Tissue Deposites

1. Amyloid
Deposition of Amyloid material =
Carbohydrates + Protein + Mucopolysaccharide
Caused due to Antigen- Antibody reactions
Example:
1. Amyloid Degeneration in Tongue = macroglossia
2. Liver & spleen in tuberculosis

Uric acid. 2
Uric acid is a normal end product of protein metabolism (purine
catabolism).
Normal level of 4 mg/100 ml of blood. Excess uric acid is excreted in
urine.
Hyperuricaemia:

It results in the deposition of

ureates in kidney tubules
(ureate stones) or in soft
tissues and joints specially
big toe, fingers and knee in
what is known as gout.

3. Cholesterol
Normal cholesterol level in blood is 150-250 mg/100ml
blood.
Controlled with the diet intake and its synthesis in the
liver in one side and its utilization, storage or excretion
through the biliary tree on the other side.
1. Physiological hypercholesterolaemia ex: Familial
2. Pathological hypercholesterolaemia: results from
increased lipid intake, diabetes or obstructive jaundice.

Hypercholesterolaemia usually results in

the
deposition of cholesterol in the intima of the arteries
leading to atheroma or in skin :xanthoma.

Xanthomas

Atheroma

4. Calcium
. The normal serum level of calcium is 9-11 mg/ 100 ml blood for
ionized and colloidal forms
Calcium metabolism is regulated by
i- Parathyroid: which regulate the calcium and phosphate level.
ii- Kidney: which regulate also the phosphate excretion.
iii- Vitamin D; which regulate the calcium absorption from the
intestine and renal tubules.
v- Bone: which is responsible for the calcium and phosphate
deposition.
The deposition of calcium salts as phosphates or carbonates in
tissues other than bone and teeth is known as pathological
calcification.

Types of Pathological Calcification

1- Dystrophic calcification: Calcium deposition occur in
already necrotic tissue despite of normal serum level.
2- Metastatic calcification: Calcium deposition occur in
normal tissue and is associated with increased level of serum
calcium due to;
i- Hyperparathyrodism.
ii- Mobilization of Ca and PO4 from bones in malignancy.
iii- Hyperabsorption of calcium from the intestine due to
sensitivity to vitamin D, or excessive administration of vitamin D.
Kidney and stomach, cornea and lungs are the main organs
affected.
3- Calcinosis: This type of calcification occurs despite normal
tissue and normal calcium level in serum. It usually occurs in skin
and subcutaneous tissues.

:The decrease in calcium level in bones

In children leads to
rickets
In adults lead to
osteomelacia

5. Immunological deposits
(Rheumatoid arthritis)
is an autoimmune disease that causes chronic
inflammation of the joints.

The Heart

Heart failure
transudate of edema
A- Left-sided heart failure (forward failure):
1- Hypertension
2- Ischaemic coronary diseases
3- Aortic valvular diseases as rheumatic endocarditis
(mitral stenosis) aortic stenosis congenital heart
diseases

B- Right-sided heart failure (backward failure):

1-Right ventricle infarction.
2-Primary diseases of the
circulation.
3-Constrictive pericarditis.
4-Right-sided valvular lesions.

pulmonary

vascular

General causes of heart

failure

1- Inadequate venous return due to hemorrhage.

2- Constriction of the pericardium due to:

a- Fibrous pericarditis caused with tuberculous infection.

b- Presence of fluids in the pericardium sac
Both a and b will hinder the normal filling of the heart (diastole).

3- Inability of the myocardium to act properly due to:

a- Coronary thrombosis: causing sudden cut of blood supply to the heart.
b- Coronary arteriosclerosis: gradual cut of the blood supply to the heart. Both
a and b results in 80% of heart failure and death.
c- Disease in the myocardium: caused by bacterial toxins e.g. diphtheria, vitamin
B deficiency, and also acute rheumatic myocarditis.
d- Fatty degeneration of the myocardium caused by alcoholism.
e- Rapid beating of the myocardium in atrial fibrillation and thyrotoxicosis. There
will be no sufficient time for systole and diastole.
f- Direct injury of the myocardium with bullet or stab.

