exogenous pigments - Ústav patologie 1.lfpau.lf1.cuni.cz/file/6450/9-pigm-exog.pdf · exogenous...
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Jaroslava Dušková
Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague
General Pathology
Basic Principles of Cellular and Organ
Pathology
Exogenous
Pigments
Exogenous pigments – table of contents
definition
portals of entry
traumatic lesions
gastrointestinal tract
respiratory tract - pneumoconioses
silicosis
asbestosis
miners´disease
diff. dg. to pneumoconioses
- coniotoxicoses
- conioallergoses
PigmentsDefinition:
colored substances
in the organism
or environment
Colors result from the reflection of a particular wavelength of light from an object.
PigmentsClassification:
endogenous
– hemoproteins
derived
– autogenous
exogenous
Exogenous Pigments
- colored substances
entering the organism via traumatic lesions
gastrointestinal tract
respiratory tract
Exogenous Pigmentation
traumatic origin – tatuatio traumatica, arteficialis
gastrointestinal tract
– intoxication Pb, Ag, Au, Fe (!), Hg, Pt……
Exogenous Pigmentation
traumatic origin – tatuatio traumatica, arteficialis
mechanic instilation of „inert“ dyes
(china ink)
into the deep dermis
Tattoo
From Polynesian tatau.
In Tahitian - tatu.
The Polynesian practice became popular among
European sailors, before spreading to Western
societies
Mummy of Amunet from Ancient Egypt
Pre-Christian Germanic, Celtic and other central
and northern European tribes were often heavily
tatooed
Auschwitz survivor
Sam Rosenzweig
displays his
identification tattoo.
The Art ??
Tattoo
Tatuatio arteficialis
protest? aesthetic social communication?
Prevalence
• Female gender
• White or Hispanic
• Age 24 to 39 years
• Self-described risk takers
• College educated
• Single
• In stable family
relationships
• Moderate to strong
religious beliefs
• Interest in dissociating
from the past
Among individuals seeking tattoo
removal, the following features were
more common:
Tattoo Removal: New
Laser Options
J. of Drugs in
Dermatology
April 2013 | Volume 12 |
Issue 4 | Feature | 492
Piercing
Medical Tattoos
to ensure instruments are properly located for repeated application of radiotherapy
for the areola in some forms of breast reconstruction.
Tattooing has also been used to convey medical information about the wearer (e.g. blood group).
Tattoos are used in skin tones to cover vitiligo, skin pigmentation disorder.
London
Tatuatio
experimentalis
Tatuatio
Tattoo
inert – persistent
macrophage degraded
macrophage transported
secondary lymph node pigmentation
Tattoo Removal - Think before you ink
Maybe your new boss frowns upon your tattoos
or your sweetheart can't stand the name of your former...
Laser treatment is now the standard method of removal
for unwanted tattoos.
Laser removal is low risk, non-invasive, and has a very
low incidence of scarring (about 5%).
Tatuatio arteficialis - therapy
LASER = Light Amplification by Stimulated
Emission of Radiation
– low performance laser – biostimulation
– high performance laser – destruction of
pigmentation shifts – postinflammatory,
melasma (chloasma), tattoo
SURGERY / CRYOSURGERY
COMBINATION
COVER UP
Tattoo Removal - Think before you ink IPL – Intense Pulsed Light Therapy does not involve lasers, but the two processes are
similar. Most tattoos can be removed with only 3-4 sessions. The drawback is the expense -IPL can cost $10 and more per pulse.
The Process starts with a consultation with a dermatologist. There are around 100 different tattoo inks in use today, and some can be removed more easily than others.
The Pain of the laser pulse is most often compared to the sensation of having hot grease spattered on the skin, hair removed by extraction or to being repeatedly snapped with a rubber band. Anti-inflammatory drugs like ibuprofen are not recommended, as they may result in bruising.
The Procedure usually lasts 15-30 minutes per session. It involves laser pulses passing through the epidermis of your skin and into the dermis, where the tattoo ink absorbs the light energy. Over the following three to six weeks, the skin naturally removes the ink, which has been fragmented by the laser energy. A low-grade inflammation may occur after each procedure; this has been compared to mild sunburn, and any discomfort usually passes within a few days. After the skin has rested and the immune system has done its job (usually after 4-8 weeks), the patient is ready for another visit to the dermatologist.
Black, blue and red inks are most responsive to lasers and easiest to remove. Tattoos with green and yellow inks are the most resistant. Old tattoos may be easier to remove than new ones, as the inks can fade over time.
