病理學(xué)解剖pathology-課件chapter

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Metaplasiaisareversiblechangeinwhichoneadultcelltypeisreplacedbyanotheradultcelltype.Metaplasia化生

一種分化成熟的細(xì)胞為另一種分化成熟的細(xì)胞所替代的過程。是存在于正常組織中的干細(xì)胞或結(jié)締組織中未分化間葉細(xì)胞通過增生轉(zhuǎn)變，即重新程序化的結(jié)果化生只出現(xiàn)于具有增生能力的細(xì)胞特異性低的細(xì)胞取代特異性高的細(xì)胞化生只發(fā)生于同源細(xì)胞之間

Definition:

LogoMetaplasia-TypesEpithelialmetaplasiaMesenchymalmetaplasiacolumnarepithelium(trachea,cervix,cholecyst)transitionalepithelium(pelvis)Squamousmetaplasia鱗狀上皮化生Intestinalmetaplasia腸上皮化生GastricglandularepitheliumPseudo-pyloricgland

Metaplasia假幽門腺化生corpusandsinusgastricglandOsseous,cartilageandadiposetissue

metaplasia骨、軟骨、脂肪組織化生FibroblastsLogoMetaplasia-TypesLogoMetaplasia-TypesSquamousmetaplasianormalLogo正常氣管上皮鱗狀上皮化生

LogoMetaplasia-TypesSquamousmetaplasiaLogosquamousmetaplasiavilliofnormaltracheaMetaplasia-TypesLogoMetaplasia-TypesLogoAdvantagelossofnormalfunctionCancertransformationDisadvantageMetaplasia-significanceMetaplasia---a“double-edgedsword”Defending

Logoatrophy

hypertrophyhyperplasiametaplasiaadaptationAdaptationIncreaseddemandsGrowthstimulationDiminishednutritionLowstimulationChronicstimulationPathologicalLogo第一章TissueandCellularInjuryLogoCellandtissueinjury當(dāng)機(jī)體內(nèi)外環(huán)境改變超過組織和細(xì)胞的適應(yīng)能力，引起受損細(xì)胞和細(xì)胞間質(zhì)發(fā)生物質(zhì)代謝、組織化學(xué)、超微結(jié)構(gòu)乃至光鏡和肉眼可見的異常變化，稱為損傷NormalcellsirreversibleinjuryreversibleinjuryAdaptation（injury）LogoHypoxia1Physicalagents3Biologicagents4Immunologicreactions5Genetic

defects6Nutritionalimbalances7Others82Chemical

agents---CausesCellandtissueinjuryLogo

ATP的耗竭（ATPdepletion）

線粒體的損傷（Irreversiblemitochondriadamage）膜滲透性的缺陷（Lossofmembranepermeability）細(xì)胞內(nèi)鈣的流入和鈣內(nèi)環(huán)境穩(wěn)定的破壞（Overloadofintracellularcalciumandlossofcalciumhomeostasis）氧自由基的集聚（Accumulationofoxygen-derivedfreeradicals）---MechanismsofcellinjuryCellandtissueinjuryLogo---Morphologicchanges細(xì)胞損傷cellularinjury

可逆性損傷

reversibleinjury

變性

Degeneration

細(xì)胞死亡celldeath不可逆性損傷

irreversibleinjury壞死Necrosis凋亡apoptosisCellandtissueinjuryLogoMorphologicchanges--Reversibleinjury各種細(xì)胞損傷的早期改變?yōu)锳TP減少、細(xì)胞膜完整性缺失、蛋白合成下降、細(xì)胞骨架損傷和DNA損傷。在一定限度內(nèi)損傷的改變?yōu)榭赡娴?，傳統(tǒng)形態(tài)學(xué)上稱變性（Degeneration）變性指細(xì)胞或細(xì)胞間質(zhì)受損傷后，由于代謝障礙，使細(xì)胞內(nèi)或細(xì)胞間質(zhì)內(nèi)出現(xiàn)異常物質(zhì)或正常物質(zhì)異常蓄積的現(xiàn)象，通常伴有細(xì)胞功能低下。

