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Onlypathologiesaretreatedinthissummary,notumorsarewri5en:
theywillbesummarizedinasingletable
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Insanegraphicreviewforthe2semesterexam
AlessandroMo5a,UVVG,3rdyear
COMPLETEVersion
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CardiacPathologiesRheuma;c
IschemicHeart
Disease
Ischemicheartdiseaseiscausedbytheinterrup;on,par;alorcomplete,ofarterialbloodflowtothe
myocardium.Diseasebeginstomanifestwhencoronarybloodsupplynolongersa;sfytheoxygen
demandmyocardium.Themaincausethatgeneratescardiacischemiaiscoronaryatherosclerosis
(narrowingoftheofarteriallumenbyplaque),some;mesaggravatedbyarterialspasmoraprocess
ofsuperimposedthrombosis.Cardiacischemiamaybesilentormaymanifestclinicallyinseveral
forms:anginapectoris,myocardialinfarc;on,chronicischemicheartdisease.
Cardiac
Pathology 1Pericardium
Myocardium
Endocardium
Anginapectoris:transientpainfulcriseslocalizedpredominantlyprecordial,threetypes
ofangina:
Stableanginaisusuallyunder15minutes,
triggeredbyfactorsthatoverloadheart
(emo;ons,exercise)andresolvesatrestand
administra;onofcoronaryvasodilators
(nitroglycerin)Instableangina(premyocardial
infarc;on,aggravatedangina)iscausedbythe
forma;onofanon-obstruc;velythrombussuperimposedtoaplaque.Prinzmetalanginais
anunusualformofanginathatoccursatrest,
oenduringsleep,causedbyarterialspasm
superimposedtoaatherosclerosislesions.
Myocardialinfarc6onisthemostimportantcauseofmorbidityandmortalityinmodernsociety.Isanexpressionofbrutal,completeand
persistentinterrup;onofbloodflowthroughacoronaryarterybranch,
whichtranslatesmorphologicallybynecrosisofmyocardialterritoryserved
bythatartery.ComeswithAtherosclerosis+superimposedthrombosis,
hemorrhageintoplaque,persistentarterialspasm,arteri;s,congenital
coronaryanomaliesetc.Labfindings:raisedLDH,CPK.Types:transmural
subendocardial.Chronologicalmorphologychanges:
1. First12hours:nomacroscopicalchanges2. In1-2days:swollen,paleyellowcentralarea,raisedneutrophilsac;on3. In3-7days:necrosisareabecomeyellowish,macrophagesreplace
neutrophils,granula;on;ssueforma;on
4. In2-3weeks:depressedareawithsotexture5. In4-5weeks:hardscarearea,retracted,palegray
Chronicischemicheartdiseasedefinesslowinstalla;onofconges;veheartfailureduetomyocardialaltera;onsbychronicischemia.
Mostofthesepa;entshaveahistoryofepisodesofanginapectorisormyocardialinfarc;on.
Thehearthasvariabledimensions,myocardiumhasabrowncolorandcansome;mesbeiden;fiedareaofinfarc;onwithdifferentseniority.Thereisalwaysadvancedlesionsofatherosclerosisofthecoronaryarteries.
Valves
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Rheuma;cHeartDisease
Cardiac
Pathology 1
Isasystemicinflammatorydiseaseofconnec;ve;ssue,affectschildrenfrom5to15yearsold,symptomsstartsaer1-4weeksfroma
tonsilli;scontrac;on,usuallycomeswithstreptococcalinfec;ons.TheAcuteform(rheuma6cfever)hassomeextra-cardiac
manifesta;onssuchas:largejointsimpairments,tegumentaryimpairmentsandneurologicaldamage.Cardiacmanifesta;ons(rheuma;c
pancardi;s)hasrheuma;cinvolvementssuchaspericardi;s,myocardi;s(withAschoffgranulomas)andendocardi;s.TheChronicphase
isasequeloftheacuteoneandtriggersvalvulardeforma;ons,CHF,endocardi;sandthromboembolism.
Pericardi;sInflammatory
Non-
inflammatory
Calledeffusions,triggershydropericardium,haemopericardiumandchilleffusion
(lymph).Theaccumula;oncanbefrom50to2000mlwithorwithoutclinical
manifesta;ons
Acute:bybiologicalfactors,canbeinformof:serous,fibrinous,suppura;veor
hemorragic.inChroniconewefindathickperitoneum,constric;ve,fibroustriggered
byTBC,staphylococcalsep;cemiaandradioteraphy
Cardiomyopathies
dis;nctgroupofprimi;vediseaseoftheheartmusclethatdid
notcauseinflamma;onandarenotassociatedwith
hypertension,congenitalheartdisease,valvularorcoronary
arterydisease.Itischaracterizedbyheartfailure,ventricular
volumeandincreasedventriculararrhythmias.
Conges6ve/dilata6ve:isthemostcommon,triggeredbyalcohol/
drugs,dilata;onoccursinbothventricles,HFin5years
Hypertrophy:inyoungpa;ents,forlong;measymptoma;c,
gene;ccausesarestudied,decreasestheintraventricularvolume
Restric;ve:limi;ngdiastolicfilling,generateatrialdilata;onand
retrogradevenousstasis,bringtoaglobalHF
Myocardi;s
Definedasgeneralizedinflamma;onofthemyocardium.Areclassifiedintotwobroadcategories,
rheuma;c(discussedbefore)andnon-rheuma;csuchas:
1. Viral(toxic):byHIV,influenzavirus,generallyreversible,worseinchildrenandpregnancystatus2. Non-Viral:dividedinbacterial,drivenbyhypersensivitytomedicamentsandararegiantcells
myocardi;s
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Cardiac
Pathology 1 Endocardi;s
Non-infec6ousmayalsobeofseveraltypes:
Non-bacterial,associatedwithmetasta;ccancer Libman-Sacks,associatedwithSLEandvalvularvegeta;on
progress
FromCarcinoidSyndrome
,genera;ngendocardialplaquesatRHValves
Infec6ouscausedbybacterialcoloniza;on,rarelyfungal,of
endocardium,withasevereimpairmentofvalvularapparatus.
AcuteBacterial,orulcera;veisdrivenbyStaphylococcusAureusanddetroysthevalvesun;ltheHF
Sub-AcuteBacterial,orpolypousiscausedbystreptococcusViridiansandtriggersapolypoidvegeta;onthatgenerate
embolism
ValvulopathiesMitralStenosisiscaused
usuallybyrheuma;c
diseases,thebloodflowfromLAtoLVdiminishes,
ini;allytriggersanatrial
dila;on,in;me
hypertrophyand
pulmunarystasiswithrisk
ofpulmunaryedema.
MitralInsufficiencyaverycommonvalvedisease,
generatedbyamitral
prolapseorpapillarmuscle
rupture,bloodregurgita;on
insystoletriggersLV
hypertrophyandLAhyp.
Aor6cStenosisiscausedusuallybycalcifica;onsorcongenital
condi;onssuchasbicuspidvalve.
BloodflowdiminishesfromLVto
Aorta,triggersamarkesLV
hypertrophyandbovineheart
inradiologyfindings
Aor6cInsufficiency
maybecongenitalor
aerasyphili;c
aor;;s,blood
regurgitatesfrom
AortatoLV
Tricuspidorpulmonaryonesareveryrare,associatedwithmitral
problems.PulmonarycanbeaffectedincongenitalorinFallots
tetralogy
Congenital
HeartDiseases
Abnormali;esofembryonicdevelopmentbygene;ccausesorviralinfec;onsorteratogensubstances.WithBloodShuntsfromLtoRsidewefindventricularseptaldefects,interatrialseptaldefects,fetalductus
arteriosusthattriggeralatecyanosis.FromLtoRbutwithearlycyanosis=Fallotstetralogy:pulmonary
stenosis,v.septaldefect,Dxposi;onoftheAorta,rightventricularhypertrophy.Withoutbloodshuntsthere
aretransposi;onsofgreatvessels,coarcta;onoftheAortaandSitusInversus(dextrocardia)
HeartFailure
Definedastheinabilityofthehearttodealwiththebody'sdemands,ontheLEFTsideistriggeredby:
ischemicheartdisease,MI,arterialhypertension,valvulopathies,myocardiopathies.Generatesdispnea,
pulmonaryedema,hydrothorax,lowrenalperfusion,cerebralanoxia.OntheRIGHTsidecanbetriggeredby
apreviousleheartfailure,apulmunaryvascularhypertension,valvulopathies,cardiomyopathies.Triggersperipheraledema,ascitesandhepatomegaly 4
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Vascular
System 2 Arteriosclerosis
Arteriolo-sclerosiscanbedividedin:
Hyaline,inchronicischemia,benignnephroangiosclerosis
Hyperplas;c,aconcentricthickeningofarterioleswalls,reducedlumenand
malignantnephroangiosclerosis
Atherosclerosisoratheromatosis,hasamixedandnotfullyelucidatedpathogenesis,
hasvariousriskfactors(hypercholesterolemia,highLDLconcentra;ons,hypertension,
diabetes,aging,sex=male,smoking).Lesionsarefoundedinthein;mallayerof
arteries(atheromas)andarefibrino-lipidicplaques(withalipidiccenterandafiibrous
capsule).Evolu;ons:calcifica;on,ulcera;on,superimposedthrombosis(occlusionof
thearteria),hemorrage,aneurysm.Clinicalmanifesta;on:MI,chronicischemia,
aneurysm,emboliza;on
Arteri;s
Inflamma;onmaybegininin;ma,mediaoradven;;a(atthelevelof
vasavasorum)ofthearteries.In
termsoftheseloca;onscan
dis;nguish:endarteri;s,mesarteri;s
orperiarteri;s.Arteri6stypes:
Thromboangi;sobliterans,namedBuergersDisease
Polyarteri;sNodosa Syphili;cArteri;s Raynaudsdisease
Aneurysms
Abnormaldilata;ons,
localized,permanent
ofthebloodvessels
Atherosclero;c Celebral Dissec;ng(aorta) Arteromatous
Fistula(post-
trauma;c) Syphili;c
VenousThrombosis
Forma;onofthrombi,oeninthedeepveinsofthelower
limbs.Theprocessisfavoredbythestasisatthislevelcaused
byimpedingofvenousreturnasaresultofheartfailure,
pregnancy,prolongedbedreposeorvaricoseveins.