Each laser removal session can cost from $200-$1500, depending upon your practitioner. Most insurance companies don’t cover tattoo removal, since it is considered a cosmetic procedure. Some tattoos can be removed in 6-8 sessions, while others may require 16-18 sessions spanning over two years or more.
Tattoo
Removal
Tattoo Removal - Think before you ink
Temporary tattoo – e.g. with Henna
The paste is applied
and left on the skin
for several hours to
stain. The stain will
gradually fade away
as the skin sheds.
Henna tattoos can
last days to over a
month depending on
application and
aftercare.
Think before you inkTemporary tattoo - autocollants de tatouage
Exogenous Pigmentation
gastrointestinal tract
Pb, Ag, Au, Fe (!),
Hg, Pt, Bi…..
intoxication
side effect in metals containing therapies
Bismuth staining of the
tongue
(gastric ulcer treatment)
Lead poisoning
Exogenous Pigmentation
through Airways
PNEUMOCONIOSES
Def.:
conditions or diseases elicited with dust particles
inhalation (<5)
Pneumoconioses– coniosis simplex
(anthracosis, siderosis)
– coniofibrosis (silicosis, asbestosis,
coal workers disease, siderosis)
– coniotoxicosis conioalergosis(byssinosis, berylliosis)
organic dusts
Anthracosis
Def.:
pneumoconiosis caused by inert coal-like dust
(without quartz admixture)
no symptoms = coniosis simplex
100% population prevalence
Anthracosis pleurae
Anthracosis pulmonum et lnn. peribronchialium.
Metastases carcinomatosae lnn. peribronchialium
Anthracosis pulmonum
Anthracosis pulmonum
Anthracosis pulmonum
Sputum - macrophages
Sputum - siderophages / coniophages
SilicosisDef.:
pneumoconiosis caused by quartz dust with pronounced fibrosis response
CONIOFIBROSIS
long lasting exposition (20–40 years)
progression even after exposure elimination
part of miners disease
affinity to other lung diseases (tbc)
Silicosis
Pathogenesis:
toxic activity of quartz dust to macrophages
production of PDGF1, IGF-1, fibronectin
chemotaxins, IL-8
enzyme activation,
lung injury, inflammation,
FIBROSIS
SilicosisStages:
– diffuse reticular fibrosis (often clinically silent)
– silicotic nodules (+ perifocal emphysema)
– massive fibrosis
Silicosis
Silicosis gr. II
Silicosis – silica crystals (polarised light)
Silicosis
Complications:
pulmonary fibrosis
pulmonary hypertension
cor pulmonale
Cause of death
cardiorespiratory insuffitiency
Hypertrophia
excentrica ventriculi
dx. cordis
Coal Workers
Pneumoconiosis - CWP -
miners´disease
Coal macules- dust laden macrophages
Coal nodules – mild collagen admixture
Advanced
Combined silicosis & anthracosis
complicated often with tbc
AsbestosisDef.:
pneumoconiosis caused by Asbestos fibrils with pronounced fibrotising response
CONIOFIBROSIS
Asbestosfibrillar mineral with various forms and
fibrogenic capacity chrysotile (90%), amosite, croccydolite
etc.
AsbestosisPathogenesis:
toxic influence due to fibrils size and
concentration
fibrosis with feruginous bodies
hyalin pleural plaques
risk of mesotelioma and lung carcinoma and GIT
malignancies (Carlos Bedrossian-Venice 2006)
pleural effusions („mesot. in situ“ – Bedrosjan 2004)
other neoplasias?
Fibrous pleural plaque – marker of possible asbestosis!
Hyalinosis pleurae
Asbestosis
Asbestosis
Asbestosis
Hyalinosis pleuraeMesothelioma
Mesothelioma
Ca bronchogenes
Hyalinosis et metastases
carcinomatosae pleurae
parietalis
Asbestos is banned in most Western countries but related malignancies are still of clinical concern because of their long latencies.
The retrospective assessment of exposure - questionnaires and collection of medical history.
Fibers and asbestos bodies are counted in lung tissue, broncho-alveolar lavage, and sputum.
The etiology of lung cancer is difficult to define in cases of low-level asbestos exposure and concurrent smoking habits.
MESOTHELIOMA: The diagnosis difficult, because of sampling, fixation, and processing, and uses of immunohistochemical probes.
