Dr.Maha Arafah

To study:  Overview of intracellular accumulations  Accumulation of Lipids  Accumulation of Cholesterol  Accumulation of Proteins  Accumulation of Glycogen  Accumulation of Pigments  Pathologic Calcification

 Under some circumstances cells may accumulate abnormal amounts of various substances,.  They may be harmless or associated with varying degrees of injury.

 May be found:  in the cytoplasm  within organelles (typically lysosomes)  in the nucleus  Came to the cell through:  Synthesis by affected cells  Produced elsewhere

1. Normal or increased rate of production of a normal substance, but metabolic rate is inadequate to remove it (e.g. fatty change in liver)

2. A normal or an abnormal endogenous substance accumulates because of genetic or acquired defects in its folding, packaging, transport, or secretion. e.g. In α -1antitrypsin deficiency, α 1at accumulates in the liver causing cirrhosis)

3. An inherited defect in an enzyme may result in failure to degrade a metabolite. The resulting disorders are called storage diseases.

4. An abnormal exogenous substance is deposited and accumulates because the cell has neither the enzymatic machinery to degrade the substance nor the ability to transport it to other sites. (e.g. Accumulations of carbon or silica particles)

 Overview of intracellular accumulations  Accumulation of Lipids  Accumulation of Cholesterol  Accumulation of Proteins  Accumulation of Glycogen  Accumulation of Pigments  Pathologic Calcification

(Steatosis)

 Fatty change refers to any abnormal accumulation of triglycerides within parenchymal cells.  Site: liver, most common site  it may also occur in heart, skeletal muscle, kidney, and other organs.

 Toxins (most importantly: Alcohol abuse)  diabetes mellitus  Protein malnutrition (starvation)  Obesity  Anoxia

Hepatotoxins (e.g. alcohol) by disrupting mitochondria and SER ; anoxia CCl4 and protein malnutrition Starvation will increase this Defects in any of the steps of uptake, catabolism, or secretion can lead to lipid accumulation.

 Depends on the cause and severity of the accumulation.  Mild it may have no effect on cellular function.  Severe fatty change may transiently impair cellular function  In the severe form, fatty change may precede cell death, and may be an early lesion in a serious liver disease called nonalcoholic steatohepatitis

 Most common site: the liver and the heart.  With increasing accumulation, the organ enlarges and becomes progressively yellow, soft, and greasy.

 Early: small fat vacuoles in the cytoplasm around the nucleus.  Later stages: the vacuoles coalesce to create cleared spaces that displace the nucleus to the cell periphery  Occasionally contiguous cells rupture (fatty cysts)

 Fatty change is reversible except if some vital intracellular process is irreversibly impaired (e.g., in CCl4 poisoning),

 Mild: benign natural history (approximately 3% will develop cirrhosis  Moderate to sever: inflammation, degeneration in hepatocytes, +/- fibrosis (30% develop cirrhosis)  5 to 10 year survival:67% and 59%

 Overview of intracellular accumulations  Accumulation of Lipids  Accumulation of Cholesterol  Accumulation of Proteins  Accumulation of Glycogen  Accumulation of Pigments  Pathologic Calcification

 Cellular cholesterol metabolism is tightly regulated to ensure normal cell membrane synthesis without significant intracellular accumulation

S everal different pathologic processes: 1. Macrophages in contact with the lipid debris of necrotic cells or abnormal (e.g., oxidized) forms of lipoproteins

These macrophages may be filled with minute, membrane-bound vacuoles of lipid, imparting a foamy appearance to their cytoplasm (foam cells).

2. Atherosclerosis: smooth muscle cells and macrophages are filled with lipid vacuoles composed of cholesterol and cholesteryl esters

 These give atherosclerotic plaques their characteristic yellow color and contribute to the pathogenesis of the lesion

3. In hereditary and acquired hyperlipidemic syndromes, macrophages accumulate intracellular cholesterol 4. Xanthomas: clusters of foamy macrophages present in the subepithelial connective tissue of skin or in tendons

To study:  Overview of intracellular accumulations  Accumulation of Lipids  Accumulation of Cholesterol  Accumulation of Proteins  Accumulation of Glycogen  Accumulation of Pigments  Pathologic Calcification

 Morphologically visible protein accumulations are much less common than lipid accumulations  They may occur because excesses are presented to the cells or because the cells synthesize excessive amounts

1. Nephrotic syndrome:  In the kidney trace amounts of albumin filtered through the glomerulus are normally reabsorbed by pinocytosis in the proximal convoluted tubules  After heavy protein leakage, pinocytic vesicles containing this protein fuse with lysosomes, resulting in the histologic appearance of pink, hyaline cytoplasmic droplets

The process is reversible; if the proteinuria abates, the protein droplets are metabolized and disappear.

