ACCUMULATIONS AND DEPOSITS
Ed Friedlander, M.D., Pathologist
scalpel_blade@yahoo.com

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This page was last modified June 11, 2014.

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Welcome to Ed's Pathology Notes, placed here originally for the convenience of medical students at my school. You need to check the accuracy of any information, from any source, against other credible sources. I cannot diagnose or treat over the web, I cannot comment on the health care you have already received, and these notes cannot substitute for your own doctor's care. I am good at helping people find resources and answers. If you need me, send me an E-mail at scalpel_blade@yahoo.com No texting or chat messages, please. Ordinary e-mails are welcome. Your confidentiality is completely respected.

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Freely have you received, give freely With one of four large boxes of "Pathguy" replies.

I'm still doing my best to answer everybody. Sometimes I get backlogged, sometimes my E-mail crashes, and sometimes my literature search software crashes. If you've not heard from me in a week, post me again. I send my most challenging questions to the medical student pathology interest group, minus the name, but with your E-mail where you can receive a reply.

Numbers in {curly braces} are from the magnificent Slice of Life videodisk. No medical student should be without access to this wonderful resource.

I am presently adding clickable links to images in these notes. Let me know about good online sources in addition to these:

Freely have you received, freely give. -- Matthew 10:8. My site receives an enormous amount of traffic, and I'm still handling dozens of requests for information weekly, all as a public service.

Pathology's modern founder, Rudolf Virchow M.D., left a legacy of realism and social conscience for the discipline. I am a mainstream Christian, a man of science, and a proponent of common sense and common kindness. I am an outspoken enemy of all the make-believe and bunk that interfere with peoples' health, reasonable freedom, and happiness. I talk and write straight, and without apology.

Throughout these notes, I am speaking only for myself, and not for any employer, organization, or associate.

Special thanks to my friend and colleague, Charles Wheeler M.D., pathologist and former Kansas City mayor. Thanks also to the real Patch Adams M.D., who wrote me encouragement when we were both beginning our unusual medical careers.

If you're a private individual who's enjoyed this site, and want to say, "Thank you, Ed!", then what I'd like best is a contribution to the Episcopalian home for abandoned, neglected, and abused kids in Nevada:

I've spent time there and they are good. Write "Thanks Ed" on your check.

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Especially if you're looking for information on a disease with a name that you know, here are a couple of great places for you to go right now and use Medline, which will allow you to find every relevant current scientific publication. You owe it to yourself to learn to use this invaluable internet resource. Not only will you find some information immediately, but you'll have references to journal articles which you can obtain by interlibrary loan, plus the names of the world's foremost experts and their institutions.

Alternative (complementary) medicine has made real progress since my generally-unfavorable 1983 review. If you are interested in complementary medicine, then I would urge you to visit my new Alternative Medicine page. If you are looking for something on complementary medicine, please go first to the American Association of Naturopathic Physicians. And for your enjoyment... here are some of my old pathology exams for medical school undergraduates.

I cannot examine every claim that my correspondents share with me. Sometimes the independent thinkers prove to be correct, and paradigms shift as a result. You also know that extraordinary claims require extraordinary evidence. When a discovery proves to square with the observable world, scientists make reputations by confirming it, and corporations are soon making profits from it. When a decades-old claim by a "persecuted genius" finds no acceptance from mainstream science, it probably failed some basic experimental tests designed to eliminate self-deception. If you ask me about something like this, I will simply invite you to do some tests yourself, perhaps as a high-school science project. Who knows? Perhaps it'll be you who makes the next great discovery!

Our world is full of people who have found peace, fulfillment, and friendship by suspending their own reasoning and simply accepting a single authority that seems wise and good. I've learned that they leave the movements when, and only when, they discover they have been maliciously deceived. In the meantime, nothing that I can say or do will convince such people that I am a decent human being. I no longer answer my crank mail.

This site is my hobby, and I do not accept donations, though I appreciate those who have offered to help.

