病理学解剖pathology-课件chapter

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Metaplasiaisareversiblechangeinwhichoneadultcelltypeisreplacedbyanotheradultcelltype.Metaplasia化生

一种分化成熟的细胞为另一种分化成熟的细胞所替代的过程。是存在于正常组织中的干细胞或结缔组织中未分化间叶细胞通过增生转变，即重新程序化的结果化生只出现于具有增生能力的细胞特异性低的细胞取代特异性高的细胞化生只发生于同源细胞之间

Definition:

LogoMetaplasia-TypesEpithelialmetaplasiaMesenchymalmetaplasiacolumnarepithelium(trachea,cervix,cholecyst)transitionalepithelium(pelvis)Squamousmetaplasia鳞状上皮化生Intestinalmetaplasia肠上皮化生GastricglandularepitheliumPseudo-pyloricgland

Metaplasia假幽门腺化生corpusandsinusgastricglandOsseous,cartilageandadiposetissue

metaplasia骨、软骨、脂肪组织化生FibroblastsLogoMetaplasia-TypesLogoMetaplasia-TypesSquamousmetaplasianormalLogo正常气管上皮鳞状上皮化生

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

Logoatrophy

hypertrophyhyperplasiametaplasiaadaptationAdaptationIncreaseddemandsGrowthstimulationDiminishednutritionLowstimulationChronicstimulationPathologicalLogo第一章TissueandCellularInjuryLogoCellandtissueinjury当机体内外环境改变超过组织和细胞的适应能力，引起受损细胞和细胞间质发生物质代谢、组织化学、超微结构乃至光镜和肉眼可见的异常变化，称为损伤NormalcellsirreversibleinjuryreversibleinjuryAdaptation（injury）LogoHypoxia1Physicalagents3Biologicagents4Immunologicreactions5Genetic

defects6Nutritionalimbalances7Others82Chemical

agents---CausesCellandtissueinjuryLogo

ATP的耗竭（ATPdepletion）

线粒体的损伤（Irreversiblemitochondriadamage）膜渗透性的缺陷（Lossofmembranepermeability）细胞内钙的流入和钙内环境稳定的破坏（Overloadofintracellularcalciumandlossofcalciumhomeostasis）氧自由基的集聚（Accumulationofoxygen-derivedfreeradicals）---MechanismsofcellinjuryCellandtissueinjuryLogo---Morphologicchanges细胞损伤cellularinjury

可逆性损伤

reversibleinjury

变性

Degeneration

细胞死亡celldeath不可逆性损伤

irreversibleinjury坏死Necrosis凋亡apoptosisCellandtissueinjuryLogoMorphologicchanges--Reversibleinjury各种细胞损伤的早期改变为ATP减少、细胞膜完整性缺失、蛋白合成下降、细胞骨架损伤和DNA损伤。在一定限度内损伤的改变为可逆的，传统形态学上称变性（Degeneration）变性指细胞或细胞间质受损伤后，由于代谢障碍，使细胞内或细胞间质内出现异常物质或正常物质异常蓄积的现象，通常伴有细胞功能低下。

Whencellularinjuryissublethalandsustained,cellsandtissuestendtoaccumulatesubstancesinabnormalquantities.Thesematerialsmaybeendogenousorexogenous.CellandtissueinjuryLogo---Morphologicchanges脂质lipidsreversiblecellinjury细胞肿胀Cellularswelling脂肪变FattychangeIntra(extra)-cellularaccumulations蛋白质proteins

淀粉样变Amyloidchange

玻璃样变hyalinechange黏液样变mucoidchange病理性色素沉着Pigments糖原glycogen病理性钙化Pathologiccalcification

CellandtissueinjuryLogoThecommonsite---liver,kidney,heart

Reversibleinjury--cellularswellingCellandtissueinjuryThecommonestandearliestformofcellinjuryfromalmostallcauses.

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

肿大，包膜紧张，切面隆起，边缘外翻，混浊无光，如沸水烫过Cellandtissueinjury

Cellularswellingofliver

LogoReversibleinjury--cellularswellingNormalcellGranularitychangeHydropicchange

Viralhepatitis

LM:Thecellsareswollen.