Whencellularinjuryissublethalandsustained,cellsandtissuestendtoaccumulatesubstancesinabnormalquantities.Thesematerialsmaybeendogenousorexogenous.CellandtissueinjuryLogo---Morphologicchanges脂質(zhì)lipidsreversiblecellinjury細(xì)胞腫脹Cellularswelling脂肪變FattychangeIntra(extra)-cellularaccumulations蛋白質(zhì)proteins

淀粉樣變Amyloidchange

玻璃樣變hyalinechange黏液樣變mucoidchange病理性色素沉著Pigments糖原glycogen病理性鈣化Pathologiccalcification

CellandtissueinjuryLogoThecommonsite---liver,kidney,heart

Reversibleinjury--cellularswellingCellandtissueinjuryThecommonestandearliestformofcellinjuryfromalmostallcauses.

HypoxiainfectionintoxicationmitochondriainjuryATP↓Na+-K+pumpdysfunctionIntracellularaccumulationofNa+andH2OLogoReversibleinjury--cellularswellingGrossly:Theaffectedorganisenlargedduetoswelling.Thecutsurfacebulgesoutwardsandisslightlyopaque.

腫大，包膜緊張，切面隆起，邊緣外翻，混濁無光，如沸水燙過Cellandtissueinjury

Cellularswellingofliver

LogoReversibleinjury--cellularswellingNormalcellGranularitychangeHydropicchange

Viralhepatitis

LM:Thecellsareswollen.

Smallclearvacuolesareseeninthecells.病變初期，細(xì)胞質(zhì)內(nèi)出現(xiàn)的紅染細(xì)顆粒狀物。若水鈉進(jìn)一步積聚，細(xì)胞基質(zhì)高度疏松呈空泡狀，其極期稱為氣球樣變

CellandtissueinjuryLogoReversibleinjury--cellularswellingCellandtissueinjuryLogo肝細(xì)胞水腫（氣球樣變）Reversibleinjury--cellularswellingCellandtissueinjuryLogoHydropicdegenerationofrenaltubuleReversibleinjury--cellularswellingCellandtissueinjuryLogoReversibleinjury--cellularswelling

EM:dilatationofendoplasmicreticulumandmitochondrialswelling

線粒體、內(nèi)質(zhì)網(wǎng)腫脹

mitochondrialswellingCellandtissueinjury

dilatationofendoplasmicreticulumLogoReversibleinjury--cellularswelling肉眼:腫大，包膜緊張，切面隆起，邊緣外翻，混濁無光，如沸水燙過光鏡:病變初期，細(xì)胞質(zhì)內(nèi)出現(xiàn)的紅染細(xì)顆粒狀物。若水鈉進(jìn)一步積聚，細(xì)胞基質(zhì)高度疏松呈空泡狀，其極期稱為氣球樣變

電鏡:

線粒體、內(nèi)質(zhì)網(wǎng)腫脹

Gross:

Theaffectedorganisenlargedduetoswelling.Thecutsurfacebulgesoutwardsandisslightlyopaque.

LM:Thecellsareswollen.Smallclearvacuolesinthecells.EM:swellingofendoplasmicreticulumandmitochondriaCellandtissueinjuryLogoDefinition:Theaccumulationoffatinnon-fattyparenchymalcells.

脂肪變:實(shí)質(zhì)細(xì)胞內(nèi)脂肪的異常蓄積CellandtissueinjuryReversibleinjury--fattychangeLiver,heart,kidneysandotherorgans肉眼:器官體積增大，淡黃色，邊緣圓鈍，切面呈油膩感

光鏡:細(xì)胞內(nèi)出現(xiàn)邊緣較整齊的大小不等的圓形空泡，蘇丹Ⅲ呈桔紅色，鋨酸呈黑色Gross:

enlarges,yellow,soft,andgreasy.LM:Thefattychangeappearsasclearvacuoleswithinparenchymalcells.

