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    Micro Specimens 1-7 Concluding 1

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    Micro Specimens 1-7 Concluding 1

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    Micro specimens 1-7 Concluding 1

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    Micro Specimens 1-7 Concluding 1

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    Hemodynamic disorders part (II)

    Hemodynamic disorders II

    I. Microspecimens:

    № 4. Recent red thrombus in the vein. (H-E. stain). Indications:


    1. Vein wall.
    2. Thrombus within the lumen of the vessel:
    a) fibrin strands;
    b) hemolyzed erythrocytes.

    Cross section through the vein, the lumen is obturated by a thrombus, consisting of a network
    of filaments and homogeneous, eosinophilic masses of fibrin, in which there are figurative
    elements of the blood, predominantly hemolysed erythrocytes. The thrombus adheres to the
    vessel intima.

    № 140. Lymphatic vessels celluar (cancerous) embolism. (H-E. stain). Indications:


    1. Dilated lymphatic vessel.
    2. Embolus (cancer cells) in the lymph vessel lumen.
    3. Vein.
    4. Pulmonary alveoli.

    Pulmonary lymphatic vessels, which accompany blood vessels, are dilated, in their lumen are
    present clusters of cancer cells (cell emboli).
    1

    № 4. Recent red thrombus in the vein. (H-E. stain).


    2
    4
    1

    № 140. Lymphatic vessels cellular (cancerous) embolism. (H-E. stain).


    № 101. Microbial embolism of the renal vessels. (H-E. stain). Indications:
    1. Microbial emboli in glomerular capillary lumen.
    2. Focus of microbial necrosis around emboli.
    3. Clusters of neutrophils (abscess).
    4. Unchanged glomerulus.

    In some glomeruli there are clusters of microbes (microbial emboli), of intensely


    basophilic color ( look like ink spots), around which necrotic changes (karyolysis) and
    agglomerations of neutrophilic leukocytes (metastatic abscesses) are determined; microbial
    emboli are also observed in the lumen of some arterioles and veins; In some microspecimens
    microbial masses are found in the lumen of the collecting tubules in the medullary layer of
    the kidney.

    № 13. Diapedesis hemorrhage in the brain. (H-E. stain). Indications:


    1. Clusters of erythrocytes (hemorrhagic focus).
    2. Blood vessel.
    3. The brain tissue.

    In the cerebral tissue, agglomerations of red blood cells (haemorrhagic foci) are observed,
    arranged in shape of rings around small blood vessels; the integrity of the blood vessel
    walls is preserved.
    4

    2 3

    № 101. Microbial embolism of the renal vessels. (H-E. stain).


    2
    1

    № 13. Diapedesis hemorrhage in the brain. (H-E. stain).


    II. Macrospecimens:

    № 3. Parietal thrombus in the abdominal aorta.

    The intima of the aorta is irregular, rough, with multiple protrusions of the wall (atherosclerotic plaques) and
    ulcerations, covered with atheromatous masses of yellow color; there is a parietal thrombus, adherent to the intima
    of red-dark color, dense consistency, irregular surface.

    № 37. Thromboembolism of pulmonary artery.

    In the common trunk of the pulmonary artery or at the level of the bifurcation, fragments of dark red cylindrical
    thrombi of 0.5-1.0 cm diameter are observed, which do not adhere to the vessel wall (thromboemboli); at the level
    of the bifurcation the thrombus obstructs the lumen of both pulmonary arteries, having the appearance of "rider in
    the saddle".

    № 42. Metastases of cancer into lung.


    In the lung under the pleura and on the section, there are multiple whitish-gray tumor nodules, round or oval in
    shape, up to 3-5 cm in diameter, well delimited by the adjacent tissue.

    № 85. Purulent embolic nephritis (metastatic abscess into the kidney).


    The kidney is enlarged in size, under the capsule there are multiple disseminated foci of purulent inflammation, of
    yellowish color, with a diameter of 0.5-1.0 cm, which protrude on the surface of the organ - metastatic abscesses.

    № 121. Cerebral hemorrhage (parenchymal hematoma).