Thrombophlebi6s,comeswithinflamma;onandcanbe
dividedinto:bacterial,intravenouschemicalirrita;onand
post-trauma;c.Phlebothrombosis,inturn,comeswithout
inflamma;on,itcanbepost-opera;ve,obstetrical,medical-
associatedandmigratory
VaricoseVeinsAreabnormallydilatedveins,withatortuouscourse,mainlyarefoundedinlowerlimbs,but
wecanalsofindtheminformofesophagealvarices(portalhypertension),hemorrhoidsand
varicocele
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Respiratory
System 3
RespiratorySystemPathologies
Rhini6sareinflamma;onofthenasalmucosa.Canbeacuteandchronic.Acuterhini;s,inturn,canbe:
Acuteviralrhini6s(commoncold)iscausedmainlybyadenoviruses.Itmanifestsclinicallywithincreasednasalsecre;on,nasal
conges;on,sneezing.Morphologicalsubstrateisrepresentedbyanacutecatarrhalinflamma;onofthenasalmucosa
Allergicrhini;siscausedbyatypeIhypersensi;vityreac;ons(IgE),followingexposuretovariousan;gens:pollen,dust,flouretc.
Ismanifestedbyabundantwaterynasalsecre;on,sneezingcrisis.Specifically,istheappearanceofinflammatoryinfiltraterichin
eosinophilsinthenasalmucosaBacterialrhini;susuallyoccursasacomplica;onofformsdescribedabove,characteris;cisthe
transforma;onofinflammatoryexudatefromawateryintoapurulentone.Chronicrhini6s,canalsobeoftwotypes:Hyperplasicchronicrhini;soccursduetorepeatednasalinflamma;on.Itis
characterizedbyhyperplasiaofmucousglandssome;mesrealizingrealadenomatouspolypsthatcanextenduptothethroat.
Theyappearasmul;ple,so,pedicledforma;ons,withbunchofgrapes-looking.Chronicatrophicrhini;s(ozena)isalsoa
possibleconsequenceofrepeatedacuteinflamma;on.Ismanifestedbydiminishingsenseofsmellduetopavimentosase
metaplasia,fibrosisandreducingofthemucousglands.
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Bronchi
Pulmonary
Parenchyma
Pleural
Laryngi6sareinflamma;onofthelarynx.Maybeacuteorchronic.Ofacutelaryngi;s,themostimportantformsare:
Catarrhallaryngi;sisinmostcasescausedbyaviralinfec;on(influenzavirus).Manifestedclinicallybydrythroatandhoarseness.
Morphologicallyischaracterizedbyedemaandhyperemiaofthelaryngealmucosa,mucousexudatewhich,duetomicrobial
superinfec;ons,becomesmucosal-purulentLaryngealdiphtheriaisnowrare.Itisanacutepseudomembranousinflamma;onof
thelarynx,hasapar;cularseverityduetopossiblemechanicalasphyxia;onthroughmembranesofthepa;ent.Chroniclaryngi;s
maycon;nueacuteforms,ormayhavechronicitycharactersfromthebeginning,becauselocalac;onofchronicirrita;vefactors
(smoking,pollu;on).Ismanifestedbyhoarsenessandirrita;onspas;ccough.Morphologicalcanbedescribedtwoforms:
Hyperplasiclaryngi;swiththickeningofthepharyngealmucosa.Some;mesmayoccurlocalizedhypertrophy,pseudotumoral
(singersnodules)Atrophic,drylaryngi;s.
UpperResp.Tract
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BronchialDiseasesRespiratory
System 3
Bronchi6sareinflamma;onofthelargeandmediumbronchi.Maybeaffectedconcomitantandtrachea,inwhichcasewespeakofa
tracheobronchi;s.Canbeacuteandchronic.
Acutebronchi;sareini;atedbymicrobes(pneumococcus,streptococcus,etc.),viruses(influenza),ormayhavecausebyirrita;on
(pollu;on).Dependingonthequalityofinflammatoryexudate,aredescribedseveraltypesofacutebronchi;s:catarrhalbronchi;s,
ini;allymanifestedbyconges;on,edemaandhypersecre;onofmucus,whileinadvancedstagesoccurandserousexudate.Soontherewillbeamicrobialsuperinfec;on,exudatebecomingpurulentduetotheinfluxofgranulocytesulcera;vebronchi;sisamoresevere
form,characterizedbytheoccurrenceofulcersofvariabledepthinbronchialmucosa,atwhicharesome;mesassociatedprocessesof
necrosisandhemorrhagepseudomembranousbronchi;s(diphtheria)
gangrenousbronchi;sisrare,occursconsecu;velytomalignanttumors,infec;onswithanaerobicstreptococcietc.Bronchialmucosa
showsextensivenecrosiswithdepositoffibrin,necro;cmaterial,microbialcolonies.
Chronicbronchi6sischaracterizedclinicallybytheappearanceofmorethan2yearsconsecu;velyofepisodesofproduc;vecoughfor
atleast3months.Itispar;cularlycommoninsmokersandthosewholiveinpollutedurbanenvironments.
Thediseaseismanifestedwithhypersecre;onofmucus,andasaresultofmicrobialsuperinfec;on,thereisamucosal-purulent
exudate.Themaincomplica;onsofchronicbronchi;sinclude:pulmonaryhypertensionwithcorpulmonaleoccurrencesquamousmetaplasiaofciliatedbronchialepithelium,withpossibilityofdevelopingmalignancies.
Asthmaisclinicallymanifestedbydyspneacrisisandexpiratorywheezing.Frome;opathogenicpointofviewcanbedescribedtwotypes:
extrinsicasthma,isbasedonatypeIhypersensi;vityreac;on,beginsinchildhoodandusuallythereisanallergicfamilyhistory
intrinsicasthmaoccursinadults,cannotbeiden;fiedanallergicfactorandusuallycomplicatesachronicbronchi;s.Morphologically,is
characterizedbyhypersecre;onofmucus,bybronchialglandhyperplasia,inflammatoryinfiltraterichineosinophils,basementmembrane
thickeningandbronchialmusclehypertrophy.Sputumofthepa;entscontainsCharcot-Leydencrystal,producedbythedisintegra;onof
eosinophils.
Bronchiectasisimpliestheexistenceofabnormal,persistentdilata;onofbronchi.Canbecausedbyseveralfactors:sequelaeofsome
suppura;vepneumonia,influenza,whoopingcoughmechanicalbronchialobstruc;oncausedbytumors,foreignbodiesetc.
congenitaldiseases:muciviscidosis,Kartagenersyndrome(sinusi;s,situsinversusandcongenitalbronchiectasisbyimmobilityciliaof
bronchialepithelium).Bronchialdila;oniscalledbronchiectasiscavity.Theycanhavediffuseorlocalizedcharacter,canbesingleor
mul;pleandmayhavedifferentshapes:cylindrical,saccularormoniliforme(dilatedpor;onsalterna;ngwithunaffectedpor;ons).
