PATHOLOGIC CALCIFICATION.pdf of pathology

Patho note

1. Dr.RamThapa
Pathologist

2. Abnormal tissue deposition of calcium salts
Along with the calcium, magnesium, iron and other
mineral salts are also deposited.

3. 1.DYSTROPHIC CALCIFICATION
2.METASTATIC CALCIFICATION

4. When the deposition occurs in dying tissue/
degenerated tissue
Normal serum levels of calcium
Absence of derangement of calcium metabolism
Occurs in areas of necrosis→coagulative, caseous,
liquefactiveor in enzymatic necrosis of fat

5. Aortic valve in heart with
calcificaortic stenosis
Occurs in atheromasof
atherosclerosis
In aging or damaged heart
valves
Grossly:
fine, white granules or
clumps, often felt as gritty
deposits
DYSTROPHIC CALCIFICATION

6. Histolgically:
the calcium salts have a basophilic, amorphous
granular, sometimes clumped, appearance
can be intracellular, extracellular, or in both
locations.
Heterotopicbone formation may occur

7. Psammomabodies:-The progressive
acquisition of outer layers may create
lamellatedconfigurations.
Asbestos bodies:-calcium and iron salts gather
about long slender spiculescreating exotic,
beaded dumbbell shape and found asbestos in
the lung,

8. DYSTROPHIC CALCIFICATION

9. Single necrotic cells as seed crystal
progressive acquisition by the
mineral deposits in outer layer
lamellated configurations
Psammoma bodies

10. crystalline calcium phosphate mineral
in the form of an apatite similar to the
hydroxyapatite of bone.
Intracellular/
extracellular

11. EXTRACELLULAR
•Phospholipids in membrane
bound vesicles
•Dead & dying cells

12. INITIATION:-
➢Following cell injury (i.e. degeneration or
necrosis), there is membrane damage and
release of membrane phospholipids.
➢Phosphatases associated with phospholipids
generate phosphate ions.
➢there is excess uptake of calcium by injured
mitochondria in degeneration and necrosis.
➢ calcium and phosphate so generated
➢form precipitates of calcium phosphate.
PATHOGENESIS OF DYSTROPHIC
CALCIFICATION

13. Ca
2+
ion binds to the
phospholipids present
in the vesicle
membrane
phosphatases associated with
the membrane generate
phosphate groups, which bind
to the calcium
the cycle of calcium and
phosphate binding is
repeated
structural change occurs in
the arrangement of calcium
and phosphate groups
microcrystal
CALCIFICATION

15. CAUSES OF HYPERCALCAEMIA:
1.↑
ed
secretion of parathyroid hormone (PTH) with
subsequent bone resorption. Eg. In
hyperparathyroidism due to parathyroid tumors, and
ectopic secretion of PTH-related protein by malignant
tumors
2.Destruction of bone tissue:
→primary tumorsof bone marrow (e.g., multiple myeloma,
leukemia) or
→diffuse skeletal metastasis (e.g., breast cancer), accelerated
bone turnover (e.g., Paget disease), or
→immobilization;

16. 3)Vitamin D-related disorders:
→vitamin D intoxication,
→sarcoidosis (in which macrophages activate a
vitamin D precursor), and
→idiopathic hypercalcemia of infancy (Williams
syndrome), characterized by abnormal sensitivity to
vitamin D;
4) Renal failure →retention of Po4 →secondary
hyperparathyroidism

17. 5) aluminumintoxication, which occurs in patients on
chronic renal dialysis, and
6) milk-alkali syndrome, which is due to excessive
ingestion of calcium and absorbable antacids such as
milk or calcium carbonate.

18. SITE:
Interstitial tissues of
gastric mucosa,
kidneys,
lungs,
systemic arteries, and
pulmonary veins

19. occurs due to excessive binding of inorganic
phosphate ions with elevated calcium ions
due to underlying metabolic derangement.
precipitates of calcium phosphate at the
preferential sites, due to presence of acid
secretions or rapid changes in pH levels
Metastatic calcification is reversible upon
correction of underlying metabolic disorder.

20. Clinically,
mild deposition →asymptomatic
massive deposition→
lung-respiratory problems
kidney-“nephrocalcinosis”

22. THANK U !