Smallclearvacuolesareseeninthecells.病变初期，细胞质内出现的红染细颗粒状物。若水钠进一步积聚，细胞基质高度疏松呈空泡状，其极期称为气球样变

CellandtissueinjuryLogoReversibleinjury--cellularswellingCellandtissueinjuryLogo肝细胞水肿（气球样变）Reversibleinjury--cellularswellingCellandtissueinjuryLogoHydropicdegenerationofrenaltubuleReversibleinjury--cellularswellingCellandtissueinjuryLogoReversibleinjury--cellularswelling

EM:dilatationofendoplasmicreticulumandmitochondrialswelling

线粒体、内质网肿胀

mitochondrialswellingCellandtissueinjury

dilatationofendoplasmicreticulumLogoReversibleinjury--cellularswelling肉眼:肿大，包膜紧张，切面隆起，边缘外翻，混浊无光，如沸水烫过光镜:病变初期，细胞质内出现的红染细颗粒状物。若水钠进一步积聚，细胞基质高度疏松呈空泡状，其极期称为气球样变

电镜:

线粒体、内质网肿胀

Gross:

Theaffectedorganisenlargedduetoswelling.Thecutsurfacebulgesoutwardsandisslightlyopaque.

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

脂肪变:实质细胞内脂肪的异常蓄积CellandtissueinjuryReversibleinjury--fattychangeLiver,heart,kidneysandotherorgans肉眼:器官体积增大，淡黄色，边缘圆钝，切面呈油腻感

光镜:细胞内出现边缘较整齐的大小不等的圆形空泡，苏丹Ⅲ呈桔红色，锇酸呈黑色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：弥慢性:两侧心室心肌弥漫淡黄色,见于严重缺氧和中毒心肌脂肪浸润：心外膜下过多脂肪并向心肌伸入，严重可致猝死部位：左心室的内膜下和乳头肌肉眼：虎斑心--成排黄色条纹(脂肪变），未受侵犯的心肌（红色）镜下：脂肪滴较小，串珠状，位于细胞核附近临床：对心功能一般无大影响Intracellularaccumulations

---fattychangeofmyocardiumCellandtissueinjuryLogoFattychangeofmyocardiumTigerstripeheartCellandtissueinjuryBandsofyellowstreaksalternatewithred-brownmuscleappearanceFattychangeareinyellowMyocardiumareinred-brownLogoSpecialstainSudanIII:orangeredOsmicacid:blackfattychangeofmyocardiumCellandtissueinjuryLogoMyocardiumfattyinfiltrationCellandtissueinjuryLogo动脉粥样硬化Atherosclerosis黄色瘤Xanthomas炎症和坏死inflammationandnecrosisLipid—cholesterolandcholesterylesters

胆固醇和胆固醇酯CellandtissueinjuryAtherosclerosis—foamcells

LogoReabsorbentdroplets:renaltubulesRussellbodies:plasmacellsDefectinproteinfoldingIntra(extra)-cellularaccumulations---Proteins细胞内蛋白积聚，胞质内圆形嗜酸性小滴、空泡或不规则聚集物CellandtissueinjuryLogoReabsorbentdropletsIntracellularaccumulations---ProteinsCellandtissueinjuryLogoRussellbodies浆细胞胞浆内可见圆形的嗜伊红小体,将核挤向一侧，是免疫球蛋白蓄积的结果Intracellularaccumulations---ProteinsCellandtissueinjuryLogoMallory小体--酒精性肝病时，肝细胞胞质中细胞中间丝前角蛋白变性Intracellularaccumulations---ProteinsCellandtissueinjuryLogoVarioushistologicalorcytologicalalterationscharacterizedbyhomogeneous,glasslikeeosinophilicappearanceinHEstainedsections

玻璃样变通常用来描述在常规HE切片中细胞内或细胞外组织变成均质、红染、毛玻璃样。又称透明变Definition:Intra(extra)-cellularaccumulations---Hyalinechange玻璃样变CellandtissueinjuryLogoReabsorbdroplets:renaltubulesMalloryalcoholicbodies:hepatocytesRussellbodies:plasmacells