LogoFattychangeofliverCellandtissueinjuryalcoholabuseproteinmalnutrition

obesityhepatotoxindiabetesLogoIntracellularaccumulations

---fattychangeIntracellularaccumulations

---fattychangeCellandtissueinjuryLogoLM:Smallvacuolesaroundnucleus↓coalescelargevacuolesthatdisplacethenucleustotheperipheryofthecell.FattychangeofliverCellandtissueinjuryLogoSpecialstainingSudanIII:

orangeredOsmicacid:

blackFattychangeofliverCellandtissueinjuryLogoFattychangeoflivercongestion:centralpartsofthelobulestoxication:perilobulesCellandtissueinjuryLogoUpperLeft:grossappearance.Lowerleft:HEstain.UpperRight:SudanIIIstainforfat.LowerRight:electronmicroscopyFattychangeoftheliverLogo灶性：彌慢性:兩側(cè)心室心肌彌漫淡黃色,見于嚴(yán)重缺氧和中毒心肌脂肪浸潤：心外膜下過多脂肪并向心肌伸入，嚴(yán)重可致猝死部位：左心室的內(nèi)膜下和乳頭肌肉眼：虎斑心--成排黃色條紋(脂肪變），未受侵犯的心?。t色）鏡下：脂肪滴較小，串珠狀，位于細(xì)胞核附近臨床：對心功能一般無大影響Intracellularaccumulations

---fattychangeofmyocardiumCellandtissueinjuryLogoFattychangeofmyocardiumTigerstripeheartCellandtissueinjuryBandsofyellowstreaksalternatewithred-brownmuscleappearanceFattychangeareinyellowMyocardiumareinred-brownLogoSpecialstainSudanIII:orangeredOsmicacid:blackfattychangeofmyocardiumCellandtissueinjuryLogoMyocardiumfattyinfiltrationCellandtissueinjuryLogo動脈粥樣硬化Atherosclerosis黃色瘤Xanthomas炎癥和壞死inflammationandnecrosisLipid—cholesterolandcholesterylesters

膽固醇和膽固醇酯CellandtissueinjuryAtherosclerosis—foamcells

LogoReabsorbentdroplets:renaltubulesRussellbodies:plasmacellsDefectinproteinfoldingIntra(extra)-cellularaccumulations---Proteins細(xì)胞內(nèi)蛋白積聚，胞質(zhì)內(nèi)圓形嗜酸性小滴、空泡或不規(guī)則聚集物CellandtissueinjuryLogoReabsorbentdropletsIntracellularaccumulations---ProteinsCellandtissueinjuryLogoRussellbodies漿細(xì)胞胞漿內(nèi)可見圓形的嗜伊紅小體,將核擠向一側(cè)，是免疫球蛋白蓄積的結(jié)果Intracellularaccumulations---ProteinsCellandtissueinjuryLogoMallory小體--酒精性肝病時，肝細(xì)胞胞質(zhì)中細(xì)胞中間絲前角蛋白變性Intracellularaccumulations---ProteinsCellandtissueinjuryLogoVarioushistologicalorcytologicalalterationscharacterizedbyhomogeneous,glasslikeeosinophilicappearanceinHEstainedsections

玻璃樣變通常用來描述在常規(guī)HE切片中細(xì)胞內(nèi)或細(xì)胞外組織變成均質(zhì)、紅染、毛玻璃樣。又稱透明變Definition:Intra(extra)-cellularaccumulations---Hyalinechange玻璃樣變CellandtissueinjuryLogoReabsorbdroplets:renaltubulesMalloryalcoholicbodies:hepatocytesRussellbodies:plasmacells

Hyalinechange-TypesIntracellularhyalineArterioleshyalineCollagenousfibroustissuehyalineCellandtissueinjuryLogoHyalinechange--IntracellularhyalineCellandtissueinjuryLogo

HypertensionanddiabetesmellitusExtravasatedplasmaproteinDepositionofbasementmembraneHyalinechange--arterioleshyaline細(xì)動脈壁玻璃樣變CellandtissueinjuryLogoArterioleshyalineCellandtissueinjuryLogo膠原蛋白交聯(lián)、變性、融合，增生的膠原纖維增粗，形成均質(zhì)紅染的梁狀或片狀結(jié)構(gòu)。其間少有血管和纖維細(xì)胞Hyalinechange---Collagenousfibroustissuehyaline纖維結(jié)締組織玻璃樣變CellandtissueinjuryLogo淀粉樣變性Amyloidchange

isaconditionthatoccursinagroupofdiseases,allhavingthelocalizedorgeneralizeddepositionofamyloid.指在細(xì)胞外間質(zhì)內(nèi)出現(xiàn)淀粉樣物質(zhì)的異常沉積病變:鏡下細(xì)胞外間質(zhì)呈淡紅色的均質(zhì)狀（HE）。因與淀粉遇碘反應(yīng)相似故得名。剛果紅染色呈橘紅色常見部位:細(xì)胞間、小血管基底膜、網(wǎng)狀纖維支架、血管壁Intra(extra)-cellularaccumulations---Amyloidchange（淀粉樣變）LogoChangecharacterizedbyaccumulationofmucininintracellularorextracellularloci.