4- lnability of the heart valves to act properly

a- Valvular stenosis (narrowing of the valve) as in acute rheumatic fever
b- Valvular incompetence (the valve does not close completely) and so
the blood returns again after pumping e.g. syphilis may cause aortic
incompetence.
5- Obstruction of the normal outflow of blood due to:
a- Pulmonary embolism.
b- Stenosis of the aortic valve.
c- High peripheral resistance as in high blood pressure.
6- Abnormal increased need of blood flow due to abnormal
shunt of blood from arterial to the venous side due to injury or
disease

Abnormalities of cell growth

Types of growth:
1. Normal Physiological and purposeful as :
Proliferation

Cells

Tissues and Organs

Differentiation

2. Reparative: To renew or balance cell loss purposeful

3. Neopalasia: Abnormal growth, Non physiological and
purposeless, Non reversible.

Abnormalities of cell growth

1. Developmental defects (congenital)
2. Cell Adaptations (acquired abnormalities)

Developmental defects.
(Congenital)
1. Aplasia
2. Hypoplasia
3. Atrophy:

1. Aplasia: Complete or almost complete fail of organ to

develop. (Absent or represented by fibrono mass)

2. Hypoplasia
failure of organ to achieve adult organ size

3. Atrophy:
A- Physiological atrophy
1- Atrophy of thymus and tonsils after puberty.
2- Atrophy of uterus, ovaries and breast after menopause.
3- Atrophy of gravid uterus after delivery.
4- Senile atrophy affecting old age
B- Pathological atrophy
1Starvation and severe malnutrition.
2lschaemia e.g. in cerebral or heart atrophy.
3Immobilization decreases the muscle work .
4Denervation also decreases muscle work due to paralysis.
5Senile atrophy affecting old age.
6Hypopitutirism.
7Osteoporosis where the bulk of bone tissue is reduced

Cell Adaptations
(acquired abnormalities)
Injuries

Normal cell

Injuries

Injuries

Adaptive changes
(Adaptation)
Reversible changes
(Degeneration)
Irreversible changes
(Necrosis)

Cell Adaptations
1.
2.
3.
4.

Atrophy
Hypertrophy
Hyperplasia
Metaplasia

Hypertrophy

Hyperplasia

Physiological

1- Uterus in pregnancy.
2- Muscle in athletes
persons

In breast, genital organs

and uterus after puberty.

Pathological

1- Stomach after pyloric

obstruction.

1- Bone marrow after

hemorrhage or
inflammation.

2- Urinary bladder in
renal obstruction
3- Myocardium after
mitral stenosis.

2- Endometrium due to
excessive estrogen
stimulation.

3- Thyroid in primary
4- Wall of arteries or heart thyrotoxicosis.
after hypertension

Hypertrophy & Hyperplasia

Metaplasia
Types of metaplasia:
1- Epithelial metaplasia: Results from chronic irritation, inflammation
or prolonged vitamin A deficiency e.g. transformation of simple
squamous epithelium of respiratory tract by squamous metaplasia.
2-Mesenchymal Metaplasia: Occur in connective tissue. Primitive
mesenchymal cells can differentiate into any other form or more
highly differentiated forms e.g. fibroblasts, which transform to
osteoblasts forming bone tissue that occurs in tuberculosis and
goiter.

Neoplasia (Tumors)
Depending on whether or not they can spread by invasion
and metastasis, tumors are classified as being either
benign or malignant.

Benign tumors are tumors

that cannot spread by
invasion or metastasis; hence,
they only grow locally.
Malignant tumors are
tumors that are capable of
spreading by invasion and
metastasis. By definition, the
term cancer applies only to
malignant tumors.

Differences between Hyperplasia and Neoplasia

Hyperplasia

Neoplasia

Occur in response to
extracellular response.

Occur without stimulus

Reversible: disappear after the

removal of the stimulus.

Persistent

Cells are normal

Cells are abnormal in case of

malignant tumors

Cells are organized.

Cells are unorganized.

Involve many tissue elements.

- Involve one tissue elements

Arise from multiple foci.

Arise from simple foci

Malignant versus Benign Tumors

Benign (not cancer) tumor
cells grow
only locally and cannot
spread by invasion or
metastasis

Time

Malignant
(cancer) cells
invade
neighboring
tissues, enter
blood vessels,
and metastasize
to different sites

Diagnosis
Histological examination is still the most valid methods of
diagnosing neoplasia.
i- Biopsy
ii- Needle Biopsy
iii-Peripheral blood studies
iv-Hormone and enzyme studies
v- Exfoliative cytology

Treatment of Cancer
1- Surgery
2- Radiotherapy
3- Chemotherapy