Bronchiectasiscavityisini;allydry,smooth,andaerwardstofillwithstagna;ngmucus.Thismucuscausesobstruc;onoftheterminal
bronchiandpromotemicrobialsuperinfec;on,withtheappearanceofpurulentsecre;ons.Epitheliumborderingthecavityisconverted
tometaplasia,andfinallytoatrophy.Bronchialwallistheseatofchronicinflamma;on,withatrophyoftheelas;cfibers,muscleand
mucousglands.Inadvancedstagesoccursgranula;on;ssueprolifera;onwithreplacementfibrosis. 7
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Respiratory
System 3 PulmonaryParenchyma
Representsinflammatorydiseasesofpulmonaryparenchyma.Arecausedbymicrobialorviralgerms.Morphopathologicalsubtypes:
Lobarpneumoniarepresentstheclassicformofbacterialpneumonia,andismainlycausedbypneumococcus(Streptococcus
pneumoniae).Currentlycompleteevolu;onofthediseaseisrare,duetoan;bio;ctherapy.Clinicallymanifestswithfever,chestpain
andcoughwithsanguinolentsputum.Thediseaseislimi;ngtoasinglepulmonarylobe(lobarpneumonia),oeninferior,rarelymore
lobes.Thestar;ngpointofthediseaseispulmonaryalveoli.Untreated,intermsofmorphology,evolvingintofourphases:acuteconges;on,redhepariza;on,greyhepariza;on,resolu;on.Lobularpneumonia(bronchopneumonia) usuallyoccursindebilitated
persons,childrenandold,asaresultofinfec;onwithpyogenicstreptococci,Staphylococcusaureus,Klebsiellapneumoniae,etc.Unlike
lobarpneumonia,thestar;ngpointofinfec;onisbronchioles,withsecondaryextendinginalveoli.
Areaffectedmorepulmonarylobules,whichappearasoutbreaksofcondensa;on.Microscopically,bronchopneumoniaoutbreak
appearcenteredbyabronchioluswithpurulentbronchioli;slesions.Itissurroundedbyalveoliwithvarioustypesofpulmonary
alveoli;s,whichseveritydiminishesfromthecentertotheperiphery.Inters66alpneumoniaiscommonlycausedbyviralinfec;on
(influenzavirus,adenoviruses,etc.)orMycoplasmapneumoniae.Pulmonarymorphologicalchangesoccurringcanbesystema;zedas
follows:inters;;allesions,thickenedalveolarsepta,withdilatedvesselsandmonocyteinflammatoryinfiltrate,withoutgranulocytes
necro;zingbronchioli;slesions,some;meswiththeappearanceofmul;nucleatedgiantcellsalveolicontainedemafluid,redblood
cells,fibrin.Pulmonaryemphysemaispermanentdila;onofterminalrespiratorybronchiolesandalveoliofthelungs.Disease
pathogenesisisnotfullyelucidated.Itisassumedthataltera;onofalveolarwallsmaybecausedbytheac;onofproteoly;cenzymes
suchaselastase,whichdestroystheelas;cfibersatthislevel.
Pneumonia
Primarytuberculosisintermsofmorphologyischaracterizedbytheappearanceofprimarytuberculosiscomplex(Ranke),consis;ngofthreeelements:primaryaffect(Ghon)consistsofanareaofcaseousnecrosiswithperipheraltuberculousfollicles,mostcommonly
localisedsubpleuralthemiddlepor;onoftherightlungconnec;nglymphangi;s:tuberculousfolliclesalongtheefferentlympha;csof
primaryaffec;onhilaradenopathy,withthepresenceofprolifera;v-altera;velesionsinthelymphnodes,tributarytothedamaged
lympha;cs.Secondarytuberculosis(postprimary)developsmostoenindebilitatedpersons,immunizedbypriorinfec;on.Sourceof
bacillimaybeendogenous(reac;va;onoflatentlesionsfromprimarydisease)orcantalkingaboutexogenouscontamina;onby
inhala;onofbacilli.Thelesionsbeginsinthebestaeratedpulmonaryareas(apicalposteriorpart),intheformofaggregatesof
tuberculousfollicles(Simonoutbreak).Folliclesconfluenceandsoonoccurstheircaseousnecrosis.
PulmonaryTBC
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Respiratory
System 3
Pleuri;s
InflammatoryTypes:Sero-fibrinouspleurisycanoccurin
rheuma;sm,uremia,tuberculosis,ormaybeacomplica;onof
pneumonia.Itischaracterizedbytheappearanceofan
intracavitaryserousexudate,withfibrinousinflamma;onof
pleuralserous.Hemorrhagicpleurisy,withexudaterichin
erythrocytes,canoccurintuberculosis,mesothelioma,
pulmonaryinfarc;on
Purulentpleurisy(pleuralempyemaorpiotorax)appearsin
pleuro-pulmonaryinfec;onwithpyogenicgerms.
Non-inflammatorypleuraleffusion:Hydrothoraxis
characterizedbytheaccumula;onoftransudateinpleuralcavity.
Hemothoraxrepresentaccumula;onofbloodinpleura,usually
asaresultofthoracictraumaorruptureofaaor;caneurysm
Chylothoraxconsistsinaccumula;onofoflymphinpleuradueto
anobstruc;onofthethoracicduct
Pneumothoraxisrepresentedbythepresenceofairinthe
pleuralcavity.Dependingonthemechanismcanbedescribed
severaltypes:spontaneous,trauma;cortherapeu;c.
Pneumoconiosisareprofessionalpulmonarydiseasecausedbyinhala;onofvariousanorganic
powders.Severityoflesionsisvariable,dependingonthetypeofdust,theirconcentra;on,dura;on
ofexposureandthecoexistenceofotherpulmonarylesions.Types:Silicosis,Anthracosis,Asbestosis
Pneumoconiosis
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Gastri;sAcute
Chronic gastricmucosalerosions smallfocaldefectsof
substanceinthegastric
mucosa
Usuallysuperficial,mayextendtotheserous
Idiopathic:SuperficialgastriHsisamildform,characterizedbyachronicinflammatoryinfiltrateinthelaminapropriae.Glandsarenotaffected.
AtrophicgastriHs,advancedstage.Itischaracterizedbyextensiveinflammatorychangesinthedeepergastricmucosa.
Autoimmune:(TypeA)occursduetothepresenceofan;bodiesagainstparietalcells,andwillbecomplicatedwithachlorhydriaandperniciousanemia.Lesionsarelocatedonthegastricfundiclevel,
beingsimilartothoseseeninidiopathicgastri;s.
Infec6ous:(typeB)isproducedbyHelicobacterpylori,presentlesionsofchronicsuperficialgastri;slocatedintheantrumandgastricbody.Germscanbeiden;fiedingastricmucusand,inac;veforms,
appeargranulocytesintheneckofglands.
Hyperplas6c:(Menetrier)ischaracterizedbyahighlyexpressedthickeningofthegastricmucosa,thepresenceofgiantfoldsthatgivethegastricareaacerebroidaspect.Itisconsideredaprecancerous
condi;on.
Gastric
Pathology
Pep;c
Ulcer
Duodenal
Gastric
Isusuallylocalizedonthelowcurvature,inantralandpre-pyloricregion.Appearsasasolu;onof
con;nuity(crater),usuallysingle,rounded,withadiameterof2-3cm,withnet,prominentmargins.
Gastricmucosafoldsconvergetowardsulcer.Gastricwallpenetra;onisvariable,ulcerscanhave
differentdepths.Some;mesthereareovercomingallthestructuresofstomach,thebasisofulcer
beingcomposedofaroughfibrous;ssueblock(callosulcer).Microscopically,thebasisofgastric
ulcerconsistsoffourlayers.Theyare,fromsurfacetodepth:Superficial,anareawithfibrino-
leukocyteexudate,areaoffibrinoidnecrosis,areaofgranula;on;ssue,areaoffibrous;ssuewithinflammatoryinfiltrate.
Causedbyincreasedacidifyingofduodenal
environment.Frequently,itislocalizedonthe
anteriororposteriorwalloftheduodenum,in
thepost-pyloricarea.Usuallyunique,but
therearealsodoubleduodenalulcers,
situatedoppositeontheanteriorand
posteriorwall(ulcersinthemirror).
Complica;ons:
Haemorrhages:fromoccultbleedingsto
massivebloodloss(haematemesisor
melaena)Perfora6on:morecommonin
duodenalulcers(peritoni;s)
Penetra6on->(liver,pancreas).
Pyloricstenosis,duetoulcerhealing,with
occurrenceofaretrac;lefibrousscars. 10
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Crohn'sdisease
Chronicinflammatorydiseaseofunknowne;ologythatcanaffecttheen;regastrointes;naltract,butespeciallytheterminalileumand
colon.Thediseasehastwospecificfeatures:theinflammatoryprocessaffec;ngalllayersoftheintes;neandsegmentalnatureofthe
lesions(impairedsegmentsofintes;nesalterna;ngwithunaffectedareas).