Assessment of exposure is crucial
Given the premise that asbestosis is necessary to causally link lung cancer to asbestos, it follows that the assessment of both lung fibrosis and asbestos body burden is necessary.
Lotti M, Bergamo L, Murer B.
Occupational toxicology of asbestos-related malignancies.
Clin Toxicol (Phila). 2010 Jul;48(6):485-96.
Park EK, Takahashi K, Jiang Y, Movahed M, Kameda T.:
Elimination of asbestos use and asbestos-related
diseases: An unfinished story.Cancer Sci. 2012 Oct;103(10):1751-5.
Asbestos - a proven human carcinogen.
Asbestos-related diseases (ARDs):
– lung cancer,
– malignant mesothelioma,
– asbestosis,
– pleural plaques, thickening and effusion.
The WHO and the International Labour Organization have called on
countries to stop using asbestos.
ARDs are increasing and asbestos use is continuing in the world.
Industrializing countries are faced with a myriad of forces prompting
them to continue using asbestos.
Full-scale international cooperation will thus be needed to achieve the
goal of eliminating ARDs.
Ultrastruct Pathol. 2014 Sep 30:1-6. [Epub ahead of print]
Electron Microscopy Remains the Gold
Standard for the Diagnosis of Epithelial
Malignant Mesothelioma: A Case Study.Oczypok EA, Oury TD.
Department of Pathology, University of Pittsburgh School of Medicine , Pittsburgh, PA , USA.
carcinoma
Mesothelioma
Mesothelioma
Emri SA:
The Cappadocia mesothelioma epidemic: its
influence in Turkey and abroad Ann Transl Med. 2017 Jun;5(11):239.
In three Cappadocian villages, Karain, Tuzkoy and
"old" Sarihidir, about 50% of all deaths (including
neonatal deaths and traffic fatalities) have been
caused by mesothelioma.
the epidemic linked to erionite exposure
interaction between genetic predisposition and
environmental exposure
carriers of germline BAP1 mutations have a very high
risk of developing mesothelioma and other
malignancies.
According to the most recent World
Health Organization (WHO) estimates, more than 107 000
people die each year from asbestos-related lung cancer,
mesothelioma, and asbestosis resulting from exposure at
work (1). The asbestos epidemic is far from over.
http://www2.epa.gov/asbestos
Pneumoconioses– coniosis simplex
(anthracosis, mild siderosis)
– coniofibrosis (silicosis, asbestosis, coal workers
disease, severe siderosis)
---------------------– coniotoxicosis conioalergosis
(byssinosis, berylliosis,….)organic „dusts“
Coniotoxicosis Conioalergosis
- diff. dg. to Coniofibroses
Berylliosis
• acute - toxic pneumonitis
• chronic – non caseating granulomas
Byssinosis – cotton dust
Farmer´s lung – moldy hay, actinomycetes,
Bird fanciers disease - bird feather dust
(dif. dg. chlamydophilla psittaci inf.)
Fibrosis pulmonum intersticialis
Hypertrophia excentrica
ventriculi dx. cordis
COR PULMONALE
decompensatum
Sergio Pin˜a-Oviedo, Carlos Ortiz-Hidalgo, Alberto G. Ayala Houston, Texas:
Human Colors—The Rainbow Garden of PathologyWhat Gives Normal and Pathologic Tissues Their Color?
Colors are important to all biologic organisms (that is, microorganisms,
plants, and animals, because they are crucial for camouflage and
protection, metabolism, sexual behavior, and communication.
Coloration of organisms results from the production of molecules
derived from cyclic compounds.
Because cells are microscopic and colorless as single units, they result
in a given color only when they accumulate in millions.
Unhealthy and/or neoplastic tissues usually retain the color of the cells
from which they derive but may also exhibit completely different color
characteristics.
Arch Pathol Lab Med, 2017, 141, 445-462
Sergio Pin˜a-Oviedo, Carlos Ortiz-Hidalgo, Alberto G. Ayala:
Human Colors—The Rainbow Garden of PathologyWhat Gives Normal and Pathologic Tissues Their Color?
Arch Pathol Lab Med, 2017, 141, 445-462
Melanins derived from the
metabolism of tyrosine
converted to
dihydroxyphenylalanine
(DOPA) and
dopaquinone
3 forms:
neuromelanin (B),
eumelanin (both
brown-black) (C), and
pheomelanin (golden
yellow-red) .
Sergio Pin˜a-Oviedo, Carlos Ortiz-Hidalgo, Alberto G. Ayala:
Human Colors—The Rainbow Garden of PathologyWhat Gives Normal and Pathologic Tissues Their Color?
