic Medical Sciences Chapter 1
c)Gas gangreneConception: A serious complication of war wounds. deep contaminated wound(massive necrosis) + clostridia group bacterial infection→gas production through the action of saccharolytic and proteolytic enzyme released from bacteria.
Course of Basic Medical Sciences Chapter 1
Course of Basic Medical Sciences Chapter 1
Cellular aging
functional alterationmorphorlogy
Aging clock•telomeres: its length ∝ life span• telomerase: control of the length
Course of Basic Medical Sciences Chapter 1
II. ApoptosisConception: Apoptosis is a distinct type of cell death(cell suicide). It usually involves single cells, or cluster of cells. It is thought to be responsible for numerous physiologic events as well pathologic including the programmed destruction of cells during embryo-genesis..
Course of Basic Medical Sciences Chapter 1
Course of Basic Medical Scie ter 1nces Chap
Biochemical Characteristics of Apoptosis:
• 由基因调控,是耗能的主动过程
• Ca2+/Mg2+依赖的核酸内切酶活化
• DNA断裂以核小体为单位
• DNA电泳呈阶梯状图谱
Course of Basic Medical Sciences Chapter 1
Course of Basic Medical Sciences Chapter 1
Molecular Mechanism of Apoptosis:
Course of Basic Medical Sciences Chapter 1
Course of Basic Medical Sciences Chapter 1
I. Physiology of Apoptosis :
Course of Basic Medical Sciences Chapter 1
Biological significances of Apoptosis:
1. Programmed cell death in embryo-development for shaping the body morphology.
2. Hormone-depended cell retrogrades in adult.
e.g. uterus endomembrane in menses cycle, ovary follicle occlusion in manopause, post-feed breast gland retrogrades.
3. Relative balance of cell number in cellular dynamics, e.g. epithelium in crypt of small intestine.
4. The remove of post-life cell: neutrophils post-acute inflammation, lymphocytes post-immune reactions,
5. The remove of harmful cell: self-reaction lymphocytes, post-reaction Tc cell after virus infection and neoplasm.
The diseases caused by abnormal increment of apoptosis :
Course of Basic Medical Sciences Chapter 1
Alzheimer’s disease /neuron cell
AIDS/ MΦ,TH
some virus infection: Councilman body in viral hepatitis
post-radio injury or drug injuryprotected from mutation of DNA
infarction of myocardium or stroke (apoplexy)
Biological significances of Apoptosis:II. Pathology of Apoptosis :
some types of pathological atrophy due to duct occlusion of pancreas, parotid or kidney
post-gonadectomy atrophy: post-testectomy prostate gland
Course of Basic Medical Sciences Chapter 1
The diseases caused by abnormal decrement of apoptosis :
Some type of neoplasia
Some type of Autoimmune diseases: e.g. SLE
Key words in this chapter
Course of Basic Medical Sciences Chapter 1
NecrosisCoagulative necrosisCaseous necrosisLiquefactive necrosisFat necrosisFibrinoid necrosis Gangrenea)Dry gangreneb)Moist gangrenec)Gas gangrene
ApoptosisAdaptationAtrophyHypertrophyHyperplasiaMetaplasia
Degeneration Cellular swellingFatty changeHyaline changeAmyloid change(amyloidosis)Mucoid degenerationIntracellular pigment accumulationPathological calcification
Chapter 2 Regeneration and Repair
Course of Basic Medical Sciences Chapter 2
REGENERATION
Control of Cell GrowthMolecular events in cell growthDifferentiation at site of injuryExtracellular matrix and Cell-Matrix interactions
Course of Basic Medical Sciences Chapter 2
1. Labile cells continue to multiply throughout the life to replace those shed or destroyed cells during physiologic processes, including epidermis, alimentary, respiratory and urinary epithelium, hemopoietic cells, lymphoid cells.
Course of Basic Medical Sciences Chapter 2
2. Stable cells normally cease multiplication but retain mitotic ability during adult life. e.g. liver cell, kidney tubular cells, endocrine cells.
3. Permanent cells loss mitotic ability, comprise neurons and skeletal and cardiac muscle cells.
Course of Basic Medical Sciences Chapter 2
Course of Basic Medical Sciences Chapter 2
Course of Basic Medical Sciences Chapter 2
Regeneration: The migration and proliferation of specialized cells re- establishing the anatomical and functional integrity of an organ or tissue. These processes may ac t a lone, but usua l ly found incombination.
Course of Basic Medical Sciences Chapter 2
Molecular events of cell growthCourse of Basic Medical Sciences Chapter 2
Course of Basic Medical Sciences Chapter 2
Course of Basic Medical Sciences Chapter 2
Extracellular matrix and Cell-Matrix interactionsCourse of Basic Medical Sciences Chapter 2
REPAIRRepair: the migration and proliferation of connective tissue cells
leading to scar formation.(Organization)
1. Angiogenesis2. Fibrosis3. Maturation and organization of the scar (remodeling)
Organization is the replacement of dead tissue or inert material by granulation tissue—immature fibrovasculartissue. It is seen in infarct, hematoma, thrombi, and fibrinous exudates.
Granulation tissue is formed by proliferative (novel) fibroblasts and capillaries.