During the eighteen years my site has been online, it's proved to be one of the most popular of all internet sites for undergraduate physician and allied-health education. It is so well-known that I'm not worried about borrowers. I never refuse requests from colleagues for permission to adapt or duplicate it for their own courses... and many do. So, fellow-teachers, help yourselves. Don't sell it for a profit, don't use it for a bad purpose, and at some time in your course, mention me as author and KCUMB as my institution. Drop me a note about your successes. And special thanks to everyone who's helped and encouraged me, and especially the people at KCUMB for making it possible, and my teaching assistants over the years.

Whatever you're looking for on the web, I hope you find it, here or elsewhere. Health and friendship!

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More of Ed's Notes: Ed's Medical Terminology Page

Perspectives on Disease
Cell Injury and Death
Accumulations and Deposits
Inflammation
Fluids
Genes
What is Cancer?
Cancer: Causes and Effects
Immune Injury
Autoimmunity
Other Immune
HIV infections
The Anti-Immunization Activists
Infancy and Childhood
Aging
Infections
Nutrition
Environmental Lung Disease
Violence, Accidents, Poisoning
Heart
Vessels
Respiratory
Red Cells
White Cells
Coagulation
Oral Cavity
GI Tract
Liver
Pancreas (including Diabetes)
Kidney
Bladder
Men
Women
Breast
Pituitary
Thyroid
Adrenal and Thymus
Bones
Joints
Muscles
Skin
Nervous System
Eye
Ear
Autopsy
Lab Profiling
Blood Component Therapy
Serum Proteins
Renal Function Tests
Adrenal Testing
Arthritis Labs
Glucose Testing
Liver Testing
Porphyria
Urinalysis
Spinal Fluid
Lab Problem
Quackery
Alternative Medicine (current)
Preventing "F"'s: For Teachers!
Medical Dictionary

Courtesy of CancerWEB

LEARNING OBJECTIVES

The student will describe the specificity of the common stains used in histopathology.

The student will correctly define the following terms as used in pathology, supply them (given a definition), and mention their significance:

Given a photomicrograph or glass slide, plus any clinical or special-stain information that may be necessary, the student will recognize:

The student will explain the origins of each of the important tissue pigments (bilirubin, carbon, hemosiderin, lipofuscin, melanin), and recognize each in tissue sections (given appropriate supplementary information when necessary).

The student will recognize the following "hyaline" substances, given the appropriate setting:

The student will recognize why liver cells accumulate fat during alcohol abuse, and list the classic causes of fatty change in the liver and heart respectively.

The student will describe and account for the accumulation of glycogen in cells in patients with diabetes, storage disease, and on IVs.

The student will recognize the major mechanisms of jaundice.

Given a yellow patient, the student will correctly distinguish carotenemia, jaundice, and uremia.

The student will describe typical sites and settings for dystrophic and metastatic calcification, myxoid change, and mitochondrial aberrations.

KCUMB Students
"Big Robbins" -- Cell Injury
Lectures follow Textbook

QUIZBANK

Iatrogenic Disease
Photo Library of Pathology
U. of Tokushima

Immunocytochemistry Images
University of Washington
Pictures and comments

Lipids
From Chile
In Spanish

Adaptation and Accumulations
Iowa Virtual Microscopy
Have fun

Pigments
From Chile
In Spanish

Proteins and Mucopolysaccharids
From Chile
In Spanish

LEARN FIRST

INTRODUCTION

STAINS FOR MEDICAL STUDENTS

Common stains
Eye pathology site

Stains and molecular markers
"Pathology Outlines"
Nat Pernick MD
GREAT reference, Thanks, Nat!

* Hematoxylin comes from logwood, the exotic jungle tree. The blues and purples of the clothes of the baroque era were mostly hematoxylin. The logwood tree formed the basis of the economy, and drove the history, of Belize, where it appears on the flag and coat of arms.

PERIODIC ACID-SCHIFF (PAS) is a stain based on the familiar periodic acid (H+IO4-) oxidation (cis-diols to aldehydes) and Schiff-base reactions.

