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A 48-year-old chronic alcoholic comes in for check-up. While he can still perform his work noother major illnesses noted. Physical examination is unremarkable. Laboratory tests show thefollowing results:Albumin = 4.1 g/dLALT = 30 U/LAST = 33 U/LTotal bilirubin = 1.1 mg/dLThe patient subsequently dies from a vehicular accident and autopsy was done.Refer to slide #1. Give the microscopic descriptions of your diagnosis based on the slide given.2. Histologically, compare fatty change (steatosis) and fatty infiltration histologically:Pathogenesis:9Organs commonly involved:Case 4A pathologist receives the body of a 40-year-old motorcycle rider who recently died due to avehicular crash. Upon autopsy, a gross inspection of his chest cavity finds black streaks betweenthe lobules of his lungs beneath the pleural surface. This finding is represented by slide #1. What is this finding and what is its pathological consequence?2. How does this pigment get to this location?

Question

A 48-year-old chronic alcoholic comes in for check-up. While he can still perform his work noother major illnesses noted. Physical examination is unremarkable. Laboratory tests show thefollowing results:Albumin = 4.1 g/dLALT = 30 U/LAST = 33 U/LTotal bilirubin = 1.1 mg/dLThe patient subsequently dies from a vehicular accident and autopsy was done.Refer to slide #1. Give the microscopic descriptions of your diagnosis based on the slide given.2. Histologically, compare fatty change (steatosis) and fatty infiltration histologically:Pathogenesis:9Organs commonly involved:Case 4A pathologist receives the body of a 40-year-old motorcycle rider who recently died due to avehicular crash. Upon autopsy, a gross inspection of his chest cavity finds black streaks betweenthe lobules of his lungs beneath the pleural surface. This finding is represented by slide #1. What is this finding and what is its pathological consequence?2. How does this pigment get to this location?

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Solution

  1. Based on slide #1, the microscopic description of the diagnosis is the presence of anthracosis. Anthracosis is characterized by the deposition of black pigment in the lungs, specifically between the lobules beneath the pleural surface. This pigment is composed of carbon particles derived from inhaled environmental pollutants, such as soot or coal dust.

  2. Fatty change (steatosis) and fatty infiltration can be compared histologically as follows:

  • Fatty change (steatosis): This refers to the accumulation of triglycerides within hepatocytes, leading to the appearance of vacuoles in the cytoplasm. These vacuoles displace the nucleus to the periphery of the cell. Fatty change is reversible and can be caused by various factors, including alcohol abuse.
  • Fatty infiltration: This refers to the infiltration of adipose tissue into the liver parenchyma. It is characterized by the presence of adipocytes within the liver lobules. Fatty infiltration is usually associated with obesity, metabolic syndrome, or certain medical conditions.

Pathogenesis:

  • Fatty change (steatosis): It occurs due to an imbalance between the uptake, synthesis, and export of fatty acids in hepatocytes. Alcohol abuse can disrupt these processes, leading to the accumulation of triglycerides within the liver cells.
  • Fatty infiltration: It occurs when there is an excessive influx of free fatty acids into the liver, which are then converted into triglycerides and stored as fat droplets within hepatocytes.

Organs commonly involved:

  • Fatty change (steatosis): The liver is the most commonly affected organ, but fatty change can also occur in other organs such as the heart, kidneys, and skeletal muscles.
  • Fatty infiltration: The liver is primarily affected by fatty infiltration, but it can also involve other organs such as the pancreas, heart, and skeletal muscles.

Regarding the second part of the question, the finding represented by slide #1, the black streaks between the lobules of the lungs beneath the pleural surface, is consistent with anthracosis. Anthracosis is the deposition of carbon particles in the lungs, which is commonly seen in individuals exposed to environmental pollutants, such as soot or coal dust. The pathological consequence of anthracosis is the impairment of lung function, as the deposited carbon particles can lead to inflammation and fibrosis, ultimately affecting respiratory capacity.

The pigment reaches this location through inhalation of airborne particles containing carbon, such as those released during the combustion of fossil fuels or exposure to industrial pollutants. These particles are inhaled into the respiratory system and can accumulate in the lungs over time, leading to the development of anthracosis.

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