指間質(zhì)內(nèi)有粘多糖和蛋白質(zhì)的蓄積Intra(extra)cellularaccumulations---Mucoidchange粘液樣變病變:

鏡下間質(zhì)疏松，多突起的星芒纖維細(xì)胞散在于灰蘭色的粘液樣基質(zhì)中常見部位:膠原病,如風(fēng)濕病等,動脈粥樣硬化及間葉組織腫瘤基質(zhì)中CellandtissueinjuryLogo有色物質(zhì)在細(xì)胞內(nèi)、外的異常蓄積

含鐵血黃素Hemosiderin脂褐素Lipofuscin黑色素Melanin膽紅素bilirubin

碳末Carbon煤塵smut紋身色素tattooingPathologicpigmentation

病理性色素沉著endogenousexogenousCellandtissueinjuryLogoexogenousLogo

HeartfailurecellPathologicpigmentation--HemosiderinCellandtissueinjuryLogoPathologicpigmentation--LipofuscinCellandtissueinjuryLogoPathologicpigmentation--MelaninCellandtissueinjuryLogoPathologicpigmentation--bilirubinCellandtissueinjuryLogoPathologiccalcification

病理性鈣化Types:

Definition:

Abnormaldepositsofcalciumsaltsoccurinanytissuesexceptbonesandteeth骨、牙之外的組織中固態(tài)鈣鹽沉積

鈣磷代謝障礙,見于甲狀旁腺功能障礙、骨腫瘤、維生素D攝入過多導(dǎo)致高鈣繼發(fā)于局部變性、壞死或其他異物，鈣磷代謝正常dystrophic

calcificationmetastaticcalcificationCellandtissueinjuryLogoPathologiccalcification

病理性鈣化DystrophiccalcificationCellandtissueinjuryLogoPathologiccalcification

病理性鈣化MetastaticcalcificationCellandtissueinjuryLogoMorphologicchangesoftissueandcellularinjury脂質(zhì)lipidsreversiblecellinjury細(xì)胞水腫Cellularswelling脂肪變FattychangeIntra(extra)-cellularaccumulations蛋白質(zhì)proteins

淀粉樣變Amyloidchange

玻璃樣變hyalinechange黏液樣變mucoidchange病理性色素沉著Pigments糖原glycogen病理性鈣化Pathologiccalcification

LogoTissueandCellularinjuryirreversibleinjuryReversibleinjuryCelldeath

LogoIrreversibleinjury--Celldeath細(xì)胞死亡

SeveredamageinvolvenucleusFunctionloseStructuredestroyMetabolismstopnecrosisapoptosisIrreversibleinjuryCelldeath

TissueandCellularinjury細(xì)胞受到嚴(yán)重?fù)p傷累及細(xì)胞核時，呈現(xiàn)代謝停止、結(jié)構(gòu)破壞和功能喪失等不可逆性改變即細(xì)胞死亡LogoAsequenceofmorphologicchangesthatfollowcelldeathinlivingtissue.Necrosis

壞死活體內(nèi)局部組織、細(xì)胞的死亡Enzymaticdigestionofthecells(autolysis&heterolysis)DenaturationofproteinsThemorphologicappearanceofnecrosisistheresultoftwoessentiallyconcurrentprocesses:TissueandCellularinjuryLogoMorphologyofnecroticcellsChangesinthenucleus1

Karyolysis（核溶解）

Pyknosis(核固縮)Karyorrhexis（核碎裂）2ChangesincytoplasmandcellularmembraneChangesinmesenchyma3

IncreasedEosinophilia(嗜酸性染色增強(qiáng)）:

