309.
Anthracosis and chronic emphysema of the lungs
A 68-year-old man was found dead on the right side of the road. The medico-legal expertise revealed
multiple skull factures, subdural hematoma and laceration of brain. Incidental autopsy findings
revealed inflated lungs with black, pigmented linear streaks especially near the hilar region which also
showed blackened lymph nodes.
Note the markedly enlarged, almost cystic formation of the alveoli. This is the basic feature of
emphysema and is due to rupture of the interalveolar septae. There is peribronchial fibrosis that
extends from the bronchial areas into the alveolar septae. Black, carbon pigment is abundant in the
lymphatic tissue in the specimen, as well as in type-1 pneumocytes.
Formalin pigment in contrast - representing overfixation artifact presents as fine black granules not as
phagocytised material in cells.
401
Cardiac hypertrophy
Note : The same slide shows representative sections of infant myocardium; normal myocardium and
hypertrophied myocardium.
A post-mortem specimen from a 62 year-old man showed he had died of an intracranial hemorrhage of
the right temporo-occipital lobe. He had been known to have a blood pressure of 210-110 mm Hg for
the past 5 years but had refused treatment. At autopsy the heart weight was 450gr. and showed marked
hypertrophy of the left ventricle, it’s lateral wall measuring 24 mm thickness (normal 13-15 mm). A
moderate aortic stenosis was also found.
Microscopy : The hypertrophied myocardium is cut in different planes and shows myocardial fibres of
variable thickness, mostly being thicker than normal (cf. normal and infant’s myocardium). The
striations are also thickened and increased in number. The chromatin rich nuclei are enlarged and
irregular in size and shape. Some are bizarre in shape and may resemble “stag horns”. The total
number of nuclei per microscopic field is, due to the increase in size thereof, reduced. Surrounding and
adjacent to these enlarged nuclei, in some of the hypertrophied fibres, a granular golden-yellow
pigment (lipofuscin) can be found. This is the so-called “wear and tear” pigment (that can be found in
normal myocardium too). Scattered areas of fibrosis, in between the hypertrophied muscle fibres can
be seen - repreenting areas of hypoxia with resultant fibrosis.
Compare the findings of the hypertrophied muscle with the normal muscle represented.
Question :
314 Name as many conditions as you know that may cause the cardiac muscle fibres to
hypertrophy.
650
Fatty change, liver
(Steatosis; Fatty metamorphosis)
Macroscopically the liver may appear enlarged and flabby, yellowish in color and have a greasy cut
surface.
Microscopic examination shows liver tissue in which the lobular pattern is preserved. The prominent
pathologic change is the swollen appearance of hepatocytes. These distended cells contain many fat
vacuoles in their cytoplasm, compressing the nucleus to the periphery of the cell. In some cells, the
nucleus may not be visible at all. Kuppfer cells are not affected.
Questions.
1. What is the pathogenesis of fatty change?
3. What are the causes of fatty change in the liver?
4. In which other organs does fatty change occur and what are the causes?
5. What is meant by the term fatty infiltration?
660/A Hemachromatosis, liver (& Prussian blue stain).
A 58 year-old man who suffered for years from diabetes, bronze pigmentation of skin and
hepatomegaly (“bronze diabetes”), developed ascites and died of cardiac failure.
Full blown hemochromatosis is characterized by a triad of pigment cirrhosis, diabetes and skin
pigmentation (hence the old term “bronze diabetes).
Morphologically hemachromatosis shows pigment cirrhosis (hemosiderin) of the liver and systemic
hemosiderin, involving pancreas, endocrine glands, myocardium, skin and any other parenchymal
organ.
In the liver, the involvement varies from delicate fibrous scarring around portal tracts to the full blown
picture of thick bands of fibrous tissue resulting in cirrhosis.
The cirrhotic liver, macroscopically, shows a nodularity with nodules that vary in diameter from
several millimetres to 1cm and are of similar size to those encountered in alcoholic cirrhosis.
Microscopic features show liver architecture distorted and obliterated by broad bands of fibrous tissue
that bridge portal tract to portal tract. As a result, regenerative pseudolobules of liver tissue appear,
circumscribed by the dense fibrous tissue. These pseudolobules are devoid of central veins. Within the
fibrous connective tissue, numerous hemosiderin-laden macrophages (siderophages) are noted. The
iron deposits are also noted within hepatocytes as well as within Kuppfer cells.
Note : Compare these features of pigment cirrhosis with the slides 659 and 664 where cirrhosis is also
present.
GROUP 1
1. Hypoplastic left kidney
132911
1. Hydronephrosis
131812
1. Anthracosis of lung
92615
1. Fatty liver
827101
1. Cardiac hypertrophy
199506