    In the brain, there is an accumulation of dark red coagulated blood (hematoma), the adjacent brain tissue is
    softened, of a flaccid consistency.
    № 3. Parietal thrombus in the abdominal aorta.
    № 37. Thromboembolism of pulmonary artery.
    № 42. Metastases of cancer into lung.
    № 85. Purulent embolic nephritis (metastatic abscess into the kidney).
    № 121. Cerebral hemorrhage (parenchymal hematoma).
    Virchow triad in
    thrombosis.
    Arterial thrombosis.
    Spherical thrombus in the right
    atrium.

    Chronic cardiac aneurysm with thrombosis.


    Parietal thrombi in the abdominal aorta in Parietal thrombus in the
    atherosclerosis. iliac vein.
    Deep vein thrombosis of the lower limbs.
    Thrombus in course of
    organization. (H-E stain).
    Recanalized thrombus.
    (H-E stain).
    Consequences of thrombosis.
    Pulmonary artery thromboembolism.
    Paradoxical embolism Congenital heart defect: defect
    scheme. of the interventricular septum.
    Cancer metastases in the lung.

    Cancer metastases in the liver.


    Hemorrhage (per diabrosin)
    in tubal pregnancy.

    Fatal intracerebral
    hemorrhage
    (per rhexis).
    Petechial hemorrhages in the
    epicardium of the heart. Hemopericardium.

    Per
    diapedesis

    Per
    rhexis
    Hemorrhage
    Definition:
    “Extravasation of blood due to vessel rupture”
    Types: (depending on the site, extent and
    location)
    External
    Internal
    Hematoma: ‘Blood within the tissue’
    (small; like a Bruise, or sufficiently large as to
    be fatal)
    Causes of hemorrhage:
    - vascular diseases with rupture (atherosclerosis,
    arteritis, aneurysms, etc.).

    - low platelets (below 10-15,000/cu mm);


    coagulopathy (factors less than 10% activity);

    - ulcers, tumors, coagulation factors, infarcts,


    trauma.
    Types of hemorrhage: acute vs. chronic
    petechia (-ae) - 1 to 2 mm. hemorrhages, usually
    indicating either platelet disorder or capillary fragility
    ecchymosis (-es) - hemorrhages measuring > 1 cm.,
    often indicating coagulation factor abnormality
    purpura - ecchymotic and petechial hemorrhages into
    skin
    hemopericardium - blood into pericardium
    hemothorax - blood into thoracic cavity (ies)
    hemoperitoneum - blood into peritoneal cavity
    hematochezia - bright red blood per rectum
    melena - dark black blood per rectum
    hematuria - blood, gross or microscopic, in urine
    hemoptysis - coughing up of blood
    hematemesis - vomiting up of blood
    Hemorrhage
    Petechiae:
     Minute 1-2 mm
     Into skin, mucous membrane, or
    serosal surfaces
     Causes: Locally increased
    intravascular pressure, low platelet
    count, defect in platelet function,
    and deficiency of clotting factors.
    Petechial hemorrhages of colonic mucosa
    as a consequence of thrombocytopenia
    Hemorrhage
    Purpura:
     Slightly larger ≥ 3mm
     All causes of Petechiae, plus
     Secondary to trauma, vascular
    inflammation, and increased
    vascular fragility
    Hemorrhage
    Ecchymoses:
    (Subcutaneous hematoma; Bruises)
     Larger > 1-2 cm
     Characteristically seen after
    trauma
     Exacerbation of any of the
    aforementioned conditions
    Hemorrhage
    Ecchymoses:
    (Colours changes in hematoma)
     Hemoglobin (Red-blue)
     Bilirubin (Blue-green)
     Hemosiderin (Gold-brown)
    Petechiae & Ecchymoses
    Fatal intracerebral
    hemorrhage
    Hemorrhage:
    Ectopic pregnancy
    One complication of a transmural myocardial infarction is rupture of
    the myocardium. This is most likely to occur in the first week between
    3 to 5 days following the initial event, when the myocardium is the
    softest.
    Here are petechial
    hemorrhages seen on
    the epicardium of the
    heart.
    Subarachnoid
    Haemorrhage:
    Thrombosis: Intravascular
    coagulation
    THROMBUS solidified blood inside the
    vascular space in a living organism.