DIASTASE-PAS ("PAS-D" / "D-PAS") is the PAS reaction performed on tissue previously digested by diastase, which removes glycogen.

{10880} congo red stain of amyloid, kidney
{10883} congo red stain of amyloid, polarized

Amyloidosis
Pittsburgh Illustrated Case

{17413} fat stain, atherosclerosis, oil red O
{38782} sudan stain, fatty liver

Fatty Change
Great labels
Romanian Pathology Atlas

Fatty liver
Double normal weight
KU Collection

Liver
Fatty change
Dave Barber MD, KCUMB

Fatty liver

KU Collection

FATTY CHANGE ("fatty metamorphosis", "fatty degeneration", "steatosis"): accumulation of excess neutral fat in vacuoles within non-adipocytes

{46294} fatty liver in kwashiorkor
{40039} Reye's syndrome, liver; microvesicular fatty change
{40040} Reye's syndrome, liver; microvesicular fatty change; oil red O

{08357} fatty liver, gross (we would confirm our impression microscopically)
{08366} fatty liver, micro
{08829} fatty liver, micro
{37589} fatty liver, micro

Fatty liver
Urbana Atlas of Pathology

Fatty liver

WebPath Photo

{11051} early atherosclerosis ("fatty streaks", all of you have these already)
{11648} early atherosclerosis, gross (natural-color and "oil red O stain")

Cholesterol emboli
Plugging an artery
KU Collection

{05955} foam cells, wall of gall bladder (these are laden with cholesterol)
{08108} foam cells, wall of gall bladder (ditto)
{01453} microglia (macrophages) eating up necrotic myelin lipid following a stroke

{09741} xanthelasma
{38332} eruptive xanthomas
{24886} xanthoma histology (* the thing that looks like a flower is a "floret" giant cell)

Big Xanthoma
Pittsburgh Illustrated Case

Juvenile xanthogranuloma
Pittsburgh Pathology Cases

Cholesterol polyps
Gall bladder xanthomas!
Pittsburgh Pathology Cases

Fatty ingrowth in heart
Ed Lulo's Pathology Gallery

Fatty ingrowth
Heart
Tom Demark's Site

Fatty ingrowth
Right ventricle
KCUMB Team

GLYCOGEN ACCUMULATION

{17421} glycogen "in" hepatocyte nuclei
{17422} the real picture of a "glycogen nucleus"
{46306} glycogen in the proximal tubule in poorly-controlled diabetes

ACCUMULATIONS OF COMPLEX LIPIDS AND CARBOHYDRATES

IATROGENIC ACCUMULATIONS

PIGMENTS

{12216}carotenemia

{37887} jailhouse tattoo
{17439} interesting tattoos
{38249} more tattoos
{10943} carbon in macrophages from an excised tattoo

Tattoo Pigment
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Anthracosis
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

{17438} carbon in the lung, gross
{17437} carbon in the lung, histology
{36157} carbon in macrophages, papanicolaou stain
{26047} carbon in macrophages, papanicolaou stain

Carbon pigment, lung
Mild by today's standards.
WebPath Photo

Carbon pigment

WebPath Photo

{17348} lipofuscin (EM and H&E)

Lipofuscin in the heart
Tom Demark's Site

Lipofuscin
Liver. Trust me.
WebPath Photo

{17454} hypertrophy vs. brown atrophy
{18720} hypertrophy vs. brown atrophy

Brown atrophy of the heart
Classic drawing
Adami & McCrae, 1914

{17443} lipofuscin (H&E, EM)

Melanosis coli
There is also a colon cancer
Urbana Atlas of Pathology

{49202} melanosis coli

{53602} albino
{18250} phenylketonuria patient
{18253} phenylketonuria patient
Moby Dick, albino whale

Hemosiderosis of the liver
Prussian blue
WebPath Photo

Iron in kidney tubules
Prussian blue
WebPath Photo

Hemochromatosis Excess hemosiderin eventually causes organ injury by generating free oxygen radicals. This leads to organ failure, called "hemochromatosis". ("Hemochromatosis is generalized hemosiderosis that has made you sick.") This is a major, under-diagnosed, treatable disease in the U.S.

