Pathology

Pathology: is the study of diseases.

Diseases are the deviations from normal.
The concept of diseases:
For the pathologist: structural changes
that are accompanied by functional
changes.
For a patient
For a physician

The Scope of Human Pathology

Pathology deals with recognition of diseases,
their causes (aetiology), and their progression.
Pathologists study structural changes (gross, or
microscopic), etiology and mechanisms of
diseases (pathogenesis)
Most diseases can be placed in one of these
categories:
1. Inflammatory
2. Neoplastic
3. Degenerative conditions
4. Developmental conditions

Inflammation
Inflammation: Local defense and protective response
against cell injury or irritation or Local vascular and
cellular reaction, against an irritant.

Irritating or injurious agents (Irritant)

Living:
Bacteria,
Fungi,
Virus,
Parasite
or their toxins

Non-Living:
Chemical
Physical
Mechanical

Inflammation is designated by adding the suffix (itis) to the end

of the name of the inflamed organ or tissue.

Types of inflammation

1) Acute
inflammation
2) Sub acute
inflammation:
rarely occur.

3) Chronic
inflammation

1. Acute inflammation
Macroscopic signs:
Symptoms
1)
Redness:
2)
Hotness:
3)
Swelling:
4)
Pain and
tenderness:
5)
Loss of function:

Microscopic signs:
Inflammatory response

1. Local
vascular
change

2. Formation of
inflammatory
exudate

Inflammatory response:
(microscopic signs)

First: Local vascular changes:

1. Initial temporary vasoconstriction for few seconds.
2. Active vasodilatation of arterioles and capillaries (by
chemical mediators: Histamine) and passive dilatation of
venules. Increase in capillary permeability (fluid exudate to
the extravascular tissue) thus concentration of blood cells,
slowing of blood flow (stasis)
3. Pavmentation: the margination of leukocytes.
Normal

Inflammation

Second: Formation of inflammatory

exudates:
Immigration or infiltration of the various leukocytes, fluid
and plasma proteins outside the blood vessels into the
surrounding tissue without injury of the blood vessels.
Leukocytes seem to leave the smallest blood vessels by
inserting pseudopodia into the interendothelial junctions and
sliding through the wall by amoeboid movement.
This is also due to the increased capillary permeability
caused by the high osmotic pressure of the surroundings.
The early stages are marked by the predominance of
polymorphs especially neutrophils migration, particularly
when the inflammation is caused by pyogenic cocci, later on
monocytes infiltration occurs.
****In some cases RBCs may also pass (Diapedesis)

Function of inflammatory exudates

1- Dilute the invading microorganism and its
toxins.
2-Bring antibodies through the plasma to the
inflamed area.
3-Bring leukocytes that engulf the invading
microorganisms.
4-Bring fibrinogen through the plasma, which is
converted, to fibrin mesh, helping in trapping the
microorganism and localize the infection.

Blood stem cell

Cells of inflammatory response

1) Polymorphonuclear leukocytes: are basophils,
neutrophils and eosinophils; lobed nucleus and grainy
cytoplasm (granulocyte). Microphages (small eaters)
2) Monocytes or histocytes: macrophages. (big eaters)
3) Lymphocytes: leukocyte of fundamental importance;
they determine the specificity of the immune response
to infectious microorganisms and other foreign
substances.
4) Plasma cells: A type of immune cell that makes large
amounts of a specific antibody, developed from
activated B cells (Derived from lymphocytes originate
in the bone marrow). It is a type of WBCs and also
called plasmacyte.

Neutrop
hil

Lymphocy
te

Eosinoph
il

Plasma
cell

Basophil

Monocyte

Name

Neutrophil

Eosinophil

Basophil

Monocyte

Microphage

Acidophile

Basophil

Macrophage = >Polymorphs
Histocytes
and < RBCs

Plasmacyte

Shape

Pale pink to
blue,
Minimal
granulation.

Red with
eosin,
Coarse
granulation.

Blue with
eosin,
Coarse
granulation

1.5 to 2 times
larger,
Abundant fine
granulation

Agranular:
non-granulated,
Large round
nucleus

Basophilic,
Encentric
nucleus

% of
WBCs

60-70%

1-2% (50%
in allergy)

1%

4-6%

30%

Found in
tissue only

Functi
on

Phagositic
1st defense

Unknown
but could
neutralize
histamine,
serotonin
and other
kinins

Unknown
but contain
histamine
&heparin

Phagocytic
2nd defense
element
engulf
bacteria, dead
cells, debris &
dead
neutrophils
(pus cells)

Antibodies
production
Late stage of
the
inflammation

Primary
source of
specific
Antibodies

Monocytes

Lymphocyte

Plasma cell

Plasma
Plasma cell

Phagocytosis
Process by which Phagocytic cell (microphages and
macrophages) engulf and kill foreign particles (bacteria)

Two main types of phagocytes:

1- Motile phagocytes found in the blood stream and
migrate to the inflamed area (microphages)
2- Histocytes (macrophages) of the reticuloendothelial
system (RES) which remove bacteria that escapes from
the inflamed area.