Macroscopicinterestedsegments:appearthickened,swollenwithnarrowedlumen,onmucosalsurfaceoccurslinearulcera;onthat
graduallybecamedeeper,andcanbetransformedintofistulas.Canoccurmesentericlymphadenopathy.Microscopically,itisfound:
thepresenceofapolymorphousinflammatoryinfiltrate,afibrosisprocessthatinterestsallintes;nalstructures,oencanbeobserved
non-caseousgranulomasCrohn'sdiseasecanrarelydevelopintoacancerofthesmallintes;neorcolon.
Intes6nal
Pathology
Ulcera6veColi6s
Chronicinflammatorydiseaseofthecolonofunknowne;ologythataffectsyoungadults.3specificmorphologicalfeaturesthatallow
differen;aldiagnosiscomparedtoCrohn'sdisease:impairmentlimitedtothecolon,fromileo-cecalvalveuptoanus,therectumisthe
mostseverelyaffected,andthesmallintes;neisnotinterestedlesionshavediffusecharacterandnotsegmentalcharacterlesionsinterestcolonmucosaandsubmucosa,extendingindepthisexcep;onal.Macroscopically,affectedthemucosaisfirstred,granularand
bleedseasilyattouch.Thenappearsuperficialulcersthatextendintothesurface,surroundedbythickened,hyperplasicintes;nal
mucosa,whichprotrudesintotheintes;nallumen(inflammatorypseudo-polyps).Microscopicallythereisacongestedmucosa,swollen
withpar;allydestroyedepitheliumareiden;fiedhemorrhagicsuffusionsandlympho-plasmacellsinflammatoryinfiltrate.Specificis
glandularcryptsimpairment,withappearanceofgranulocytsinflammatoryinfiltratewithlargeareasofnecrosis(cryp;cabscesses).In
advancedstagescolonbecomesatrophied,withthepersistenceofachronicinflammatoryinfiltrateinthemucosaandsubmucosa.
AcuteAppendici6s
Exuda;veinflamma;onoftheileo-cecalappendix.Frequentlyoccursconsecu;velytotheappendicularorificeobstruc;onthroughfecal
(solidifiedfaecalmaterial),hyperplasiaoflymphoidstructuresfromappendicularwall,etc.Thisprocesspromotesstagna;onof
secre;ons,intenseprolifera;onoflocalmicrobialfloraandfinally,bacterialinvasionofthewall,withthemassiveinfluxof
polymorphonuclears.Morphologytypes:conges;veappendici;scharacterizedbydistendedappendix,congestedphlegmonous
appendici;s,thewholeappendicularwallispurulentinfiltratedgangrenousappendici;s,characterizedbytheappearanceof
hemorrhagiculcera;onofthemucosaandareasofgangrenousnecrosisofthewall.Complica;onsofacuteappendici;sareoenserious:
perfora;on,usuallyfollowedbytheappearanceofapurulentperitoni;ssep;cthrombophlebi;sofmesoappendicularveinwithpylephlebi;sandsecondaryliverabscess. 11
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TypesofNephropathies
Glomerular
Acutetubularnecrosis
Ischemicnecrosis Nephrotoxicnecrosis
Urinary
Tract 5
Tubular Vascular Inters;;al
Glomerulonephri6s
Withnephro;csyndrome
Withnephri;csyndrome
Chronic
Nephroangiosclerosis
Benign Malign
Pyelonephri6s
Acute Chronic
Mostglomerulonephri;saretheresultofimmunologicalmechanisms,themostcommonlyinvolvedofwhichare:depositofcircula;ng
immunecomplexesintheglomerulilocalforma;onofimmunecomplexesbyreac;onbetweenacircula;ngan;bodyandanan;gen
fromglomerularbasementmembraneac;va;onofalterna;vepathwayofcomplementcell-mediatedimmunologicalmechanisms.
Glomerulonephri6scharacterizedbynephro6csyndrome:
Nephro;csyndromeisagroupofpathologicalcondi;onsarisingasaresultofincreasedbasementmembranepermeabilitybythe
glomerularcapillarylevel.Itischaracterizedby:proteinuria,hypoalbuminemia,generalizededema,hyperlipidemiaand
hypercholesterolemia.Inthiscategorycanbeclassified:
Glomerulonephri6swithminimalchange (lipoidnephrosis)affectsyoungchildrenandistheprototypediseasecharacterizedby
nephro;csyndrome.Glomerulonephri6swithfocalandsegmentallesions mayappearasaprimi;vedisease(idiopathic)orasa
consequenceofsystemicdiseasewithglomerularinvolvement(polyarteri;snodosa,subacutebacterialendocardi;sandsoon).Membranousglomerulonephri6sisthemaincauseofdevelopingnephro;csyndrome.E;ologyisunknownandaffectsyoungadults.
Some;mesthereisanassocia;onwithhepa;;sB,syphilis,malignancy,systemiclupus.
Ischaracterizedbymarkedthickening(5-10;mes),regularanddiffuseofglomerularcapillarybasementmembranesduetodepositsat
thislevelofelectrondenseimmunecomplexes.Glomerulonephri6ssecondarytosystemicdiseases:
diabe6cnephropathyischaracterizedbyglomerulosclerosis,whichmaybediffuse(diffusemesangialhyalinedeposits)ornodular(nodularmesangialhyalinedeposits-Kimmels;el-Wilsonnodules).Areassociatedwithdiabe;cmicroangiopathy,tubularatrophy,fibrosisandlympho-plasmacell
inters;;alinflammatoryinfiltrate.
amyloidnephropathyoccursinasystemicamyloidosis.Ischaracterizedbyamyloiddepositpredominantlysub-endothelialandmesangial,withgradualreplacementoftheen;reglomerularstructures.Lesionsaffec;ngalmostallglomeruliinvaryingdegrees. 12
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Glomerulonephri6scharacterizedbynephri6csyndrome
Theseglomerulonephri;sarecausedbyinflamma;on,leadingtoglomerularcapillaryrupturewithsubsequenthemorrhageinthe
urinarytract.Nephri;csyndromeischaracterizedbythefollowingelements:haematuria,oliguria,azotemia,hypertension.Proteinuria
andedemamayoccur,butlowintensity.Themaintypesofglomerulonephri;sinthiscategoryare:
Poststreptococcalacuteglomerulonephri6s ismostoenasequelofaninfec;on(commontonsillar)with-hemoly;cstreptococcal
groupA.Renalimpairmentoccursaeraperiodof1-2weeks,pathogenesisbeingbycircula;ngimmunecomplexdeposit.Inchildren
evolu;onisusuallyfavorable,butinadultrenalfailuremayoccur.Affectedkidneyishypertrophied,turgid,edematous,thesurfaceis
smoothwithnumeroushaemorrhagicpointswhichcorrespondtoaffectedglomeruli.Glomeruliareaffecteddiffusely,beinghypertrophyandhypercellularity.
Subacuteglomerulonephri6s(rapidlyprogressive)ischaracterizedbysevereevolu;onwiththeadventofearlyrenalfailure.Canoccur
poststreptococcalassociatedwithsomesystemdiseases,ormaybeidiopathic.
Affectedglomeruliarehypertrophy,hypercellularityandmaydevelopthrombosisandcapillariesnecrosis.Typically,thereisa
prolifera;onofparietalcellsofBowmancapsulewithforma;onamul;layerstructurethatfillsthefilteringspace,calledepithelial
crescent.
Goodpasture'ssyndromeismostcommonlyseeninmenaroundtheageof20years.Pathogenicallyischaracterizedbydevelopment
ofan;bodieswithaffinityforglomerularandpulmonaralveolibasementmembranes.Clinicalismanifestedbyglomerulonephri;sand
pneumonicsyndrome.
Chronicglomerulonephri6s
Chronicglomerulonephri;sisthefinalstageofevolu;onofvariousglomerulopathies,clinicallycharacterizedbytheoccurrenceofrenal
failure.Affectedkidneyishypotrophy,increasedconsistencyandfinelygranularsurfaceonsec;on(smallkidney,white,granular).The
capsuleisadherentandonsec;onsurfacethereisathincor;cal,poorlydemarcatedfrommedullary.
Acutetubularnecrosisisthemajorcauseofacuterenalfailure.Acutetubularnecrosismaybetheresultofprolongedrenalischemiaortheac;onofnephrotoxicsubstances.
Ischemicnecrosisisaresultofshockofdifferente;ology,characterizedbysevererenalhypoperfusion:hemorrhagicshock,post
trauma;cshock,hemoly;cshock(incompa;bleperfusions),theshockcausedbyextensiveburnsorcrushsyndrome,endotoxicshock
(Sepsiwithgramnega;vegerms)andsoon
Affectedkidneyishypertrophied,swollen,andonthesurfaceofsec;onthereisacleardemarca;onbetweencor;calandpale
congestedmedullar.Inters;;umisswollenwithdiscreetgranulocytaireinfiltrate.