Hyalinechange-TypesIntracellularhyalineArterioleshyalineCollagenousfibroustissuehyalineCellandtissueinjuryLogoHyalinechange--IntracellularhyalineCellandtissueinjuryLogo

HypertensionanddiabetesmellitusExtravasatedplasmaproteinDepositionofbasementmembraneHyalinechange--arterioleshyaline细动脉壁玻璃样变CellandtissueinjuryLogoArterioleshyalineCellandtissueinjuryLogo胶原蛋白交联、变性、融合，增生的胶原纤维增粗，形成均质红染的梁状或片状结构。其间少有血管和纤维细胞Hyalinechange---Collagenousfibroustissuehyaline纤维结缔组织玻璃样变CellandtissueinjuryLogo淀粉样变性Amyloidchange

isaconditionthatoccursinagroupofdiseases,allhavingthelocalizedorgeneralizeddepositionofamyloid.指在细胞外间质内出现淀粉样物质的异常沉积病变:镜下细胞外间质呈淡红色的均质状（HE）。因与淀粉遇碘反应相似故得名。刚果红染色呈橘红色常见部位:细胞间、小血管基底膜、网状纤维支架、血管壁Intra(extra)-cellularaccumulations---Amyloidchange（淀粉样变）LogoChangecharacterizedbyaccumulationofmucininintracellularorextracellularloci.

指间质内有粘多糖和蛋白质的蓄积Intra(extra)cellularaccumulations---Mucoidchange粘液样变病变:

镜下间质疏松，多突起的星芒纤维细胞散在于灰兰色的粘液样基质中常见部位:胶原病,如风湿病等,动脉粥样硬化及间叶组织肿瘤基质中CellandtissueinjuryLogo有色物质在细胞内、外的异常蓄积

含铁血黄素Hemosiderin脂褐素Lipofuscin黑色素Melanin胆红素bilirubin

碳末Carbon煤尘smut纹身色素tattooingPathologicpigmentation

病理性色素沉着endogenousexogenousCellandtissueinjuryLogoexogenousLogo

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

病理性钙化Types:

Definition:

Abnormaldepositsofcalciumsaltsoccurinanytissuesexceptbonesandteeth骨、牙之外的组织中固态钙盐沉积

钙磷代谢障碍,见于甲状旁腺功能障碍、骨肿瘤、维生素D摄入过多导致高钙继发于局部变性、坏死或其他异物，钙磷代谢正常dystrophic

calcificationmetastaticcalcificationCellandtissueinjuryLogoPathologiccalcification

病理性钙化DystrophiccalcificationCellandtissueinjuryLogoPathologiccalcification

病理性钙化MetastaticcalcificationCellandtissueinjuryLogoMorphologicchangesoftissueandcellularinjury脂质lipidsreversiblecellinjury细胞水肿Cellularswelling脂肪变FattychangeIntra(extra)-cellularaccumulations蛋白质proteins

淀粉样变Amyloidchange

玻璃样变hyalinechange黏液样变mucoidchange病理性色素沉着Pigments糖原glycogen病理性钙化Pathologiccalcification

LogoTissueandCellularinjuryirreversibleinjuryReversibleinjuryCelldeath

LogoIrreversibleinjury--Celldeath细胞死亡

SeveredamageinvolvenucleusFunctionloseStructuredestroyMetabolismstopnecrosisapoptosisIrreversibleinjuryCelldeath

TissueandCellularinjury细胞受到严重损伤累及细胞核时，呈现代谢停止、结构破坏和功能丧失等不可逆性改变即细胞死亡LogoAsequenceofmorphologicchangesthatfollowcelldeathinlivingtissue.Necrosis

坏死活体内局部组织、细胞的死亡Enzymaticdigestionofthecells(autolysis&heterolysis)DenaturationofproteinsThemorphologicappearanceofnecrosisistheresultoftwoessentiallyconcurrentprocesses:TissueandCellularinjuryLogoMorphologyofnecroticcellsChangesinthenucleus1

