Cdsa, Part 2,2006-07

Uni ver si ty of S anto Tomas Depar tm ent of Pathol og y

CELL REA CTI ONS TO IN JU RY PAR T 2 CELL DEA TH AND SO MA TI C DEA TH Emmanuel dela Fuente, MD Alejandro Arevalo, MD

OBJECTIVES

3. To recognize the different lesions of cell death 4. To discuss the etiopathogenesis of the lesions 5. To explain the pathophysiologic basis for the events in the situation

Activities for this morning’s class include: 2. Lecturette on cell death and somatic death 3. Discussion of situations using the format as stated in the process approach 4. Recognition of lesions from actual gross specimens and glass slides

Irreversible Injury Cells may die if the injury is persistent. It occurs in the living body as a local or focal change (autolysis, necrosis, apoptosis) and the changes following it (gangrene, dystrophic calcification) or result in the end of life.

Irreversible Injury The following are gross and microscopic pictures. Identify the following pathologic processes as to their morphology and state the etiopathogenesis and the organs where these lesions are frequently encountered.

Identify this cell and differentiate this lesion from necrosis and autolysis. State its significance

Process Approach to the Situations 2. State or list the facts of the clinical situations presented 3. Define issues or problems in clinical situations 4. Make hypothesis on the possible pathogenesis of the problem/s 5. Recognize the lesions of the different tissues/ organs presented 6. Make a clinico-pathologic correlation i.e., give pathophysiologic basis to explain the clinical problems

SITUATION NO. 1 A 65 year old man who has apparently been well begins to experience chest pain while climbing to the 5th floor of a building. After several minutes of rest, the chest pain disappears. He seeks consultation and is told that his blood pressure is 180/110. ECG reveals left ventricular hypertrophy.

One evening, while eating, he slumps on the table. He is rushed to a nearby hospital where he is pronounced dead on arrival.

Before proceeding to the next slides, do the following: • State the facts • State the problem/s • Make possible hypotheses to explain the problem/s • Predict possible lesions to explain the problem and explain

Which of these 2 lesions of the opened coronary arteries best explains the sudden course of events of the patient? Describe and explain. (Arrows indicate the arteries.)

1. How do you classify these lesions in the coronary arteries using the concepts of cell injury? 2. Discuss the etiopathogenesis of the lesions

Which of these 2 coronary lesions correlates with the sudden course of events of the patient?

1. What is the serious consequence of the lesion of your choice in the previous slide. 2. Identify the lesion indicated by the arrow in the previous slide, which is similar to the lesion seen in the picture on this slide.

Which of these 2 hearts correlates with the lesion in the coronary artery and with the course of events of the patient? Describe and classify the lesion.

Which of these 2 lesions corresponds to your choice in the previous slide? Classify the lesion. Describe.

Classify these 2 lesions of the heart. Describe.

1. Briefly discuss the etiopathogenesis of the lesion, including the biomolecular events. 2. Correlate the lesions with the clinical events. 3. Which of the following glass slides shows a similar lesion as in this case? - CV – 006 - CV – 016 - CV – 017

Con’t of Situation No.1 The dead man from the emergency room is brought to the morgue of the hospital. After a while, his wife and relatives go to the morgue to claim his body. Upon seeing the body, she and her grandchild touch his body and try to move his left arm and observe that it is cold and stiff. Her 4 year old grandchild asks, “Bakit lola malamig at matigas ang katawan ng lolo ko? Patay na ba siya?”

1. What do you think were the basis for the physician at the emergency room to pronounce the man dead? 2. Discuss the medical concept of somatic death 3. Explain the post-mortem changes observed 4. What other changes do you expect? 5. Discuss the pathogenesis of these post-mortem changes

Situation No. 2 Identify the lesion in this coronal section of the brain. Describe and classify the lesion

Section of the affected area of the brain. Describe and classify the lesion.

40 x

400 x

1. Discuss briefly the etiopathogenesis of the lesion 2. Give possible signs and symptoms 3. Which of the following slides shows a similar lesion as in this case? - CV – 016 - LU – 014

SITUATION NO. 3 A 34 year old man has a pre-employment chest Xray and is interpreted as tuberculosis. Otherwise, he is asymptomatic.

A gross section of the lung. Indicate the lesions and describe.

A similar lesion in the hilar lymph nodes. Indicate the lesion and describe.

A microscopic section of the lesion. Indicate the lesion, describe, and classify.

1. Briefly discuss the etiopathogenesis of the lesion. 2. Give probable reasons as to why the patient is asymptomatic 3. Which of the following glass slides shows a similar lesion as in this case. - LU – 003 - LU – 009

Situation No. 4 This picture shows an area of necrosis. Indicate and classify the lesion. Discuss the etiopathogenesis.

Situation No.5 This is the foot of a 68 year old woman with a long history of diabetes mellitus. Indicate, describe, and briefly discuss the pathogenesis of the lesion.

Situation No. 6 Identify, describe, and classify the lesion seen in these pictures. Discuss the etiopathogenesis.

EVEN IN DEATH THERE IS LIFE