Vacuolatedandmoth-eatenappearance(蟲蝕狀或空泡化）cellularmembranebreakage—inflammationCalcification(鈣化）TissueandCellularinjuryLogoMorphologyofnecroticcellsChangesinthenucleus1Karyolysis（核溶解）:dissolutionofthenucleus(thebasophiliaofthechromatinfade)Pyknosis(核固縮):nuclearshrinkageandcondensationofchromatin(increasedbasophilia)Karyorrhexis（核碎裂）:thepyknoticnucleusfragments

normalpyknosiskaryorrhexiskaryolysisTissueandCellularinjuryLogo

pyknosiskaryorrhexiskaryolysisMorphologyofnecroticcellsTissueandCellularinjuryLogoCytoplasm:increasedeosinophilialossofRNAanddenaturedproteinMorphologyofnecroticcellsLogo壞死的類型TypesofnecrosiscoagulativenecrosisliquefactionnecrosisSpecializednecrosisnecrosiscaseousnecrosisgangrenefibrnoidnecrosisfatnecrosisEnzymaticdigestionofthecellsDenaturationofproteinsTissueandCellularinjuryLogoThenecrosisareaisswollen,firmandpale.灰白、干燥、堅實(shí)的凝固體，周圍見充血出血帶，與周圍組織界限清楚Coagulativenecrosis

凝固性壞死指壞死組織尚保留原組織的細(xì)胞輪廓，呈灰白、干燥的凝固狀

GrossLM:Thedeadcellspreservetheirbasicstructuraloutlinebutonlyindistinctly，appearingasamassofcoagulatedpink-staining,homogeneous細(xì)胞微細(xì)結(jié)構(gòu)消失，而組織結(jié)構(gòu)輪廓保存Sites:Infarctsofsolidorgans--heart,spleen,kidneyTissueandCellularinjuryLogoCoagulativenecrosis凝固性壞死Anemicinfarctofkidney腎貧血性梗死Thenecrosisareaisfirmandpale.灰白、質(zhì)地較硬的凝固體，充血出血帶，與周圍組織界限清楚TissueandCellularinjuryLogoCoagulativenecrosis凝固性壞死TissueandCellularinjuryLogocoagulativenecrosisofheartTissueandCellularinjuryLogoLiquefactivenecrosis

液化性壞死組織壞死因酶性分解而變成液態(tài)grosslySoftandliquid.Dischargeoftheliquidcontentsformsacysticspace.壞死組織呈液狀,可見壞死腔或軟化灶Thetissuestructuredissolvebyenzymesdigestionofthecells原組織結(jié)構(gòu)溶解消失LM:Types:Brainafterischemicinjury(richinlipid)Pancreatitis(richinprotease)AbscesseslyticnecrosisTissueandCellularinjuryLogoLiquefactivenecrosis

液化性壞死TissueandCellularinjuryCoagulativenecrosisLiquefactivenecrosisLogoLiquefactivenecrosis

液化性壞死TissueandCellularinjuryLogo液化性壞死-LiquefactivenecrosisLiquefactivenecrosisofhepatocytes

溶解性壞死（lyticnecrosis）

LogoSpecialtypesofnecrosis干酪樣壞死Caseousnecrosis

壞疽Gangrene

脂肪壞死Fatnecrosis

纖維素樣壞死FibrinoidnecrosisTissueandCellularinjuryLogoTissueandCellularinjury干酪樣壞死caseousnecrosis在結(jié)核病時，因病灶中含脂質(zhì)較多，壞死區(qū)呈黃色，狀似干酪

mostofteninTBGross:whiteorlightyellow,cheesy.LM:amorphousgranulardebristissue,architectureiscompletelyobliteratedLogo干酪樣壞死caseousnecrosis特殊類型的凝固性壞死，肉眼觀微黃，質(zhì)松軟、細(xì)膩，狀似干酪。鏡下原有的組織結(jié)構(gòu)完全崩解破壞，呈現(xiàn)一片無定形、顆粒狀紅染物。主要見于結(jié)核病TissueandCellularinjuryLogo指繼發(fā)有腐敗菌感染的大塊組織壞死。

