A 48-year-old male with a history of chronic

alcoholism who is continuing to perform

adequately on the job will most often have
which of the following findings in liver:
A Cholestasis
B Fatty change
C Hemochromatosis
D Hypertrophy of smooth endoplasmic
reticulum
E Coagulative necrosis

After years of breathing dirty city air,

your lungs have accumulated:
A Anthracotic pigment
B Lipofuscin
C Melanin
D Hemosiderin
E Biliverdin

The presence of squamous epithelium in

the lower trachea of a 42-year-old female
with a history of smoking is called:
A Dysplasia
B Aplasia
C Anaplasia
D Hyperplasia
E Metaplasia

The light brown perinuclear pigment seen on

H&E staining of the cardiac muscle fibers in
the heart of an 80 year old male is:
A Hemosiderin resulting from iron overload
B Lipochrome from "wear and tear"
C Glycogen resulting from a storage disease
D Cholesterol as a consequence of
atherosclerosis
E Calcium deposition following necrosis

Hypertrophy is best illustrated by:

A The uterine myometrium in
pregnancy
B The female breast at puberty
C The liver following partial resection
D The ovary following menopause
E The cervix with chronic inflammation

A 40-year-old schizophrenic male drank a

pint of Geritol (containing vitamins with
iron) each day for 20 years. His liver would
most likely show:
A Severe fatty change
B Coagulative necrosis
C Hemochromatosis
D Anthracosis
E Sphingolipidosis

As a physician, you should be concerned about a

surgical pathology report that describes
"metaplasia" in a biopsy because:
A This change indicates irreversible tissue damage
B It may be due to an irritant that can be avoided
C The patient will probably develop hyperplasia
D The etiology is probably a viral infection that can
be treated
E The patient will probably develop a dysplasia

DR EJAZ WARIS,FCPS (Histopathology )

ASSISTANT PROF HISTOPATHOLOGY,FMHC.

Greek word (Meaning - Falling off)

Apoptosis, or programmed cell death, is
a highly regulated process that allows a
cell to self-degrade in order for the
body to eliminate unwanted or
dysfunctional cells

During apoptosis, the genome of the

cell will fracture, the cell will shrink and
part of the cell will disintegrate into
smaller apoptotic bodies.

Unlike necrosis, where the cell dies by

swelling and bursting its content in the
area, which causes an inflammatory
response, apoptosis is a very clean and
controlled process where the content of
the cell is kept strictly within the cell
membrane as it is degraded

The apoptotic cell will be phagocytosed

by macrophages before the cells
contents have a chance to leak into the
neighbourhood .Therefore, apoptosis
can prevent unnecessary inflammatory
response.

Apoptosis is essential to embryonic

development and the maintenance of
homeostasis in multicellular organisms.
In humans, for example, the rate of
cell growth and cell death is balanced
to maintain the weight of the body.

During fetal development, cell death helps

sculpt body shape, separating digits and
making the right neuronal connections.
In the immune system, cell death
eliminates B cells and T cells that elicit
autoimmune response and selects the most
efficient lymphocytes to encounter an
antigen in the process of affinity
maturation.

Physiologic :
i. Embryogenesis: organogenesis and
development
ii. Hormone dependent apoptosis
(menstrual cycle)
iii. Thymus: selectivedeath of
lymphocytes

i. Pathologic :
i. Viral diseases:viral hepatitis
(Councilman body)
ii. Graft versus host disease
iii. Cystic fibrosis: duct obstruction and
pancreatic atrophy

i. Cell shrinks in size and has dense

eosinophilic cytoplasm
ii. Nuclear chromatin condensation followed by
fragmentation
iii. Formation of cytoplasmic membrane blebs
iv. Breakdown of the cell into fragments
(apoptotic bodies)
v. Phagocytosis of apoptotic bodies by
adjacent cells or macrophages
vi. A lack of an inflammatory response

A)Protein cleavage
B)DNA Breakdown
C)Phagocytic recognition

Initiation & Execution

Initiation can be triggered in a cell
through either the extrinsic pathway or
the intrinsic pathway.

The extrinsic pathway is initiated

through the stimulation of the
transmembrane death receptors, such
as the Fas receptors, located on the cell
membrane.
In contrast, the intrinsic pathway is
initiated through the release of signal
factors by mitochondria within the cell.

Promoting apoptosis : BAX,BAK,BIM,p53

Inhibiting apoptosis : BCL-2 family

DNA damage mediated apoptosis

Cytotoxic T-lymphocyte mediated

apoptosis