Lesson 4
Pathomorphology of accumulation of products of impaired metabolism (endogenous and exogenous pigments). Disorders of iron and hemoglobinogenic pigments metabolism. Morphological manifestations of disorders of melanin formation, nucleoprotein and copper metabolism. Calcification of tissues. Stone formation
Key points:
1. Disorders of iron metabolism and metabolism of hemoglobinogenic pigments. Classification of hemoglobinogenic pigments. Toxic forms of ferritin: causes and consequences of their formation.
2. Disruption of melanin formation. Morphological characteristics of hypopigmentation (leukoderma, vitiligo, albinism) and hyperpigmentation (general melanoderma, local melanosis, pigment nevus).
3. Disorders of nucleoprotein metabolism. Gout and gouty arthritis: morphological characteristics of joint changes, complications, consequences. Gouty nephropathy: a morphological characteristic.
4. Stone formation: localization, types of stones, consequences and complications of stone formation.
Sources:
1. Kumar, Vinay, Abul K. Abbas, and Jon C. Aster. Robbins and Cotran Pathologic Basis of Disease. Ninth edition. Philadelphia, PA: Elsevier/Saunders, 2015. P.7-64
2. Kumar, Vinay, Abul K Abbas, Jon C Aster, and Stanley L. 1915-2003 Robbins. Robbins Basic Pathology. 10th ed. Philadelphia, PA: Elsevier/Saunders, 2018. P.1-33, 51
3. Klatt, Edward C. Robbins and Cotran Atlas of Pathology. Third edition. Philadelphia, PA: Elsevier Saunders, 2015.
4. Klatt, Edward C., and Vinay Kumar. Robbins and Cotran Review of Pathology. Fourth edition. Philadelphia, PA: Elsevier Saunders, 2015. P.3-17
5. Harsh Mohan. Essential Pathology for Dental Students.Fourth edition. Jaypee Brothers,Medical Publishers Pvt. Limited, 2011. P.1-77
Wilson's disease. Kaizer's ring, copper pigmentation
Lipofuscin in cardiomyocytes. “Tear-and-wear” pigment
Brown atrophy of heart
Metastatic calcification
Deposition of calcium in normal tissues, caused by hypercalcemia (e.g. parathyroid hormone excess)
Hemochromatosis, microscopic
Accumulation of brown-coloured deposits in hepatocytes as it appears with H&E staining in this case with liver cirrhosis
Hemochromatosis, microscopic
Prussian blue Fe2+ stain reveals extensive hepatic hemosiderin deposition
Hemochromatosis, gross
The dark brown color of this liver and the pancreas and lymph nodes on cross-sectioning is a result of extensive iron deposition with hereditary hemochromatosis
Hemosiderosis of lungs. Mitral valve failure
Alveolar macrophages are laden with brown-coloured pigment. Capillaries are dilated due to the pulmonary congestion. Pulmonary edema appears as pink-coloured protein-rich fluid that fills alveolar spaces