Nephrotoxicnecrosisiscausedbydirectac;onofatoxicsubstancesontubularepithelium(an;bio;cs,cytosta;cs,anesthe;cs,
mushroomtoxins,venomandsoon).Microscopically,isshowsextensivenecrosisoftubalepithelium,moreexpressedinproximal
tubules.Tubulorexislesionsaremuchlesscommonthaninacutetubularnecrosisduetoischemia.
Tubular
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14
Causedbyarterialhypertension.Benignnephroangiosclerosisiscausedbyischemiaconsecu;velytoatherosclerosisand
arteriolosclerosisthataffectsrenalvessels.Smallarteriesandarteriolesundergoesaprocessofhyalinearteriolosclerosis.Interlobular
andarcuatelargearteriesshowsacharacteris;clesionthatconsistsinduplica;onofelas;clamina,fibrous;ssuehypertrophyofthe
media,withnarrowingofvasucularlumen(fibroelas;chyperplasia).Theselesionsexpandover;meandatglomerularcapillaries,
leadingtocompleteatrophyoftheaffectedglomeruli.Renaltubulesareatrophiedorhypertrophiedproperlyandinters;;umpresents
fibrosiswithlympho-plasmacellinfiltrate.
Malignnefroangiosclerosisischaracterizedbytheappearanceofhyperplas;carteriolosclerosis.Thisconsistsinconcentricthickening,inoverlappingsheets(inonionbulb)ofwallsofarterioles,withconsecu;velyreduc;onofthevascularlumen.Some;mesitcanappear
fibrinoidnecrosis(necro;zingarterioli;s)andthrombosesofafferentglomerulararterioles.Theselesionsextendtotheglomerular
capillaries,causinghyalinisa;onofglomeruli.Tubuleshavevaryingdegreesofatrophyandinters;;umpresentslympho-plasmacelland
granulocyteinflammatoryinfiltrate.
Vascular
14
Acutepyelonephri6siscausedbybacterialinfec;onpropagatedeitherbyhematogenouspathinthecourseofsepsis,eitherby
ascendingpathfromtheurethra,usuallyinvolvingEscherichiacoli.Aremostcommonlyaffectedwomen,especiallyduringpregnancy.
Clinically,thediseaseismanifestedbypollakiuria,dysuria,pyuria,hematuriaandbacteriuria.
Inascendinginfec;onsappearsapurulentexudateinthecalixandpelvisrenalis.Inrenalparenchymaisobservedradialpurulent
stria;onsfrompelvisrenalisintocor;cal,thatcanjoin,producingarenalabscess.Infec;onsbyhematogenouspathareleadingto
microabscessesdisseminatedinallrenalparenchyma.
Microscopically,thereisagranulocyteinflammatoryinfiltrateofvariableintensitythatini;allyinterestedpyelocalycealinters;;umandmucosa.
Chronicpyelonephri6smaycon;nueanacuteinflamma;onormayhavefromthebeginningcharactersofchronicity.Isanimportant
causeofchronicrenalfailure.Affectedkidneyissmall,withirregularsurfaceduetoretrac;lescarsconsecu;vehealingofacutephase
injuries.Thecapsuleisadherentandpyelocalycealmucosaisthickened.
Microscopically,lesionshavemul;focaldisposal,separatedbyareasofnormalparenchyma.Inoutbreaksareiden;fiedinters;;al
fibrosis,thepresenceofalympho-plasmacellinflammatoryinfiltrateandvarioustypesofglomerularlesions.Tubulescontainhyaline
cylinders,some;mesmakingpseudo;roidisa;onimages.Basically,achronicpyelonephri;scannotbedis;nguishedbychronic
glomerulonephri;sinbothdiseaseallrenalstructuresbeingaffectedinvaryingdegrees.
Inters;;al
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Female
genital
System
6 Femalegenitalsystempathology
Vulva
Vagini;sareoen
causedby
pathogenssuchas
Candidaalbicans,
Gardnerella
vaginalisand
Trichomonas
vaginalis.
Vagina
UterineBody
Vulvi;saremainlycausedbyinfec;ous
agents:Humanpapillomavirusinfec6on is
characterizedbytheappearanceofbenign
tumorlesions,calledacuminatecondyloma.
Theseforma;onsappearaspapillary,warty,
locatedonvulvartegumentsormucosa,
oenmul;pleandconfluent.Herpesviruses
infec6oniscommoninthevulva.Ini;ally
developarashwithblistersfilledwithclearfluid,thenareconvertedintopustulesthat
mayulcerate.Syphili6cinfec6oniscaused
bythespirochete(TreponemaPallidum).
Cervici;scanbedivided,dependingonthenatureofthee;ologicagent,
ininfec;ouscervici;sandnoninfec;ous.Bothcanmanifestasanacuteor
chronicinflamma;on.Itcanalsobeaffectedthepor;onofthethecervix
fromvagina(exocervici;s),orthecorrespondingsegmentofcervical
canal(endocervici;s).Noninfec6ouscervici6scanbecausedbychemicalirrita;on,useofvaginaltampons,diaphragmsandintrauterine
contracep;vedevices.Inacuteforms,thecervixishypertrophied,
erythematous,friable.Microscopicallyishighlightedstromaledema,
vascularconges;on,andinflammatoryinfiltratewithpolymorphonuclear
neutrophilsinchorion.Infec6ouscervici6smaycomplicatethose
noninfec;ousorcanmanifestfromthebeginningitself.Involvetheac;on
ofabiologicalagent.).Allfirstmanifestsasanacutecervici;s,oenwith
theappearanceofpurulentstriaeonthesurfaceofexocervixormuco-
purulentsecre;onsthatisremovedfromendocervicalcanal.
Acuteendometri6soenoccurconsecu;velytoa
birth,anabor;onorfollowinguterinesurgery.More
rarely,canoccurintheirabsence,asingonococcal
infec;onthroughascendentpathfromthevagina.
Uterinemucosaisswollenandcongested,with
desquama;onofsurfaceepithelium.Isiden;fiedamucoushypersecre;onwhichcanthenbecome
mucopurulentorpurulent.Endometriosisare
characterizedbythepresenceandprolifera;onof
endometrial;ssuenon-neoplas;canywhereelse
thaninthemucosaoftheuterus.Histologically,
ectopicendometriumcanbecompletelymadeupof
cytogenicchorionandglands,orcancontainonly
oneoftheseelements.Intermsofloca;on,canbe
describedtwotypesofendometriosis:externalandinternal.Internalendometriosis(adenomyosis)isthe
presenceofislandsofendometriuminmyometrium
thickness.
Bartholincystsoccurduetoglandularexcretory
ductsobstruc;onwithaccumula;onofsecre;on
productandconsecu;velyductaldilata;on.
Contentisclear,mucoid,translucent.Microbial
overgrowthcancausetheappearanceofanabscessBartholin,withforma;onofacircumscribed
purulentcollec;ons.Kera6ncystsinterestedoen
largelabia,aresuperficialandsmall(2-5mm).The
contentofthecys;cconsistsofacellularmass,
eosinophilicofkera;n,boundedbyflaened
squamousepithelium.
Mucinouscystsarecommonlylocatedatthe
ves;bularlevel,isseparatedbyamucous-secre;ng
epithelium,cuboidalorcylindricaltype,frequentlywithsquamousmetaplasia.
Cervix
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16
Mammary
Gland7
MammaryGlandPathologies
Inflamma;ons:Mas;;s Fibrocys;cBreastDisease
Acutemas66sareusuallyrelatedtoinstalla;onof
lacta;on,usuallyaffec;ngprimiparous.Itisabacterial
infec;on(staphylococcusaureus,streptococcuspyogenic),
favoredbytheappearanceoffissures,rhagades,nipple
excoria;onduetoadifficultlacta;ons.Fromthislevel,the
infec;onspreadsindepthbycanalicularpath.
Inbreastappearhardareas,swollenandverypainful,at
whosecompressionisexpressedinthenippleapurulent
exudate.Microscopically,atthebeginningisasero-
fibrinousacuteinflamma;on,whichcanprogressto
suppura;veinflamma;onofabscessorphlegmontype.
Chronicmas66s(mas;;swithplasmocytes)arefoundin
mul;parous,duetomammaryductsobstruc;onby
secre;onscondensa;on.Thisinducesachronic
inflammatoryreac;onwithoccurrenceinmammarygland
massofsomeinduratedareas,fromwhichatpressureis
expressedplugsofcheesymaterial.
Microscopically,canbeiden;fieddilatedductswith
epitheliuminlargepartatrophiedandnecro;cmaterialin
lumen.Peri-andintraductalappearsagranulomatous
inflammatoryreac;on,withdepositsofcholesteroland
inflammatoryinfiltraterichinplasmocytes.Some;mesmay
occuraprocessofinters;;alfibrosiswithnippleretrac;on,
similartothatfrombreastcancer.
