RUBIN PATHOLOGY CELL INJURY

1 Bone marrow cells from an organ donor are cultured in vitro at 37°C in the presence of recombinant erythropoietin. A photomicrograph of a typical “burst-forming unit” is shown in the image. This colony, committed to the erythrocyte pathway of differentiation, represents an example of which of the following physiologic adaptations to transmembrane signaling?

2 A 50-year-old chronic alcoholic presents to the emergency room with 12 hours of severe abdominal pain. The pain radiates to the back and is associated with an urge to vomit. Physical examination discloses exquisite abdominal tenderness. Laboratory studies show elevated serum amylase. Which of the following morphologic changes would be expected in the peripancreatic tissue of this patient?

A 68-year-old man with a history of gastroesophageal reflux disease suffers a massive stroke and expires. The esophagus at autopsy is shown in the image. Histologic examination of the abnormal tissue shows intestine-like epithelium composed of goblet cells and surface cells similar to those of incompletely intestinalized gastric mucosa. There is no evidence of nuclear atypia. Which of the following terms best describes this morphologic response to persistent injury in the esophagus of this patient?

A CT scan of a 43-year-old woman with a parathyroid adenoma and hyperparathyroidism reveals extensive calcium deposits in the lungs and kidney parenchyma. These radiologic findings are best explained by which of the following mechanisms of disease?

A 75-year-old woman with Alzheimer disease dies of congestive heart failure. The brain at autopsy is shown in the image. This patient’s brain exemplifi es which of the following responses to chronic injury?

A 68-year-old woman with a history of heavy smoking and repeated bouts of pneumonia presents with a 2-week history of fever and productive cough. A chest X-ray reveals a right lower lobe infi ltrate. A transbronchial biopsy confi rms pneumonia and further demonstrates preneoplastic changes within the bronchial mucosa. Which of the following best characterizes the morphology of this bronchial mucosal lesion?

A 64-year-old man with long-standing angina pectoris and arterial hypertension dies of spontaneous intracerebral hemorrhage. At autopsy, the heart appears globoid. The left ventricle measures 2.8 cm on cross section (shown in the image). This adaptation to chronic injury was mediated primarily by changes in the intracellular concentration of which of the following components?

A 24-year-old woman contracts toxoplasmosis during her pregnancy and delivers a neonate at 37 weeks of gestation with a severe malformation of the central nervous system. MRI studies of the neonate reveal porencephaly and hydrocephalus. An X-ray film of the head shows irregular densities in the basal ganglia. These X-ray findings are best explained by which of the following mechanisms of disease?

A 30-year-old man with AIDS-dementia complex develops acute pneumonia and dies of respiratory insufficiency. At autopsy, many central nervous system neurons display hydropic degeneration. This manifestation of sublethal neuronal injury was most likely mediated by impairment of which of the following cellular processes?

A 62-year-old man is brought to the emergency room in a disoriented state. Physical examination reveals jaundice, splenomegaly, and ascites. Serum levels of ALT, AST, alkaline phosphatase, and bilirubin are all elevated. A liver biopsy demonstrates alcoholic hepatitis with Mallory bodies. These cytoplasmic structures are composed of interwoven bundles of which of the following proteins?

A 65-year-old man suffers a heart attack and expires. Examination of the lungs at autopsy reveals numerous pigmented nodules scattered throughout the parenchyma (shown in the image). What is the appropriate diagnosis?

A 32-year-old woman with poorly controlled diabetes mellitus delivers a healthy boy at 38 weeks of gestation. As a result of maternal hyperglycemia during pregnancy, pancreatic islets in the neonate would be expected to show which of the following morphologic responses to injury?

A 59-year-old female alcoholic is brought to the emergency room with a fever (38.7°C/103°F) and foul-smelling breath. The patient subsequently develops acute bronchopneumonia and dies of respiratory insufficiency. A pulmonary abscess is identified at autopsy (shown in the image). Histologic examination of the wall of this lesion would most likely demonstrate which of the following pathologic changes?

A 20-year-old man from China is evaluated for persistent cough, night sweats, low-grade fever, and general malaise. A chest X-ray reveals fi ndings “consistent with a Ghon complex.” Sputum cultures grow acid-fast bacilli. Examination of hilar lymph nodes in this patient would most likely demonstrate which of the following pathologic changes?

A 31-year-old woman complains of increased vaginal discharge of 1-month duration. A cervical Pap smear is shown in the image. Superfi cial epithelial cells are identifi ed with arrows. When compared to cells from the deeper intermediate layer (top), the nuclei of these superfi cial cells exhibit which of the following cytologic features?

A 30-year-old woman suffers a tonic-clonic seizure and presents with delirium and hydrophobia. The patient states that she was bitten on the hand by a bat about 1 month ago. The patient subsequently dies of respiratory failure. Viral particles are found throughout the brainstem and cerebellum at autopsy. In addition to direct viral cytotoxicity, the necrosis of virally infected neurons in this patient was mediated primarily by which of the following mechanisms?

A 52-year-old woman loses her right kidney following an automobile accident. A CT scan of the abdomen 2 years later shows marked enlargement of the left kidney. The renal enlargement is an example of which of the following adaptations?

An 82-year-old man has profound bleeding from a peptic ulcer and dies of hypovolemic shock. The liver at autopsy displays centrilobular necrosis. Compared to viable hepatocytes, the necrotic cells contain higher intracellular concentrations of which of the following?

