Clinical Topics Conference: Chapter 1, Cell Injury

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  1. Endocrine gland atrophy
  2. Myocardial infarction
  3. Fatty Change
  4. Toxic liver cell necrosis
  5. Aging
Case 1: Endocrine gland atrophy

Clinical vignette

A 23 year old woman complained of persistent headaches that could not be relieved by aspirin, and blurry vision. An intracranial tumor (craniopharyngioma) was diagnosed by CAT-scan. The tumor was resected. Following the operation the patient never regained strength and felt weak and tired. She never menstruated again. Hormonal studies revealed low levels of thyroid hormones, adrenal corticoids and estrogens. Hormonal replacement therapy was instituted. Two years after the operation she had a fracture of the head of femur. She was treated by orthopedic surgeons but died due to postoperative complications.

Discussion topics

  1. Relate the symptoms of this patient to the intracranial tumor.

  2. Which organ showed signs of atrophy before the operation?

  3. Which organs showed signs of atrophy after the operation?

  4. Why did she break the head of her femur?
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    Case 2: Myocardial infarction

    Clinical vignette 2

    A 60 year old man had coronary heart disease for 5 years and experienced frequent bouts of angina pectoris. One day he experienced excruciating pain over his left chest, became short of breath and collapsed. He was transferred to the coronary intensive care unit. EKG was diagnostic of myocardial infarction. A coronary angiography was performed and an occlusion was noticed in the descending branch of the left coronary artery. An intracoronary infusion of TPA (tissue plasminogen activator) was instituted and the blood flow through the coronary artery was reestablished. He improved but the next day experienced a cardiac block and died.

    Discussion topics

    1. Which of the following pathologic changes could one expect to see in the heart of this man:
      • cell necrosis,
      • apoptosis,
      • atrophy,
      • hypertrophy,
      • hyperplasia,
      • metaplasia,
      • dysplasia,
      • calcification,
      • fibrinoid necrosis,
      • lipofuscin,
      • contracture band necrosis?

    2. Obviously, the patient died. Do you think the TPA treatment helped at all, or did it actually aggravate his condition?

    3. Did oxygen radicals form in this heart? Which radicals? How do oxygen radicals damage cells in so-called "reperfusion injury"?

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    Case 3: Fatty Change

    Clinical vignette 3

    A 40 year old lawyer was admitted to the hospital with delirium tremens. Among other abnormalities an enlarged liver was palpated. After his neurologic symptoms improved, liver biopsy was performed to rule out cirrhosis. The liver biopsy disclosed only fatty change and a few scattered Mallory bodies in some hepatocytes.

    Discussion topics

    1. What is the pathogenesis of fatty liver in this case?

    2. Is the fatty liver change reversible? How would you treat this man?

    3. List other causes of fatty liver.

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    Case 4: Toxic liver cell necrosis

    Clinical vignette 4

    A 20 year old woman tried to commit suicide by swallowing 150 tablets of Tylenol. She was brought to the hospital in coma. Laboratory studies discussed elevated levels of serum aminotransferases (AST, ALT), gamma glutamyl transpeptidase (GGT) and lactate dehydrogenase. Liver biopsy disclosed widespread liver cell necrosis.

    Discussion topics

    1. Discuss the pathogenesis of the above mentioned clinical laboratory and pathologic changes.

    2. Describe the anticipated morphologic changes in the liver.

    3. Discuss the probable clinical outcome of this case.

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    Case 5: Aging

    Clinical vignette 5

    An 85 year old man was admitted to an extended care facility with the clinical diagnosis of dementia. The CAT-scan showed atrophy of the brain with widening of the cerebral ventricles. During his hospitalization which lasted 3 years he was diagnosed as having the following diseases: ischemic heart disease, diverticulosis of colon and chronic constipation, actinic keratosis, osteoporosis. One day he developed pneumonia and died five days thereafter.

    Discussion topics

    1. Correlate dementia and CAT-scan brain findings and predicts what could one expect to find in the brain at autopsy.

    2. Which of the diseases of this man are typical of aging?

    3. Discuss 3 theories of aging and choose one that makes the most sense to you.

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