Karyolysis（核溶解）

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

IncreasedEosinophilia(嗜酸性染色增强）:

Vacuolatedandmoth-eatenappearance(虫蚀状或空泡化）cellularmembranebreakage—inflammationCalcification(钙化）TissueandCellularinjuryLogoMorphologyofnecroticcellsChangesinthenucleus1Karyolysis（核溶解）:dissolutionofthenucleus(thebasophiliaofthechromatinfade)Pyknosis(核固缩):nuclearshrinkageandcondensationofchromatin(increasedbasophilia)Karyorrhexis（核碎裂）:thepyknoticnucleusfragments

normalpyknosiskaryorrhexiskaryolysisTissueandCellularinjuryLogo

pyknosiskaryorrhexiskaryolysisMorphologyofnecroticcellsTissueandCellularinjuryLogoCytoplasm:increasedeosinophilialossofRNAanddenaturedproteinMorphologyofnecroticcellsLogo坏死的类型TypesofnecrosiscoagulativenecrosisliquefactionnecrosisSpecializednecrosisnecrosiscaseousnecrosisgangrenefibrnoidnecrosisfatnecrosisEnzymaticdigestionofthecellsDenaturationofproteinsTissueandCellularinjuryLogoThenecrosisareaisswollen,firmandpale.灰白、干燥、坚实的凝固体，周围见充血出血带，与周围组织界限清楚Coagulativenecrosis

凝固性坏死指坏死组织尚保留原组织的细胞轮廓，呈灰白、干燥的凝固状

GrossLM:Thedeadcellspreservetheirbasicstructuraloutlinebutonlyindistinctly，appearingasamassofcoagulatedpink-staining,homogeneous细胞微细结构消失，而组织结构轮廓保存Sites:Infarctsofsolidorgans--heart,spleen,kidneyTissueandCellularinjuryLogoCoagulativenecrosis凝固性坏死Anemicinfarctofkidney肾贫血性梗死Thenecrosisareaisfirmandpale.灰白、质地较硬的凝固体，充血出血带，与周围组织界限清楚TissueandCellularinjuryLogoCoagulativenecrosis凝固性坏死TissueandCellularinjuryLogocoagulativenecrosisofheartTissueandCellularinjuryLogoLiquefactivenecrosis

液化性坏死组织坏死因酶性分解而变成液态grosslySoftandliquid.Dischargeoftheliquidcontentsformsacysticspace.坏死组织呈液状,可见坏死腔或软化灶Thetissuestructuredissolvebyenzymesdigestionofthecells原组织结构溶解消失LM:Types:Brainafterischemicinjury(richinlipid)Pancreatitis(richinprotease)AbscesseslyticnecrosisTissueandCellularinjuryLogoLiquefactivenecrosis

液化性坏死TissueandCellularinjuryCoagulativenecrosisLiquefactivenecrosisLogoLiquefactivenecrosis

液化性坏死TissueandCellularinjuryLogo液化性坏死-LiquefactivenecrosisLiquefactivenecrosisofhepatocytes

溶解性坏死（lyticnecrosis）

LogoSpecialtypesofnecrosis干酪样坏死Caseousnecrosis

坏疽Gangrene

脂肪坏死Fatnecrosis

纤维素样坏死FibrinoidnecrosisTissueandCellularinjuryLogoTissueandCellularinjury干酪样坏死caseousnecrosis在结核病时，因病灶中含脂质较多，坏死区呈黄色，状似干酪

mostofteninTBGross:whiteorlightyellow,cheesy.LM:amorphousgranulardebristissue,architectureiscompletelyobliteratedLogo干酪样坏死caseousnecrosis特殊类型的凝固性坏死，肉眼观微黄，质松软、细腻，状似干酪。镜下原有的组织结构完全崩解破坏，呈现一片无定形、颗粒状红染物。主要见于结核病TissueandCellularinjuryLogo指继发有腐败菌感染的大块组织坏死。