Condi;onthatoccursinwomenwithhormonalac;vity
causedbytheexcessofestrogen.Some;mesitcanevolve
tobreastcancer.Histologically,thediseaseischaracterized
byavariablelesionalcomplex,whichinessencecanbe
systema;zedintothreemajorcategories:
Simplefibrocys6cmofifica6on(non-prolifera;ve)isthe
mostcommonformofthedisease.Itischaracterizedbythe
appearance,oenunilateral,ofsingleormul;plemammary
nodules,elas;candmobiletosurrounding;ssues.They
consistofamassofstromalfibrosis,inwhicharefound
terminalductswithcys;cdilated.Prolifera6vefibrocys6c
modifica6onischaracterized,inaddi;ontopreviousform,
byprolifera;on(hyperplasia)ofductalepithelium.
Some;mesitcanbeverymarked,formingpapilliferous
structuresthatcanfilldistendedductallumen(ductal
papilloma).Sclerosingadenosisischaracterizedby
increasingthenumberofsmallductsoracini.Theyappear
microscopicallyasnests,cordonsofductalcellsembedded
inafibrousstroma.Some;mes,theductscanbeinalarge
number,placedbacktoback,beingdeformedbybandsof
fibrosis,inwhichcasethedifferen;aldiagnosiswithbreast
cancerisverydifficult.
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OtherCondi6ons:Cryptorchidismislackofdescentofthetes;sintothescrotum.Itfrequentlyaccompaniesbytes;cularatrophy
withsterility,andanincreasedrateofmalignantdegenera;on.Torsionofsperma;ccord,compromisingbloodperfusion,which
canleadtotes;culargangrene.
Hydroceleiscausedbytheaccumula;onofserousfluid,withdistensionofthetunicavaginalis,formostofthe;meisidiopathic,
butmaybecongenital,secondarytoinfec;onorasaresultoflympha;cblockingoftumoralorigin.Hematoceleisan
accumula;onofbloodthatrelaxtunicavaginalis,isusuallyposrauma;c,butmayindicatethepresenceofarenaltumor.
Varicoceleisavaricosedilata;onofthesperma;ccordvein.Spermatoceleisacystoenintrates;cularcontainingsperm.
17
Male
Genital
System
8 MaleGenitalSystemPathologies
Tes;cular ProstatePathology
Inflamma;onofthetes;clesiscalledOrchi6s.Thesecanbe
acuteorchronic,andmaybeassociatedwithinflamma;onof
theepididymis(orchiepididymi;s).
Acuteorchi;sareoenofgonococcalnature,butmayalso
includesyphili;corviral,some;mescomplica;nganepidemic
paro;di;s.Theyarerarelyencounteredininflamma;onof
tuberculousnature.Affectedtes;cleisswollen,painfulandmicroscopicallyshowsapolymorphousinflammatoryinfiltrate,
predominantlywithneutrophils.Gonococcalorchi6sevolves
towardssuppura;on,withtheforma;onofabscess.Acute
orchi;sunhealedcanbecomechronic,andbilateralformscan
becomplicatedbysterility
Prostateinflamma;onsarecalledprosta66s.Theyare
oenbacterial(gonorrhea,streptococci,coli,etc..)
consecu;veofanurinaryinfec;on.
Acuteprosta;;sischaracterizedbyaglandularpainful
swelling,withurethralexpressionofasero-purulentfluidat
compression.Microscopically,thereisarichgranulocy;c
inflammatoryinfiltratelocatedintheprosta;cglandsand
stroma.Chronicprosta66saretheresultofrepeatedacute
inflamma;on.Clinically,ismanifestedbynocturiaand
dysuria,andin;meoccursprogressiveatrophyofthe
prostate.Some;mescanoccurcharacteris;cinjuriesfor
tuberculousprosta;;s.
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18
Pathology
ofBlood9
Anemias
Post-Hemorrhagic:Acuteasaresultofsudden,severe,internalorexternalhemorrhage.Intheearly
stagesthereisnotadecreaseofhematocritandhemoglobinconcentra;onduetoconcomitantlossof
redbloodcellsandplasmafluid.Alilelater,hypervolemiaiscompensatedbythebodythroughan
increasedproduc;onofplasmaliquid,withtheadventofhemodilu;on.Chronicposthaemorrhagic
anemiasoccuraerrepeatedsmallhaemorrhages(gastriculcer,tumor,meno-metrorrhagiaandso
on).Anemiabecomessignificantonlyaerdeple;onofbodyirondeposits(irondeficiencyanemias)
Hemoly6c:causedbyanexcessivedestruc;onofredbloodcells,withreducingtheirlifespan.
Destruc;oncanoccurinmacrophagesfromspleen,bonemarrow,orwithinbloodvessels(intravascularhemolysis).Asacompensatoryresponse,erythropoiesisiss;mulated,anemiabecame
manifestonlywhendamagerateexceedstheproduc;onofredbloodcells.Hemoly;canemiais
characterizedbythefollowingelements:increasedserumlevelsofunconjugatedbilirubin,
appearanceinthebloodandurineoffreebilirubin(hemoglobinemiaandhemoglobinuria),
intensifica;onoferythropoiesis,Splenomegaly
IronDeficiency:canbecausedbyinadequatedietaryintake,anincreaseinbodyiron
requirements(pregnancy,growthperiod)ormaycomplicatemalabsorp;onsyndromes
andchronichemorrhages.Itischaracterizedbytheappearanceintheperipheralbloodoferythrocytesofsmallsize(microcytes),pale,hypochromic.Significantisadecrease
serumlevelofferri;n,whichreflectsadecreaseofironreservesinthebody.
Aplas6c:resultofaltera;onofbonemarrowstemcellswithpancytopeniaoccurrenceandbonemarrowcelldepopula;on.
Impairmentmaybeidiopathicormaybeduetotheac;onofmarrowtoxicagents:chemotherapy,sulphonamides,benzene,
radia;on,viruses,etc.
Anemiaisoenmacrocy;c,andleukocytesandthrombocytesaregreatlyreducedinnumber.Thepopula;onofnormalbone
marrowisreplacedbyfat;ssueprolifera;on.
Dyshematopoie6c:resultof
deficienciesoffactorsrequiredfornormal
erythrocytematura;on,
despitetheexistenceofan
adequatenumberofmarrow
precursorsfortheirsynthesis.
Mostimportantinthis
categoryaremegaloblas;c
andirondeficiencyanemia.
Megaloblas6canemiasaretheconsequenceofareducedDNAsynthesis,dueto
deficiencyoffolicacidorvitaminB12.MostcommoncauseinvitaminB12deficiencyis
theabsenceofintrinsicfactornecessaryforintes;nalabsorp;onofthevitamin.This
deficiencyoccursinatrophicgastri;s(perniciousanemia).
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19
Pathology
ofBlood9 PolycythemiaOrErythrocytosis,ischaracterizedbyincreasedtotalmassofcircula;ngerythrocytes,aprocessmostaccurately
reflectedbyincreasinghematocrit.Thedirectconsequenceisincreasedbloodviscosity,withaffec;ngitsflow
andthepossibleoccurrenceof;ssularhypoxia.Polycythemiamayberela;ve,occcurredasaresultofthe
decreaseinplasmavolume(hemoconcentra;on),andabsolute(perse),characterizedbyincreasednumberof
erythrocytes.
Primi6veerythrocytosis(polycythemiavera)isaneoplas;caltera;onofmul;potentstemcells,resul;nginprolifera;onof
allmarrowcelllines,butmoreoferythrocyteseries.Thediseaseoccursmainlyinmen,inoldageheredityseemstoplayan
importantrole.Inperipheralbloodisanincreaseinthenumberoferythrocytes(over6million/ml)withincreasing
hematocrit(60%)andhemoglobinconcentra;on(over2g%).Inaddi;on,increasesthenumberofleukocytesand
thrombocytes.Hematogenousmarrowishypercellular,withthepresenceofnumerousprecursorsofallcelllines.
Secondaryerythrocytosisistheconsequenceofhypersecre;onoferythropoie;n.Thisincreaseistypicallyreac;ve,consecu;velyto
aarterialhypoxia(highal;tudewithrarefiedair,lungdisease,hemoglobinopathies,etc.).Some;mes,thediseasemaybecausedby
theappearanceoferythropoie;n-secre;ngtumors(renalcarcinoma,livercarcinomaetc.).
Leukemiawillbediscussedinthetablededicatedtotumorsandcancers
Thrombocytopenia
Itisadecreaseinthrombocytesnumberbelow150.000/ml.Moreseveredecreases,under50.000/ml,increasetheriskfor
posrauma;chemorrhagesorbysurgery,andatvalueslessthan20.000/mlspontaneousbleedingoccurs.Thrombocytopeniamaybe
theresultofreducedmedullarythrombocytopoiesis(aplas;canemia,leukemia)ordestruc;on,excessivesequestra;onof
thrombocytesatspleenlevel.Themostcommonmanifesta;on,butnotpathognomonic,ofthrombocytopeniaispurpura
Primarythrombocytopenicpurpura(essen;al)haveimmune
e;ology,beingtheresultofappearanceinthebloodof
an;thrombocy;coran;megakaryocy;can;bodies.Thismay
occurinadultsasaconsequenceofseriouschronicdiseases
(collagenosis,leukemia,AIDS),orinchildrenduringviral
infec;ons.
