General Pathology

1. Prof.Dr.
Khalil Hassan Zenad
Aljeboori
Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
Degenerative
Changes And
Cellular Injury
Lecture 2

2. Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
1- cloudy swelling : reaction of cells to injury by swelling and accumulation of the water in their
organelles or albumin so called albuminous or parenchymatous degeneration it usually reversible type
of cell injury , most of acute infection or toxic condition are accompanied by cloudy swelling , mostly
seen in liver , kidney .
Grossly :
Affected area in organ was swollen , capsule is tense and bulging during cut section , organ opaque .
Microscopically :
The affected cell are swollen , granular cytoplasm due to protein or albumin and water in cells organells such as
mitochondria, endoplasmic reticulum so the cell cytoplasm as ground glass appearance .
Causes:
1- Hypoxia .
A. Decrease O2 in blood.
B. Ischemia . i.e . No oxygenated blood reach tissue due to thrombus.
C. Reduce oxygen capacity of RBCS due to anemia and Ccl4 toxicity .
2- Chemical agents , ethanol Co2.
3- Infections .
4- Genetic defects .
5- Nutritional imbalances .
6- Immunological reactions Ag- Ab complexes .
7- Aging .
8- Physical agents, radiation and electric shock .
* All these agents cause disturbances in oxidation- phosphorylation process due to ATP in cell membrane and
plasma membrane so Na+ and water or albumin pumped inside cell cytoplasm or cell organelles resulted to cell
swelling. The pumping of these materials are through pores in the cell membrane or plasma membrane .

3. Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
2-Hydropic degeneration : Hydrops or vacuolar degeneration While in cloudy swelling there is too
little amount of water in cell organelles, in hydropic degeneration too much amount of water in the cell
cytoplasma is related to severity o the etiological agents
so the organ.
Grossly :
Swollen but more degree than in cloudy swelling .
Microscopically :
Clear spaces (water or albumin)these removed during tissue processing so appear clear spaces
irregular or hazy borders in liver , kidney ..
Cause : Similar to cloudy swelling but extensive degree .
Blisters : Specific defect of hydropic degeneration in which cystic swelling filled with water or albumin
surrounded by thin membrane .
Causes :
A. hot metallic materials.
B. Hot oil &water
C. Hard materials
D. Virus herpes virus

4. Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
3- fatty change or steotosis
Abnormal accumulation of fat droplets in cell cytoplasm of the parenchymal cells ,kidney ,heart
and liver .
Grossly :
Seen mostly in liver ,kidney and heart target organs for fat metabolism (triglycerides mainly)so
the affected organs are yellow, fatty in nature ,greasy inconsistency .
Microscopically :
Fat droplets appear as clear spaces with regular borders in the cytoplasm, these vacuoles or clear
spaces coalesce together to form large vacuole displace the nucleus to the periphery.
The clear space originally was fat droplets removed during the tissue processing under the effect
of alcohol or xylole in (H&E) by special stain :
Fat droplets : staining sudan iii → orange
Sudan iv → pink
Osmic acid → black
Causes :
1- toxins, alcohol, ethanol .
2- metabolic disease diabetes mellitus .
3- obesity ( normally extra cellular fat ) .
4- protein malnutrition ↓ lipoproteins .
5- anoxia .
6- starvation release fatty acids from adipose tissue .

5. Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
abnormal level of cholesterol termed hyper cholesterolemia occur in;
A. hypothyroidism. B. some renal disease.
C. lipoid nephrosis. D. biliary obstruction .
so deposition of cholesterol in tissue occur such as in atherosclerosis, in
gall bladder, old hemorrhage, necrotic tissue, the macrophages in contact
with these lipid debris and engulf the lipid appear as a foamy appearance
of their cytoplasm so called foam cells . in atherosclerosis both the smooth
muscle and macrophages are filled with these lipid .
similarly in the hereditary hyperlipidemia and in acquired hyperlipidemia
the macrophage filled with these lipid form masses in the dermis and
tendon called :
A. Xanthomas .
B. Gauchers disease in which lipid in spleen, brain, skin .
C. Neimann – pick disease in all tissues .
Disturbances in metabolism of cholesterol :

6. Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
4- Hyaline degeneration : after line degeneration translucent, homogenous,
structureless, materials, protein in nature and stain eosinophilic .
Types :
A. connective tissue hyaline : occur in pleura, spleen capsule, Corpus albicans C.T hyaline in arteriosclerosis in both
the fibroblast lose their nuclei and old age tissue injury .
B. epithelial hyaline which occur :
→ In the kidney when more albumin excrete and accumulated in PCT epithelial hyaline droplet, occur in case of
nephrotic syndrome in which combine albumin with lysosomes in PCT epithelium by pinocytosis .
→ In kidney hyaline casts when albumin or protein aggregated renal tubules .
→ or in liver in case of alcoholic hepatitis Mallory bodies .
→ immunoglobulin proteins aggregated in plasma cells russels bodies .
→ In prostate corpora amylacea also aggregation of protein hyaline, Onion like appearances in prostatic acini
protein .
→ In brain – Alzheimer disease – a Neurofibrillary tangle (NFTs) protein in neuron cells aggregated .
C. Keratohyaline : in skin which indicate extensive thickening of stratum corneum, keratin without nuclei for
examples hand calluses and foot corns .
Causes :
1. prolonged irritation and friction .
2. warts viral disease papilloma virus and pox virus .
3. Ichthyosis fish scaly skin, congenital disease .
Specific type Zinker degeneration is a hyaline degeneration occur in skeletal muscles fibers described by zinker
occur due to extensive bacterial toxins or excessive accumulation of lactic acid, so muscles pale friable and loss of
striation due to lack of vitamin E .

7. Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
5- glycogen infiltration : normally in liver, SK, muscles excessive intracellular
deposits of glycogen are associated with the abnormalities In the metabolism of either
glucose or glycogen .
Causes :
A. metabolic disease diabetes mellitus in which abnormal glucose metabolism,
so glycogen accumulates in kidney and cardiac muscles .
B. glycogen storage disease in which defect in enzyme synthesis or
breakdown of glycogen resulted into massive accumulation and death of cells
or cell injury grossly – cells swollen .
Microscopically :
glycogen particles appear in the cytoplasm solitary or coalesce together → a
(alpha) particles (150-300 A⁰) or ᵦ (beta) particles in electronic microscope ) .)
Special stain : PAS stain +ve
Best carmine stain → pink

8. Copyrights©2017lAliraqiaUniversitylDentistrylPathologylProf.Dr.KhalilHassanZenadAljeboori.
6- Mucinous degeneration :
Mucin is a structureless material pale in H&E secreted from epithelium of intestine .
Causes :
( catarrhal inflammation ) or in some ovarian tumor when present in more
amount termed in epithelial mucinous degeneration .
Mucoid degeneration or myxomatous degeneration formed by connective
tissue fibroblast normally in umbilical cord or in subcutaneous tissue in case of
thyroid deficiency ( myxedema ) and in C.T tumor myxoma … stain pale
basophilic sky appearance with criss – cross arrangement of fibrils and
pleomorphic fibroblast nuclei, mucoid degeneration of fat tissue, serous
atrophy, gelatin material in fat tissue, stain pink due to fatty acid react with k+ .

9. PRESENTATION ENDS
Copyrights © 2017 l Aliraqia University l Dentistry l Pathology l Prof.Dr. Khalil Hassan Zenad Aljeboori.
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