Gangrene

壞疽NecrosisofbigtissuewithsecondaryputrefactiveorganismsinfectionBlackandgreenappearanceGangreneDrygangrenesWetgangreneGasgangreneTissueandCellularinjuryLogofrostbiteinjury壞死組織水分少,蒸發(fā)干固皺縮，呈黑褐色，分界明顯四肢末端多見，動脈受阻，靜脈通暢腐敗菌感染一般較輕Occursontheskinsurfacefollowingarterialobstruction.Itisparticularlyliabletoaffectthelimbs,especiallythetoes.TissueandCellularinjuryDrygangrenesLogodry,black,clearborderwithsurroundingnormaltissueTissueandCellularinjuryLogo與外界相通的內(nèi)臟(如肺、腸、子宮、闌尾、膽囊等)或四肢，動脈受阻，靜脈也不暢或受阻(淤血，水腫)壞死組織水分多，局部腫脹、暗綠色、分界不清腐敗菌感染重，產(chǎn)生吲跺，糞臭素、惡臭；毒素吸收，毒血癥Conditions:occursinnaturallymoisttissuesandorgans.Botharterialandvenous

obstruction;

Character:wetswollen,foul-smelling,blackorgreen.Location:smallintestine,appendix,lung,uterus,limbsWetgangreneTissueandCellularinjuryLogoWetgangreneSoft,swollen,dark.TissueandCellularinjuryLogoGasgangrene深在的開放性創(chuàng)傷合并產(chǎn)氣莢膜桿菌感染壞死組織含大量氣體，呈蜂窩狀，污穢、暗棕色，捻發(fā)感；戰(zhàn)傷，外傷，厭氧菌感染Conditions:deepcontaminatedwoundsinwhichthereisconsiderablemuscledamagedbygasformingbacteria.Character:swollenobviously,gasbubblesformationwarwoundsTissueandCellularinjuryLogoFibrinoidnecrosis纖維素樣壞死原因：變態(tài)反應(yīng)性疾病、急進(jìn)性高血壓部位：結(jié)締組織和血管壁病變：病變部位形成細(xì)絲狀、顆粒狀或小條塊狀無結(jié)構(gòu)物質(zhì)，染色深紅，有折光性，由于其與纖維素染色性質(zhì)相似，故名纖維素樣壞死TissueandCellularinjuryLogoFatnecrosis脂肪壞死酶解性脂肪壞死外傷性脂肪壞死TissueandCellularinjuryLogoFatnecrosis脂肪壞死外傷性脂肪壞死TissueandCellularinjuryLM:shadowyoutlinesofnecroticfatcells,withbasophiliccalciumdepositsandasurroundinginflammationreaction酶解性脂肪壞死Logo壞死的類型TypesofnecrosiscoagulativenecrosisliquefactionnecrosisSpecializednecrosisnecrosiscaseousnecrosisgangrenefibrnoidnecrosisfatnecrosisEnzymaticdigestionofthecellsDenaturationofproteinsTissueandCellularinjuryLogo溶解和吸收Lysisandabsorption分離排出Isolationanddischarge機(jī)化和包裹Organization鈣化Encapsulation

calcification生理上的重要性Physiologicimportance壞死細(xì)胞數(shù)量Amountofnecroticcells細(xì)胞再生能力Abilityofcells器官代償能力CompensatorycapacityTissueandCellularinjury壞死對機(jī)體的影響壞死結(jié)局

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淋巴管，血管巨噬細(xì)胞TissueandCellularinjurySequelofnecrosis

--Lysisandabsorption

引起急性炎癥（與死后自溶區(qū)別）蛋白水解酶→溶解液化Logo形成缺損糜爛：皮膚粘膜處淺表性壞死缺損潰瘍：皮膚粘膜處較深的壞死性缺損竇道：由于壞死形成的開口于表面的深在性盲管瘺管：兩端開口的通道樣缺損

空洞：壞死物質(zhì)溶解后經(jīng)由自然管道排出后殘留的空腔Sequelofnecrosis--IsolationanddischargeTissueandCellularinjuryLogoUlcer&erosionSequelofnecrosis

--IsolationanddischargeTissueandCellularinjuryulcercavityLogo腕關(guān)節(jié)竇道瘺管（肛周圍膿腫）Sequelofnecrosis

--IsolationanddischargeTissueandCellularinjuryLogo機(jī)化：由肉芽組織取代壞死組織、纖維素性滲出物、濃縮的膿液、組織內(nèi)血腫和血栓等無生機(jī)物質(zhì)的過程。Sequelofnecrosis--OrganizationTissueandCellularinjur