Secondarythrombocytopenicpurpuramayoccurdueto
thromboly;cac;onofchemicalagents,drugs,orsecondaryto
myelo-orlymphoprolifera;veneoplas;cprocesses.
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Pathology
ofBlood9
Lymphadeni;s
Lymphadeni;sareinflamma;onoflymphnodes,secondarytotheac;onof
exogenousagents,oenbiological(bacteria,viruses,parasites,etc.).
Acutelymphadeni6soccurinthelymphnodesthatdrainlymphfrom;ssularterritoriesinwhich
ittakeplaceanacuteinflammatoryprocess.Affectedlymphnodesarehypertrophied,havealow
consistencyandarepainfulatpalpa;on.Microscopiclymphnodehistologicalstructureisaltered
bytheappearanceofaprolifera;onofsinusalhis;omacrophages(sinushis;ocytosis)andtheoccurrenceofasubcapsulargranulocy;cinfiltra;on(catarrhallymphadeni;s).Some;mes
inflamma;oncangetasuppura;vecharacterwithextensiontosurrounding;ssues.
Chroniclymphadeni6smaybe:-Nonspecificchroniclymphadeni;saccompanieschronicinfec;onwithvarioussites,having
appropriateregionaltopography.Lymphnodesarehypertrophied,withfibro;ccapsulemicroscopicpresentssinusalhis;ocytosisand
hypertrophyoflymphoidfollicles.Specificchroniclymphadeni;sarecharacterizedbytheappearanceoflesionscharacteris;cof
underlyingdisease:intuberculosisappeartuberculousfolliclesandandcaseousnecrosis,insyphilis,vasculi;swithplasmocytesrichin
inflammatoryinfiltrate.
Reac6vesplenomegalyaccompaniessomeacuteorchronicinflamma;onsuchasbacterial,viral,
parasi;corimmunological.Inbacterialinfec;onspleenismoderatelyincreasedinvolume,redpulp
beingintenselypopulatedwithmacrophagesandpolymorphonuclearneutrophils.Insep;cemia
mayappearabscessesandsep;csplenicinfarcts,aswellasinvolvementofcapsuleand
surroundingstructures(perispleni;s).Ininfec;ousmononucleosissplenomegalyisdueto
occurrenceofaninfiltraterichinlymphocytesandimmunoblastslocatedinthesinusesand
medullarycordons.Inmalaria,thespleenismuchhypertrophied(10kg),ofgray-blackishcolour
duetoincreasedan;malarialpigmentcontent(hemateina).
Conges6vesplenomegalyoccursinportalhypertension(hepa;ccirrhosis,heartfailure).Thespleenismoderately
hypertrophied,hard,withfibro;ccapsule.Microscopically,intheearlystages,sinusoidsaredilated,withalargenumber
ofmacrophages.Inadvancedstages,redpulptendstobecomehypocellularduetoaprocessoffibrosis.
Infiltra6vesplenomegalycanoccurinseveralcircumstances:intrasplenicadventofcellularinfiltrates(macrophagesin
haemoly;canemia,malignantcellsinlymphomaorleukemia)orextracellulardepositsofabnormalsubstances
(amyloidosis).
Others:Splenomegalyduetoprimi;veormetasta;csplenictumoralprocesses/Splenomegalyduetooccurrenceatthislevelof
hyda;dcysts.
Splenomegaly
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Endocrine 10
***NopeZappala,thesearenottesHcles
PathologyofHypophysis
Injuriesassociatedwithhypofunc;on
ofadenohypophysis:
Pituitarycachexiaiscausedby
panhypopituitarism,canbeproduced
byanyfactorthatdestroysthepituitarygland(varioustumors,
postpartumnecrosisofpituitary
gland).Selec6vedeficitsofoneor
morepituitaryhormones:growth
hormonedeficiency(retarda;onin
growth),gonadotropindeficiency
(delayedsexualmatura;on),TSH
deficiency(hypothyroidism),ACTH
deficiency(hypocor;cism).
Injuriesofneurohypophysis:
ADHsecre6ondeficiencyismanifested
bydiabetesinsipidus(polyuria,
dehydra;on,permanentthirst).Canoccurconsecu;velytoanyprocessthat
leadstothedestruc;onofthe
posteriorhypophysis(trauma,tumors,
inflamma;onandsoon).
Ectopicsecre6onofADHisthe
preroga;veofsometumorssuchas
smallcelllungcarcinoma.Itis
characterizedbyreten;onofwater
andconcentratedurine.
Thyroidi;sAcutethyroidi6sareusuallybacterial,occurringasaresultofinfec;oushematogenous
dissemina;on,rarelyspreadfromaneighboringorgan.Thethyroidisenlargedinvolumeandpainful.
Themostcommonencounteredaresuppura;veforms,abscessorphlegmontype
Subacutethyroidi6s(deQuervain)havemostlikelyavirale;ology(mumpsvirus,Coxsakieetc).Itisaself-limited
inflamma;on,characterizedbyfocaldestruc;onsofthyroid;ssuewithgranulomtoaselesions.Inadvancedstages
mayoccuraprocessoffibrosiswithsymptomsofhypothyroidism.Thethyroidisenlargedinvolume,notadhering
tothesurroundingorgans,increasedconsistencyandirregularsurface
Hashimoto'sthyroidi6s(diffuselymphocy;cthyroidi;s)isanautoimmunediseasewithfamilialaggrega;on,morecommonin
women.Inadvancedformsismanifestedbyhypothyroidism.Thethyroidisdiffuselyandmoderatelyincreasedinvolume,with
increasedconsistencyandintactcapsule,nonadhesive
21
Riedlthyroidi6s(ligneousthyroidi;s)hasunknowne;ologyandmayclinicallymimicthecarcinoma.Thethyroidisusuallyreducedin
volume,withirregularsurface,adherentcapsuleandveryhighconsistency.
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22
Endocrine 10Goi;er
Definetheincreaseinvolumeandweightofthethyroid,intheabsenceof
inflammatoryprocessesortumors.Fromafunc;onalperspec;ve,theremaybe
simplegoiters,withoutendocrinedisorders,andgoitersassociatedwithhyper-
orhypothyroidism.
WithEuthyroidsm WithHyperthyroidism WithHypothyroidism
(Simple,non-toxic)arecausedby
iodinedeficiencyduetoeitheran
insufficientexogenousoranincreased
needofthebody(pregnancy,growth
period,etc..).Iodinedeficiencyleads
toadefec;vesynthesisofthyroid
hormones,withconsequentdecreaseofserumlevelofthese.This
abnormalityisfeltbyhypophysis,
whichwillintensifythesynthesisof
TSH.Underitsac;onwillproduces
compensatoryhypertrophyand
hyperplasiaofthyroidfollicular
epitheliumwiththeadventofgoiter.
Simplegoitermaybediffuseor
nodular.Simpledifusegoiterisaccompaniedbyeuthyroidism,andis
characterizedbyauniformdamageof
allthyroidianmass.Maybeendemic,
occurringinmountainareas(Andes,
Alps,Carpathians).Evolvesintwo
stages:hyperplas;cphase,colloid
involu;onphase
(toxic)aremanifestedclinicallybya
complexclinicalpicture:irritability,
tremor,heatintolerance,tachycardia
witharrhythmia,diarrhea,menstrual
disordersetc..Morphologicallycanbe
dis;nguished:Diffusetoxicgoiter
(exophtalmosgoiter,Graves-
BasedowDisease)isthemostfrequent
goiterassociatedwithhyperthyroidism.Thediseasehasa
hereditarycomponent,andin;mate
produc;onmechanismis
autoimmune...Clinically,presents
signsandsymptomsof
hyperthyroidism,plusexophthalmia
andinfiltra;vedermatopathy.
Thethyroidisoverallenlargedin
volume,butoenwithunequallobesishard,brileandhighlyvascularized
thecapsuleisintegraland
nonadhesive.Toxicnodulargoiteris
rare,occursmorefrequentlyin
womenwithahistoryofsimplegoiter.
Thethyroidisunevenincreasedin
volume,withthepresenceofnodules
ofvaryingsizes.
maybeencounteredinchildrenfrom
goitrousregions,asaresultofchronic
deficitofiodineoradministra;onof
an;thyroidagents.Ithasahereditary
characterresul;ngfromco-blood
families.Arenodulargoiters,inwhich
predominatemicroscopicaspectsof
pseudo-thyroidianhyperplasia.
Hypothyroidismismanifestedinadultsthroughmyxedemaandinchildrenby
cre;nism.