    Composed of fibrin, platelets, and rbc's


    Hemostatic plug formation
    endothelial injury
    platelet aggregation
    fibrin meshwork

    Location of thrombi: Arteries, veins, heart


    chambers, heart valves

    Types of thrombi: Arterial vs. venous; bland


    vs. septic
    Virchow triad in thrombosis.
    Endothelial integrity is the single most important factor. Note that injury
    to endothelial cells can affect local blood flow and/or coagulability;
    abnormal blood flow (stasis or turbulence) can, in turn, cause endothelial
    injury. The elements of the triad may act independently or may combine to
    cause thrombus formation.
    Diagrammatic representation of the
    normal hemostatic process
    Diagrammatic representation of
    the normal hemostatic process
    Platelets adhere to exposed
    extracellular matrix (ECM)
    via von Willebrand factor
    (vWF) and are activated,
    undergoing a shape change
    and granule release;
    released adenosine
    diphosphate (ADP) and
    thromboxane A2 (TxA2)
    lead to further platelet
    aggregation to form the
    primary hemostatic plug.
    Diagrammatic representation of the normal
    hemostatic process

    Local activation of
    the coagulation
    cascade (involving
    tissue factor and
    platelet
    phospholipids)
    results in fibrin
    polymerization,
    "cementing" the
    platelets into a
    definitive
    secondary
    hemostatic plug.
    Diagrammatic
    representation of the
    normal hemostatic process
    Counter -
    regulatory
    mechanisms, such as
    release of tissue
    type plasminogen
    activator (t-PA)
    (fibrinolytic) and
    thrombomodulin
    (interfering with the
    coagulation
    cascade), limit the
    hemostatic process
    to the site of injury.
    Mural
    thrombi.
    Sites of Thrombosis
    in heart (atria , ventricles & on valves); in arteries ; in veins ; and
    in capillaries.

    Large mural
    thrombus on top of Left atrial mural thrombus in a
    myocardial infarction case of rheumatic mitral stenosis
    Venous Thrombi:
    Fates
     Organization
     Ingrowth of cells
    into thrombus with
    incorporation into
    wall
     Resolution
     It goes away
     Embolization
     Travels from its
    site of origin to a
    distal part of
    circulation
    VENOUS THROMBI FATES
    Arterial Thrombi
    Morphology  Adherent masses of
    blood that demonstrate
    areas of pale
    alternating with areas
    of red
     Lines of Zahn
    Coronary
    Atheorsclerosis
    Coronary
    Thrombosis
    With Infarction
    Arterial Thrombi
    Morphology
    Arterial Thrombi
    Outcome

     Similar to venous thrombi


     Resolution
     Organization/Incorporation/Recanalization
     Embolization (arterial)
     Propagation
    Atherosclerosis
    Aorta
    Ruptured aneurism
    Nephrosclerosis
    Aorta Dissecting Aneurisms:
    Coronary Narrowing in
    Atherosclerosis:
    Low-power view of a
    thrombosed artery.
    A, H&E-stained section. B, Stain for elastic tissue. The original
    lumen is delineated by the internal elastic lamina (arrows)
    and is totally filled with organized thrombus, now
    punctuated by a number of small recanalized channels.
    Embolism & Thromboembolism
    Embolism:
     Abnormal solid mass carried in blood.
     Source – destination
     Types.
     Thromboembolism - atherosclerosis
     Fat - Fractures
     Tumor - cancers
     Gas – ‘Caisson disease’
     Liquid – Amniotic fluid in new born.
     Rapid onset of infarction –vs. Thrombosis
    Pulmonary
    Thromboembolism
     20-25 per 100,000
    hospitalized patients
     May be fatal if 60% of
    pulmonary circulation is
    obstructed (acute cor
    pulmonale)
     Saddle PE straddles the
    bifurcation of the main PA
     Sequelae: Sudden death,
    clinically silent – resolution –
    organization, shortness of
    breath, pulmonary infarction
     Pathogenesis: Deep venous
    thrombi usual cause –often
    following immobilization-bed
    rest from hospitalization
    Fat Embolism
    Bone marrow
    embolus in the
    pulmonary
    circulation.

    Fat embolus in a
    glomerulus
    Thrombo-
    embolism
    PARADOXICAL EMBOLI

     EMBOLI WHICH
    TRAVEL FROM
    VENOUS TO
    ARTERIAL
    CIRCULATION
    VIA A
    COMMUNICATIO
    N BETWEEN
    ARTERIAL AND
    VENOUS
    CIRCULATION

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