Normal cell

Phagocytosis

Phagocytosis

Steps of Phagocytosis
1. Recognition
2. Ingestion- pseudopods engulf microbe through endocytosis

3. Vacuole Formation- vacuole contains microbe

4. Digestion- vacuole merges with enzymes to destroy microbes
5. Exocytosis- microbial debris is released

It occurs in two subsequent stages

1. Ingestion
of the m.o.

2. Intracellular killing of the m.o. (digestion):

Increased glycolysis and the PH drop to 4 -4.5
As a result, the proteolytic enzymes,
phagocytin, lysozyme and other hydrolytic
enzymes (lipase, esterase, nuclease etc.)
are released and digest the ingested
microorganism.

Some species of bacteria e.g. tuberculosis are not

killed within the phagocyte and even multiply within it.

Methods of Intracellular killing of the m.o. (digestion)

I.Oxygen-dependent intracellular killing:
Production of a superoxide.
Use of the enzyme myeloperoxidase from neutrophil granules
II.Oxygen-independent intracellular:
1. electrically charged proteins
2. lysozymes
3. lactoferrins
4. proteases and hydrolytic
enzymes

Ingestion
stage

Chemotaxis
Positive directional response to chemical stimuli
(chemotactic subs)
The migration of leukocytes (by amoeboid movement)
toward the injurious agent and the injured cells due to
chemical stimuli (chemotactic subs).
Chemotactic subs:
Exogenous (Specific): Polysaccharide secreted by
m.o.
Endogenous (General): Reaction product of the
antigen-antibody reaction .

Chemotaxis

Types of acute inflammation

(based on type of exudates)
1- Catarrhal inflammation:
2- Serous inflammation:
3- Fibrinous inflammation:
4- Membranous inflammation:
5- Hemorrhagic inflammation:
6- Gangrenous inflammation:
7- Allergic inflammation:
8- Suppurative or purulent
inflammation:

Name

Occur in

Characterized by
Exudates rich in mucous

Catarrhal

Mild inflammation in mucous membrane of

respiratory or alimentary tracts e.g. common cold
and catarrhal appendicitis

Serous

Mild inflammation in serous surface such as pleural Extensive watery low

cavity, joint cavity where no damage in endothelium protein exudates
ex. Tuberculosis pleurisy and Common blisters

Fibrinous

Exudates rich in fibrinogen

Outpouring of exudates with high protein and less
volume ex. in lobar pneumonia due to Streptococcus
pneumonia & pericardium inflammation

Fibrinous inflammation in which network of fibrin

entangling inflammatory cells and bacteria forms
Membranous
pseudo-membrane. Example: Diphtheria , Bacillary
dysentery.
Hemorrhagic
Gangrenous

Yellowish grey pseudo

membrane rich in fibrin ,
polymorphs & necrotic
tissues

In blood vessels e.g. in plague

Exudates rich RBCs

Acute appendicitis

Necrotic tissues resulting

from thrombi or emboli
Presence of edema &

Allergic

Result to Ag Ab reaction Hypersensitivity

increase in vascularity.

Suppurative

Caused by pyogenic bacteria and is characterized

by pus formation Example: Abscess.

Large amount of Pus &

Purulent exudates produced

Lobar Pneumonia due to Streptococcus pneumonia is

associated with massive fibrinous exudates in the lung alveoli.

3. Fibrinous type:

4. Membranous type
Pseudomembranous inflammation in diphtheria showing network of fibrin entangling
inflammatory cells. Bacteria forming pseudo-membrane (left).

5. Suppurative or purulent

Pyemic abscess in myocardium. Abscess containing necrotic cell debris, colonies of

bacteria, and large number of neutrophils, many of them degenerate. Myocardium is
on the right.

Suppurative or purulent inflammation

Pus: thick fluid containing viable and necrotic polymorph and
necrotic tissue
1. Localized:
ex. Abscess:
Abscess is the localized collection of pus, commonly seen solid
block of tissue - Example: dermis, liver, kidney, brain etc. Pus
consists of partly or completely liquefied dead tissue mixed with
dead or dying neutrophils and living or dead bacteria, formed of 3
zones
1. Small abscess is called boil or furuncle
2. Large one carbuncle
3. Fistula
2. Diffused: Spreading of pus to adjacent areas e.g. cellulites
occurring in subcutaneous tissue . Usually caused by streptococci.

:Abscess

Fate of acute inflammation

1- Resolution: exudates are reabsorbed
and tissue becomes normal again.
2- Healing: by repair and regeneration.
3- Spread: through lymphatics or blood
stream.
4- Chronicity

Chronic inflammation:
(granulomatous)
Results from increased resistance of the causative agent
to phagocytosis or the body defense mechanism is
depressed.
Shows lower vascular and exudative response
The inflammatory cells are mainly macrophages,
plasma cells, giant cells, lymphocytes, fibroblasts.
Occurs in the form of granuloma.
Chronic inflammation usually occur with
granulomatous infections; e.g. leprosy, tuberculosis and
fungal infections.

Phagocytosis

Acute inflammation