    In a few cases, the disease has been detected by sufferers' tripping airport metal detectors.

{34364} hemosiderin at site of hemorrhage in a malignant brain tumor
{37592} hemosiderin, Prussian blue stain; there is also black carbon
{38491} hemosiderin-laden macrophages in the lung ("heart failure cells")

Heart Failure Cells
Hemosiderin-laden macrophages in the lung
KU Collection

Hemochromatosis
Liver, H&E stain
KU Collection

Pulmonary macrophages
Mixed pigment -- iron, carbon, tobacco
Dave Barber MD, KCUMB

{36189} ferruginous body in asbestosis

{18252} ochronosis (black cartilage in the ear)

{12220} jaundice

Jaundice

WebPath Photo

Jaundice

WebPath Photo

Bile plugs
Cholestasis
WebPath Photo

Kidney, conjugated jaundice
Urbana Atlas of Pathology

{24559} liver that is green from biliary obstruction
{39787} bile plug

CALCIFICATION: A subject of interest to most physicians, not just radiologists.

{03560} calcified aortic valve, x-ray
{06461} calcified aortic valve, gross
{45702} calcified carotid artery (the proximal portion of the common carotid, and the proximal portions of both internal and external carotid arteries are visible; look carefully!)
{15856} dystrophic calcification in heart muscle (myocarditis patient)

Calcification
From Chile
In Spanish

Dystrophic calcification

WebPath Photo

{35552} Schaumann bodies in giant cells of granulomas (berylliosis case)

{39670}calcification, metastatic, in the lung;
{08099} calcification, metastatic, in the lung

Metastatic lung calcification
Uremic patient
KCUMB Team

Metastatic lung calcification
Uremic patient
KCUMB Team

Metastatic lung calcification
Uremic patient
KCUMB Team

Metastatic lung calcification
Uremic patient
KCUMB Team

Metastatic calcification
Lung
WebPath Photo

HYALINE: Any substance (intracellular or extracellular) that stains a homogeneous (say "homo-JEAN-yuss") pink on routine H&E stains.

{17485} treatise on hyaline

{46308} hyaline droplets in proximal tubules
{17440} hyaline droplets in proximal tubules

Russell Body
UHS Case
Photo by Ed

Russell Bodies
Four in one cell
Photo by Ed

Thanatosomes
Lung tumor
KCUMB Team

Thanatosomes
Lung tumor
KCUMB Team

{09103} Mallory's alcoholic hyaline, electron micrograph (upper right)
{17418} Mallory's alcoholic hyaline, H&E and electron micrograph

{17646} keloid, gross
{17647} keloid, histology
{17648} keloid, histology
{46351} keloid, histology

Keloids (hypertrophic scars?)
Actor Benjamin Bratt
UCSF Skin-In-Cinema

Keloids
Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

Keloid
Glassy fibers
KU Collection

{17472} hyaline arteriolar sclerosis (right, one on left is normal)

{13613} amyloid, H&E

Amyloid
From Chile
In Spanish

Amyloid
Congo red
WebPath Photo

{11427} fibrin in a premature baby's lung ("hyaline membranes")

Fibrin
On the epicardium
WebPath Photo

Hyaline membrane disease
Fibrin membranes in lung
KU Collection

Fibrinoid
Damaged vessel, don't know why
WebPath Photo

Fibrinoid
Damaged vessel, don't know why
WebPath Photo

Polyarteritis
Urbana Atlas of Pathology

{01917} radiation injury to vessels; the hyaline fibrinoid is pink

MYXOID CHANGE

ABNORMAL MITOCHONDRIA

Oncocytoma
Mitochondrion-rich tumor
VCU Pathology

Hürthle cell carcinoma
Thyroid
Pittsburgh Pathology Cases

BIBLIOGRAPHY / FURTHER READING

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Teaching Pathology

Pathological Chess


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