Myxedemaischaracterizedbya
localizededemapredominantlyonthe
face,tongueandhand,dryskinwith
tendencytopeeling,lilehairand
harshly.Tothiscanbeaddedcold
intolerance,tendencytogainweight,
mentalretarda;on,cons;pa;onetc.Cre;nismofthyroidiancauseis
manifestedmainlybyseveremental
retarda;on,delayedbone
development,macroglossiaand
protuberantabdomen.Thethyroidis
muchincreasedinvolume,with
markedepithelialhyperplasia.
and the spaces between them
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23
Pathology
ofCNS11
Histo
Review
DuraMater
Skull
PiaMater
Arachnoid
andthespacesbetweenthem
Epidural(Extradural)
Subdural
Subarachnoid,containingCSF
Cerebral
Infarc;on
infarc;on(soening)istheresultofatotalandpersistentischemia,causedbycerebralarteryocclusion.Themaincausesofthiseventare:thrombosis,embolism.clinicalconsequencesdependontheplaceofvascularobstruc;on
andthepossibilityofdevelopmentofcollateralcircula;on.Mostcommonlyitisaffectedmiddlecerebralartery.In
thiscaseoccurscontrolateralparalysis,withmotorandsensorydeficit,andaphasia.
Cerebralinfarc;onmaybesingleormul;ple,ofvarioussizes,dependingonthesizeofarteryaffected.Ingeneral,
infarc;onsofthrombo;ccausearewhite,andthosecausedbyemboliareredinfarcts.
Microscopicallystandsaliquefac;onnecrosisduetotheemergenceofalargeamountoflipidsfromthe
disintegra;onofthemyelinsheath.
Non
trauma;c
brain
hemorrhage
Intracerebralhemorrhage(apoplexy)isdefinedasbleedingwithinthebrainsubstance.Mostfrequentlyoccursinthebasalnuclei,theinternalcapsuleandthalamus.Themostfrequentlyinvolvedintheproduc;onofintracerebral
hemorrhageisarterialhypertension.Undertheac;onofthisthereisadecreaseintheresistanceofwallsofbrain
arterioles,withtheforma;onofmicroaneurysms,whichcanbeeasilybroken.Morerarely,areinvolved
arteriovenousmalforma;ons,hemorrhagesdiathesesortumoralprocesses.
Subarachnoidhemorrhageisableedingintothesubarachnoidspace.Mostoenitistheresultofaruptured
aneurysminthearteriesofWillispolygon.Some;messubarachnoidhemorrhagemayalsohavetrauma;ccause.
Posttrauma;c
brain
hemorrhage
Epiduralhematomausuallyoccursasaresultoftrauma;cfractureofthetemporalbone,withthemiddle
meningealarteryinjuryandaccumula;onofbloodintheextraduralspace.Clinically,itischaracterizedbyashortasymptoma;cperiod,andthenoccurcompressivecerebralphenomenaand,intheabsenceoftreatment,death.
Subduralhematomaistheresultoftrauma;cruptureoftheconnec;onveinsbetweencerebralsubstanceand
venoussinusesofthedura,withtheaccumula;onofbloodbetweenthearachnoidandduramater.Typically
locatesinthefronto-parietalregion.Itischaracterizedbygradualappearanceofsignsofcompressionofthebrain
(some;mesoveraperiodofseveralweek).
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Pathology
ofCNS11
Meningi;s
inflamma;onoftheconjunc;vemembranesthatcoverthecentralnervous
systemorgans.Maybeaffectedroughmeninges,processwearinginthiscase
thenameofpachymeningi;s,orsomeninges(arachnoid,piamaterand
subarachnoidspace),definedwiththeleptomeningi;sterm.
Bacterial Tuberculous Viral
(enterovirus,mumpsvirus,Epstein-Barrvirus,etc.)predominantlyaffectsyoung
ages,usuallywithabenignevolu;on.
Thediseaseischaracterizedbythe
appearanceofanintensecephalalgia
andthediagnosisismadebyspinal
puncture(CSFwithnumerous
lymphocytes,increasedamountof
proteinandnormalglucosecontent).
occurssecondary,inthecontextofgeneralizedmiliarytuberculosis.Itisa
non-purulentinflammatoryprocess,
withpredilectloca;oninthebrain.Here
mayoccurexuda;veorprolifera;ve
(miliarytubercles)lesions.Maybe
complicatedbymeningealfibrosisand
consequentobstruc;onofventricular
system.
Meningococcalmeningi;saffectsmostlychildren,ischaracterized
bytheappearanceofasero-
purulentinflammatoryexudate,
yellowish.Exudatecontainsa
smallamountoffibrinanda
largenumberofgranulocytes
andmacrophages.Brain
substanceisedematous,with
punctatehemorrhagesandperi
vascularinflammatoryinfiltrate.
Pneumococcalmeningi;sis
characterizedbytheappearance
ofgreenexudate,jellyhas
increasedtendencyto
delimita;on(forma;on
ofenclosedspacesfilledwith
pus)Staphylococcalandstreptococcalmeningi;sare
secondarytoneighborly
suppura;veprocesses.Exudate
hassero-purulentappearancefor
streptococcusandyellowish,
creamyforstaphylococcusthe
processhaveanincreased
tendencyforintracerebral
abscessforma;on,epi-orsubdural.
Encephalomyeli;s
(definedinflamma;onofcerebralsubstance(encephali;s)andofspinalcord(myeli;s).
Importantinmedicalprac;ceareinflamma;onsofvirale;ology,andofthese,dueto
theirseriousness,polipomyeli;sandrabiesencephali;s.
Poliomyeli6s(infan6leparalysis)iscausedbyoneofthreetypesofpolioviruses.Itisan
acuteinflamma;onthatpar;cularlyinterestedintheanteriorcornsofthespinalcord,
leadingtodestruc;onofmotorneuronswithparalysisandatrophyofcorrespondingsoma;cmuscle.Macroscopically,medullaspinalisiswithintensehyperemia,edematous
(glassy)aspectwithhemorrhagicsuffusionsonsec;on.Rabiesencephali6siscausedby
therabiesvirus,transmiedbythebiteofinfectedanimals.Fromtheentrancegate,virus
spreadsbyaxonalpathun;lspinalcord,brainandinternalorgans(includingsalivary
gland).Thediseasemanifestsitselfasasevereencephali;swithincreasedCNS
excitability,violentmusclecontrac;onsandconvulsionstriggeredbyminimals;muli.
Histologically,thediseaseischaracterizedbyneuronaldegenera;on,perivascular
lymphocy;cinflammatoryinfiltrateinthecerebralhemispheres,cerebellumandspinal
cordpathognomonicareBabes-Negricorpuscles 24
andthespacesbetweenthem
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25
Mul;ple
Sclerosis
Mul;plesclerosisisthemostcommondemyelina;ngchronicdiseaseoftheCNS.Predominantlyaffectsyoung
women,withaprogressiveevolu;on,occurringinspikes.E;ologyisunknown.
Characteris;clesionsarerepresentedbyplatesofsclerosisvisiblebynakedeyeinthecerebralwhitesubstance
andspinalcord.Itpresentsasovalpatches,irregular,insizesupto2cm,translucent,withcolorvariable,
dependingontheirage.Thesecorrespondtoareasofaxonaldemyelina;on.Microscopically,thereiscomplete
disappearanceofthemyelinsheathintheseareas,withlocalprolifera;onofglialcellsandconnec;ve;ssue.
Alzheimers
Disease
Isadegenera;vediseaseofunknowne;ology,whichisthemostimportantcauseofdemen;a.En;tyreferstodemen;aoccurringatanyage,associatedwithclinicalmanifesta;onsandspecificpathologicalchanges.
Clinicalmanifesta;ons:
slowlyprogressiveintellectualdeteriora;on:ini;allyshorttermmemoryloss,thenandthelong-termmemory,inabilitytowrite,count,speak,etc..
motorproblems:contracturesandparalyzesspecifictoterminalphaseMorphologicalabnormali;es:
neurofibrillarydisorder:intraneuronalfascicles(microtubulesandneurofilament)disorganiza;onincerebralcortex
neuri;cplaques(senile):eosinophilsneuronalprocesseswithcenterconsis;ngofaamyloiddepositsinthecerebralcortexandhippocampus
neuronalgranulocyte-vacuolardegenera;onatpyramidlevel Hiranobodies:dendri;ceosinophilicinclusions generalizedcerebralatrophymoreexpressedinhippocampusandfrontalareas.
Pathology
ofCNS11
Histo
Review
DuraMater
Skull
PiaMater
Arachnoid
p
Epidural(Extradural)
Subdural
Subarachnoid,containingCSF
ThisworkisnotsubsHtuteofdoctorPaiusansmaterial,evenifevrysinglewordisextractedbyhiswordfilessoit
willmatcheswhatweneedforthefinalexamMayTheForceBeWithYou