Course of Basic Medical Sciences Chapter 2
Course of Basic Medical Sciences Chapter 2
Course of Basic Medical Sciences Chapter 2
WOUND HEALINGHealing is the replacement of dead tissue by
viable tissue. In considering the healing of skin wound,two types of healing are usually distinguished.
Course of Basic Medical Sciences Chapter 2
1. Healing by first intention which occurs in a clean wound with a minimum space between the margins——incised wound.Stages in healing may be as follows: (1) Escape of blood and exudate(2) Acute inflammation during the first 24hr
Course of Basic Medical Sciences Chapter 2
(3)Proliferation and migration of epithelial cells of the epidermis which undermine the blood clot superficial forming a scab. This regeneration is usually complete 24 to 36 hr after injury.(4) Migration and proliferation of fibroblasts and endothelial cells (organization is seen 48 to 72 hr).
Course of Basic Medical Sciences Chapter 2
(5) Appearance of collagen fibers coated with ground substance 4 to 5 days.
(6) Scar formation during the second week.
Course of Basic Medical Sciences Chapter 2
2. Healing by second intention which occurs in open or excised wound.
Course of Basic Medical Sciences Chapter 2
Comparison of two types of healing
characteristic Primary union Secondary union (1st intention) (2nd intention)
defect size small largesuture usually yes noamount of necrotic tissue small large
PMN/monocyte less moreamount of granulation tissue small largescar size very small largerate of hearing rapid slowcomplication rarely, if any more
Course of Basic Medical Sciences Chapter 2
Course of Basic Medical Sciences Chapter 2
Fracture healing
(1) Formation of hematoma (2) Formation of fiber bone(3) Formation of osteo-bone(4) Reconstruction of novel bone
Course of Basic Medical Sciences Chapter 2
FACTORS INFLUENCING WOUND HEALING
Course of Basic Medical Sciences Chapter 2
1. local factors retarding the processes of healing
(1)infections (2)foreign bodies(3)poor blood supply
2. general factors retarding the processes of healing
(1)aging(2)poor nutrition(3)diseases (diabetes)(4)endocrine factors: adrenal
corticosteroid hormone inhibits proliferation of fibroblasts and collagen synthesis
Course of Basic Medical Sciences Chapter 2
Key words and points in this chapterRepairOrganizationGranulation tissue1st intention2nd intentionFACTORS INFLUENCING WOUND HEALING
Course of Basic Medical Sciences Chapter 2
ZHOU REN周 韧
Prof., M.D., Ph.D.
Institute of Pathology & Forensic MedicineDepartment of Pathology & Patho-physiology
Zhenjiang University Judicial Evidence & Evaluation Center
Zhejiang University School of Medicine
General Curriculum
Disorder of vascular flow
Structure and function of blood vesicle
Course of Basic Medical Sciences Chapter 3
Disorder of vascular flowmay be divided into general and local categories.
The local disorders contain:①Derangement of local blood volume: hyperemia and
ischemia,②Derangement of blood properties and content:
thrombosis, embolism and infarction.③Derangements of vascular permeability and anatomic
integrity: edema, hemorrhage.
Course of Basic Medical Sciences Chapter 3
Hyperemia
Def. Hyperemia refers to a local increased volume of blood caused by dilatation of the small vessels.
Course of Basic Medical Sciences Chapter 3
1. Arterial hyperemia (active hyperemia)It results from an augmented arterial inflow, such as occurs in the muscles during exercise, at sites of inflammation, and in the pleasing neurovascular dilatation termed blushing.
Course of Basic Medical Sciences Chapter 3
Active hyperemia causes increase of the volume of local tissue, of the metabolism and function of the organ. It is beneficial to the organism. Active hyperemia of body surface shows red in color and increase in local temperature.
Course of Basic Medical Sciences Chapter 3
2. Venous hyperemia (passive hyperemia, congestion)
It results from diminished venous flow such as follows cardiac failure or obstructive venous disease.
Course of Basic Medical Sciences Chapter 3
Etiology
(1)Compression on vein(2)Intravenous obstruction(3)Cardiac failure
Course of Basic Medical Sciences Chapter 3
Morphology
Congested organ increases in size and weight, solidifies in consistence, and shows dark color and capsular stiffness.
Course of Basic Medical Sciences Chapter 3
Chronic congestion of lung
Course of Basic Medical Sciences Chapter 3
Chronic congestion of liver
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Chronic congestion of liver
Course of Basic Medical Sciences Chapter 3
Hemorrhage
Def. Hemorrhage refers to extravasation of blood caused by rupture of blood vessel.
Course of Basic Medical Sciences Chapter 3
Hematoma:
Accumulation of large amount of blood within the tissue of the body.
Course of Basic Medical Sciences Chapter 3
Hemothorax, hemopericardium,hemoperitoneum, hemarthrosis:
blood accumulation in body cavities asthoracic cavity, pericardial cavity,Peritoneal cavity and arthritic cavityrespectively.
Course of Basic Medical Sciences Chapter 3
Petechiae: Minute hemorrhage into skin, mucous
membrane or serosal surface.
Purpura: Slight larger hemorrhage.
Ecchymosis: A large subcutaneous hematoma.
Course of Basic Medical Sciences Chapter 3