Arch Pathol Lab Med, 2017, 141, 445-462
Lipofuscin derived from the
oxidation of lipids
wear and tear pigment
accumulates with age
predominantly in the
heart, liver, retina, and
brain
often undetectable
macroscopically
A. PAS+ in cardiomyocytes
B. Autofluorescence in a
neuron
C. & D. Melanosis coli in
excessive use of laxativesnormal
color
Sergio Pin˜a-Oviedo, Carlos Ortiz-Hidalgo, Alberto G. Ayala:
Human Colors—The Rainbow Garden of PathologyWhat Gives Normal and Pathologic Tissues Their Color?
Arch Pathol Lab Med, 2017, 141, 445-462
Breast RCC
Liposarcoma
Lipoma
Schwannoma
Adrenocortical
adenoma
Carotenes are unsaturated hydrocarbons
chemically derived from isopentenyl
pyrophosphate and terpenes
include carotenes, lycopenes, and
xanthines.
Carotenes are fatsoluble molecules that
can produce all the colors of the visible
spectrum (purple, blue, green, yellow,
orange, and red) and are synthesized only
by plants.
Animals are unable to produce carotenes
and can only obtain them from their diet.
Because carotenes are lipophilic, they
associate with lipid-rich tissues.
Carotenemia (or xanthoderma) and
lycopenemia occurs after excessive
consumption of carrots, tomatoes, or
beets
Sergio Pin˜a-Oviedo, Carlos Ortiz-Hidalgo, Alberto G. Ayala:
Human Colors—The Rainbow Garden of PathologyWhat Gives Normal and Pathologic Tissues Their Color?
Arch Pathol Lab Med, 2017, 141, 445-462
Cytochromes, the
Heme Group, Iron,
and Bile PigmentsPyrroles are heterocyclic
aromatic molecules composed
of a ring of 4 carbon atoms
and one nitrogen atom
(C4H5N).
Assembly of 4 pyrrole rings
forms the tetrapyrrole ring
protoporphyrin, a precursor of
several organic molecules.
Cytochromes mainly in
mitochondria & SER – liver
and kidney
Hemoglobin (Hb) gives all organs a pink-red or dark-red hue, depending on the volume of circulating blood and oxygen
(O2) concentration.
Congested blood in a small bowel infarct (F), and in a liver cavernous hemangioma (G) gives these tissues dark purple
color (deoxygenated Hb). Myoglobin is a main component in skeletal (I) and cardiac muscle (J). The color of organs also
results from the combination of cytochromes and Hb (spleen) (K) or myoglobin (heart) (J).
Sergio Pin˜a-Oviedo, Carlos Ortiz-Hidalgo, Alberto G. Ayala:
Human Colors—The Rainbow Garden of PathologyWhat Gives Normal and Pathologic Tissues Their Color?
Arch Pathol Lab Med, 2017, 141, 445-462
Methemoglobin – Fe3 - brown
Formalin turns Hb into hematin – blue-brown-gray
Plasmodia metabolize Hb into hemozoin
Biliverdin & bilirubin – yellow, greenish after oxidation.
Molecules
related to heme
groups
Sergio Pin˜a-Oviedo, Carlos Ortiz-Hidalgo, Alberto G. Ayala:
Human Colors—The Rainbow Garden of PathologyWhat Gives Normal and Pathologic Tissues Their Color?
Arch Pathol Lab Med, 2017, 141, 445-462
lung small bowel
Sergio Pin˜a-Oviedo, Carlos Ortiz-Hidalgo, Alberto G. Ayala:
Human Colors—The Rainbow Garden of PathologyWhat Gives Normal and Pathologic Tissues Their Color?
Arch Pathol Lab Med, 2017, 141, 445-462
Like eggshells, mammalian bones
and enamel are white because they
are mostly composed of CaPO4 .
Soft tissues (collagen), epithelia,
myelin, platelets, and leukocytes
lack color because:
they can not absorb carotenes
do not have enough
cytochromes
possess high content of DNA
(intrinsically white) in cells with
high n/c ratio
they are avascular/ or
minimally supplied
do not possess melanin,
lipofuscin
Type I collagen is the most
abundant protein in animal soft
tissues and is composed of banded
fibers (tropocollagens) with a
transverse periodicity.
Bone, cartilage, tendons, fasciae,
aponeuroses, the eye sclerae, the
tunica albuginea, and corpus
albicans