2. marked accumulation of newly synthesized immunoglobulins that may occur in the RER of some plasma cells, forming rounded, eosinophilic Russell bodies.

3. Mallory body, or "alcoholic hyalin," is an eosinophilic cytoplasmic inclusion in liver cells that is highly characteristic of alcoholic liver disease  These inclusions are composed predominantly of aggregated intermediate filaments

4. The neurofibrillary tangle found in the brain in Alzheimer disease is an aggregated protein inclusion that contains microtubule-associated proteins

 Overview of intracellular accumulations  Accumulation of Lipids  Accumulation of Cholesterol  Accumulation of Proteins  Accumulation of Glycogen  Accumulation of Pigments  Pathologic Calcification

 Associated with abnormalities in the metabolism of either glucose or glycogen.  Examples: 1. In poorly controlled diabetes mellitus, glycogen accumulates in renal tubular epithelium, cardiac myocytes, and β cells of the islets of Langerhans. 2. Glycogen accumulates within cells in a group of closely related genetic disorders collectively referred to as glycogen storage diseases, or glycogenoses

 In these diseases, enzymatic defects in the synthesis or breakdown of glycogen result in massive stockpiling, with secondary injury and cell death.

 Pigments are colored substances that are either:  exogenous, coming from outside the body, or  endogenous, synthesized within the body itself.

 The most common is carbon  When inhaled, it is phagocytosed by alveolar macrophages and transported through lymphatic channels to the regional tracheobronchial lymph nodes.

 Aggregates of the pigment blacken the draining lymph nodes and pulmonary parenchyma (anthracosis).

 Heavy accumulations may induce emphysema or a fibroblastic reaction that can result in a serious lung disease ( coal workers' pneumoconiosis)

Asbestos bodies

To study:  Overview of intracellular accumulations  Accumulation of Lipids  Accumulation of Cholesterol  Accumulation of Proteins  Accumulation of Glycogen  Accumulation of Pigments  Pathologic Calcification

 Endogenous pigments include lipofuscin, melanin, and certain derivatives of hemoglobin.

 "wear-and-tear pigment" is an insoluble brownish- yellow granular intracellular material that seen in a variety of tissues (the heart, liver, and brain) as a function of age or atrophy.  Consists of complexes of lipid and protein that derive from the free radical-catalyzed peroxidation of polyunsaturated lipids of subcellular membranes.  It is not injurious to the cell but is important as a marker of past free-radical injury.  The brown pigment when present in large amounts, imparts an appearance to the tissue that is called brown atrophy.

 By electron microscopy, the pigment appears as perinuclear electron-dense granules

 is an endogenous, brown-black pigment produced in melanocytes  Although melanocytes are the only source of melanin, adjacent basal keratinocytes in the skin can accumulate the pigment (dermal macrophages)

 is a hemoglobin-derived granular pigment that is golden yellow to brown and accumulates in tissues when there is a local or systemic excess of iron.  Hemosiderin pigment represents large aggregates of ferritin micelles, can be seen by light and electron microscopy

 Although hemosiderin accumulation is usually pathologic, small amounts of this pigment are normal in the mononuclear phagocytes of the bone marrow, spleen, and liver, where there is extensive red cell breakdown

 Local excesses of iron, and consequently of hemosiderin, result from hemorrhage.  Bruise: The original red-blue color of hemoglobin is transformed to varying shades of green-blue by the local formation of biliverdin (green bile) and bilirubin (red bile) from the heme

The iron ions of hemoglobin accumulate as golden-yellow hemosiderin. The iron can be unambiguously identified by the Prussian blue histochemical reaction

 is systemic overload of iron, hemosiderin is deposited in many organs and tissues  It is found at first in the mononuclear phagocytes of the liver, bone marrow, spleen, and lymph nodes and in scattered macrophages throughout other organs.  With progressive accumulation, parenchymal cells throughout the body (principally the liver, pancreas, heart, and endocrine organs) will be affected

 Hemosiderosis occurs in the setting of: 1. increased absorption of dietary iron 2. impaired utilization of iron 3. hemolytic anemias 4. transfusions (the transfused red cells constitute an exogenous load of iron)..

 In most instances of systemic hemosiderosis, the iron pigment does not damage the parenchymal cells  However, more extensive accumulations of iron are seen in hereditary hemochromatosis with tissue injury including liver fibrosis, heart failure, and diabetes mellitus