Gangrene

坏疽NecrosisofbigtissuewithsecondaryputrefactiveorganismsinfectionBlackandgreenappearanceGangreneDrygangrenesWetgangreneGasgangreneTissueandCellularinjuryLogofrostbiteinjury坏死组织水分少,蒸发干固皱缩，呈黑褐色，分界明显四肢末端多见，动脉受阻，静脉通畅腐败菌感染一般较轻Occursontheskinsurfacefollowingarterialobstruction.Itisparticularlyliabletoaffectthelimbs,especiallythetoes.TissueandCellularinjuryDrygangrenesLogodry,black,clearborderwithsurroundingnormaltissueTissueandCellularinjuryLogo与外界相通的内脏(如肺、肠、子宫、阑尾、胆囊等)或四肢，动脉受阻，静脉也不畅或受阻(淤血，水肿)坏死组织水分多，局部肿胀、暗绿色、分界不清腐败菌感染重，产生吲跺，粪臭素、恶臭；毒素吸收，毒血症Conditions:occursinnaturallymoisttissuesandorgans.Botharterialandvenous

obstruction;

Character:wetswollen,foul-smelling,blackorgreen.Location:smallintestine,appendix,lung,uterus,limbsWetgangreneTissueandCellularinjuryLogoWetgangreneSoft,swollen,dark.TissueandCellularinjuryLogoGasgangrene深在的开放性创伤合并产气荚膜杆菌感染坏死组织含大量气体，呈蜂窝状，污秽、暗棕色，捻发感；战伤，外伤，厌氧菌感染Conditions:deepcontaminatedwoundsinwhichthereisconsiderablemuscledamagedbygasformingbacteria.Character:swollenobviously,gasbubblesformationwarwoundsTissueandCellularinjuryLogoFibrinoidnecrosis纤维素样坏死原因：变态反应性疾病、急进性高血压部位：结缔组织和血管壁病变：病变部位形成细丝状、颗粒状或小条块状无结构物质，染色深红，有折光性，由于其与纤维素染色性质相似，故名纤维素样坏死TissueandCellularinjuryLogoFatnecrosis脂肪坏死酶解性脂肪坏死外伤性脂肪坏死TissueandCellularinjuryLogoFatnecrosis脂肪坏死外伤性脂肪坏死TissueandCellularinjuryLM:shadowyoutlinesofnecroticfatcells,withbasophiliccalciumdepositsandasurroundinginflammationreaction酶解性脂肪坏死Logo坏死的类型TypesofnecrosiscoagulativenecrosisliquefactionnecrosisSpecializednecrosisnecrosiscaseousnecrosisgangrenefibrnoidnecrosisfatnecrosisEnzymaticdigestionofthecellsDenaturationofproteinsTissueandCellularinjuryLogo溶解和吸收Lysisandabsorption分离排出Isolationanddischarge机化和包裹Organization钙化Encapsulation

calcification生理上的重要性Physiologicimportance坏死细胞数量Amountofnecroticcells细胞再生能力Abilityofcells器官代偿能力CompensatorycapacityTissueandCellularinjury坏死对机体的影响坏死结局

Logo

淋巴管，血管巨噬细胞TissueandCellularinjurySequelofnecrosis

--Lysisandabsorption

引起急性炎症（与死后自溶区别）蛋白水解酶→溶解液化Logo形成缺损糜烂：皮肤粘膜处浅表性坏死缺损溃疡：皮肤粘膜处较深的坏死性缺损窦道：由于坏死形成的开口于表面的深在性盲管瘘管：两端开口的通道样缺损

空洞：坏死物质溶解后经由自然管道排出后残留的空腔Sequelofnecrosis--IsolationanddischargeTissueandCellularinjuryLogoUlcer&erosionSequelofnecrosis

--IsolationanddischargeTissueandCellularinjuryulcercavityLogo腕关节窦道瘘管（肛周围脓肿）Sequelofnecrosis

--IsolationanddischargeTissueandCellularinjuryLogo机化：由肉芽组织取代坏死组织、纤维素性渗出物、浓缩的脓液、组织内血肿和血栓等无生机物质的过程。Sequelofnecrosis--OrganizationTissueandCellularinjur