A 28-year-old woman is pinned by falling debris during a hurricane. An X-ray fi lm of the leg reveals a compound fracture of the right tibia. The leg is immobilized in a cast for 6 weeks. When the cast is removed, the patient notices that her right leg is weak and visibly smaller in circumference than the left leg. Which of the following terms best describes this change in the patient’s leg muscle?

A 70-year-old man is hospitalized after suffering a mild stroke. While in the hospital, he suddenly develops crushing substernal chest pain. Analysis of serum proteins and ECG confirm a diagnosis of acute myocardial infarction. The patient subsequently develops an arrhythmia and expires. A cross section of the left ventricle at autopsy is shown in the image. Histologic examination of the affected heart muscle would demonstrate which of the following morphologic changes?

Which of the following histologic features would provide definitive evidence of necrosis in the myocardium of the patient described in Question 20?

A 90-year-old woman with mild diabetes and Alzheimer disease dies in her sleep. At autopsy, hepatocytes are noted to contain golden cytoplasmic granules that do not stain with Prussian blue. Which of the following best accounts for pigment accumulation in the liver of this patient?

Which of the following mechanisms of disease best describes the pathogenesis of pigment accumulation in hepatocytes in the patient described in Question 22?

A 45-year-old man presents with increasing abdominal girth and yellow discoloration of his skin and sclera. Physical examination reveals hepatomegaly and jaundice. A Prussian blue stain of a liver biopsy is shown in the image. What is the major intracellular iron storage protein in this patient’s hepatocytes?

A 60-year-old man with chronic cystitis complains of urinary frequency and pelvic discomfort. Digital rectal examination is unremarkable. Biopsy of the bladder mucosa reveals foci of glandular epithelium and chronic infl ammatory cells. No cytologic signs of atypia or malignancy are observed. Which of the following terms best describes the morphologic response to chronic injury in this patient?

A 60-year-old man is rushed to the hospital with acute liver failure. He undergoes successful orthotopic liver transplantation; however, the transplanted liver does not produce much bile for the first 3 days. Poor graft function in this patient is thought to be the result of “reperfusion injury.” Which of the following substances was the most likely cause of reperfusion injury in this patient’s transplanted liver?

A 68-year-old woman with a history of hyperlipidemia dies of cardiac arrhythmia following a massive heart attack. Peroxidation of which of the following molecules was primarily responsible for causing the loss of membrane integrity in cardiac myocytes in this patient?

A 22-year-old construction worker sticks himself with a sharp, rusty nail. Within 24 hours, the wound has enlarged to become a 1-cm sore that drains thick, purulent material. This skin wound illustrates which of the following morphologic types of necrosis? (E) Liquefactive necrosis

A 42-year-old man undergoes liver biopsy for evaluation of the grade and stage of his hepatitis C virus infection. The biopsy reveals swollen (ballooned) hepatocytes and moderate lobular inflammatory activity (shown in the image). The arrow identi- fies an acidophilic (Councilman) body. Which of the following cellular processes best accounts for the presence of scattered acidophilic bodies in this liver biopsy?

Which of the following biochemical changes characterizes the formation of acidophilic bodies in the patient described in Question 29?

A 56-year-old woman with a history of hyperlipidemia and hypertension develops progressive, right renal artery stenosis. Over time, this patient’s right kidney is likely to demonstrate which of the following morphologic adaptations to partial ischemia?

A 5-year-old boy suffers blunt trauma to the leg in an automobile accident. Six months later, bone trabeculae have formed within the striated skeletal muscle at the site of tissue injury. This pathologic condition is an example of which of the following morphologic adaptations to injury?

A 43-year-old man presents with a scaly, erythematous lesion on the dorsal surface of his left hand. A skin biopsy reveals atypical keratinocytes fi lling the entire thickness of the epidermis (shown in the image). The arrows point to apoptotic bodies. Which of the following proteins plays the most important role in mediating programmed cell death in this patient’s skin cancer?

A 16-year-old girl with a history of suicidal depression swallows a commercial solvent. A liver biopsy is performed to assess the degree of damage to the hepatic parenchyma. Histologic examination demonstrates severe swelling of the centrilobular hepatocytes (shown in the image). Which of the following mechanisms of disease best accounts for the reversible changes noted in this liver biopsy

A 40-year-old man is pulled from the ocean after a boating accident and resuscitated. Six hours later, the patient develops acute renal failure. Kidney biopsy reveals evidence of karyorrhexis and karyolysis in renal tubular epithelial cells. Which of the following biochemical events preceded these pathologic changes

A 58-year-old man presents with symptoms of acute renal failure. His blood pressure is 220/130 mm Hg (malignant hypertension). While in the emergency room, the patient suffers a stroke and expires. Microscopic examination of the kidney at autopsy is shown in the image. Which of the following morphologic changes accounts for the red material in the wall of the artery?

A 10-year-old girl presents with advanced features of progeria (patient shown in the image). This child has inherited mutations in the gene that encodes which of the following types of intracellular proteins?

A 32-year-old woman develops an Addisonian crisis (acute adrenal insuffi ciency) 3 months after suffering massive hemorrhage during the delivery of her baby. A CT scan of the abdomen shows small adrenal glands. Which of the following mechanisms of disease best accounts for adrenal atrophy in this patient?

A 47-year-old man with a history of heavy smoking complains of chronic cough. A “coin lesion” is discovered in his right upper lobe on chest X-ray. Bronchoscopy and biopsy fail to identify a mass, but the bronchial mucosa displays squamous metaplasia. What is the most likely outcome of this morphologic adaptation if the patient stops smoking?