Hyalinosis

(as a type of stromal-vascular dystrophy).

(according to V.V. Serov, M.A. Paltsev)

Stromal-vascular (mesenchymal) dystrophies develop as a result of metabolic disorders in connective tissue and are detected in the stroma of organs and the walls of blood vessels.

• Characterized accumulation in the tissues of translucent dense masses resembling hyaline cartilage.
• Occurs as a result of fibrinoid swelling, plasmorrhagia, sclerosis, necrosis.
• Hyaline - complex fibrillar protein.
• The mechanism of hyaline formation consists of destruction of fibrous structures and their impregnation with fibrin and other plasma components(globulins, beta-lipoproteins, immune complexes, etc.).

Allocate hyalinosis of the connective tissue proper and hyalinosis of the vessels; both of these types of hyalinosis can be widespread and local.

An example of local hyalinosis of the connective tissue itself, which developed as a result of mucoid swelling and fibrinoid changes, is hyalinosis of the cusps of the heart valves in rheumatism (rheumatic heart disease).

Macroscopic picture: the heart is enlarged, the cavities of the ventricles are dilated. The leaflets of the mitral valve are dense, whitish in color, fused together and sharply deformed. The atrioventricular orifice is narrowed. Chordal filaments are thickened and shortened.

There are 3 types of vascular hyaline:

A) simple hyaline- occurs due to plasmorrhagia of unchanged plasma components (more common in hypertension, atherosclerosis);

b) lipogyalin — contains lipids and beta-lipoproteins (most characteristic of diabetes mellitus);

V) complex hyaline- is built from immune complexes, fibrin and collapsing structures (typical for diseases with immunopathological disorders, such as rheumatic diseases).

• Common hyalinosis of arterioles occurs with hypertension and diabetes as the outcome of plasmorrhagia.
• In hypertension due to hyalinosis of arterioles, arteriolosclerotic nephrosclerosis develops, or primary wrinkled kidneys: small dense kidneys with a fine-grained surface and a sharply thinned cortical layer.

Widespread hyalinosis of small vessels (mainly arterioles) underlies diabetic microangiopathy.

Hyalinosis

At hyalinosis(from Greek. hyalos- transparent, vitreous), or hyaline dystrophy, homogeneous translucent dense masses (hyaline) resembling hyaline cartilage are formed in the connective tissue. The tissue thickens, so hyalinosis is also considered as a type of sclerosis.

Hyaline is a fibrillar protein. Immunohistochemical examination reveals not only plasma proteins, fibrin, but also components of immune complexes (immunoglobulins, complement fractions), as well as lipids. Hyaline masses are resistant to acids, alkalis, enzymes, PAS-positive, well accept acid dyes (eosin, acid fuchsin), picrofuchsin stains yellow or red.

Mechanism hyalinosis is difficult. Leading in its development are the destruction of fibrous structures and an increase in tissue-vascular permeability (plasmorrhagia) due to angioedema (dyscirculatory), metabolic and immunopathological processes. Associated with plasmorrhagia is the impregnation of tissue with plasma proteins and their adsorption on altered fibrous structures, followed by precipitation and the formation of a protein, hyaline. Smooth muscle cells take part in the formation of vascular hyaline. Hyalinosis can develop as a result of various processes: plasma impregnation, fibrinoid swelling (fibrinoid), inflammation, necrosis, sclerosis.

Classification. There are hyalinosis of the vessels and hyalinosis of the connective tissue itself. Each of them can be widespread (systemic) and local.

Hyalinosis of vessels. Hyalinosis is predominantly small arteries and arterioles. It is preceded by damage to the endothelium, its membrane and smooth muscle cells of the wall and its impregnation with blood plasma.

Hyaline is found in the subendothelial space, it pushes outward and destroys the elastic lamina, the middle membrane becomes thinner, in the final arterioles turn into thickened vitreous tubules with a sharply narrowed or completely closed lumen

Hyalinosis of the vessels of the spleen:

a - the wall of the central artery of the spleen follicle is represented by homogeneous masses of hyaline; b - fibrin among hyaline masses when stained according to the Weigert method; c - fixation of IgG immune complexes in hyaline (luminescence microscopy); d - masses of hyaline (G) in the arteriole wall; En - endothelium; Pr - lumen of the arteriole. electronogram.

Hyalinosis of small arteries and arterioles is systemic, but is most pronounced in the kidneys, brain, retina, pancreas, and skin. It is especially characteristic of hypertension and hypertensive conditions (hypertensive arteriological disease), diabetic microangiopathy (diabetic arteriological disease) and diseases with impaired immunity. As a physiological phenomenon, local arterial hyalinosis is observed in the spleen of adults and the elderly, reflecting the functional and morphological features of the spleen as an organ of blood deposition.

Vascular hyaline is a substance of a predominantly hematogenous nature. In its formation, not only hemodynamic and metabolic, but also immune mechanisms play a role. Guided by the peculiarities of the pathogenesis of vascular hyalinosis, 3 types of vascular hyaline are distinguished:

1) simple, arising from insudation of unchanged or slightly changed blood plasma components (more common in benign hypertension, atherosclerosis, and in healthy people);

2) lipogyalin, containing lipids and β-lipoproteins (found most often in diabetes mellitus);

3) complex hyaline, built from immune complexes, fibrin and collapsing structures of the vascular wall (typical for diseases with immunopathological disorders, such as rheumatic diseases).

Hyalinosis of the connective tissue proper. It usually develops as a result of fibrinoid swelling, leading to the destruction of collagen and impregnation of the tissue with plasma proteins and polysaccharides.

Microscopic examination. Swelling of connective tissue bundles is found, they lose their fibrillarity and merge into a homogeneous dense cartilage-like mass; cellular elements are compressed and undergo atrophy. This mechanism of development of systemic hyalinosis of the connective tissue is especially common in diseases with immune disorders (rheumatic diseases). Hyalinosis can complete fibrinoid changes in the bottom of a chronic stomach ulcer, in the appendix in appendicitis; it is similar to the mechanism of local hyalinosis in the focus of chronic inflammation.

Hyalinosis as an outcome of sclerosis is also mainly local in nature: it develops in scars, fibrous adhesions of serous cavities, the vascular wall in atherosclerosis, involutional sclerosis of the arteries, in the organization of a blood clot, in capsules, tumor stroma, etc. At the heart of hyalinosis in these cases are metabolic disorders of the connective tissue. A similar mechanism has hyalinosis of necrotic tissues and fibrinous overlays.

Appearance. With severe hyalinosis appearance organs change. Hyalinosis of small arteries and arterioles leads to atrophy, deformation and wrinkling of the organ (for example, the development of arteriolosclerotic nephrocyrrhosis).

With hyalinosis of the connective tissue itself, it becomes dense, whitish, translucent (for example, hyalinosis of the heart valves in rheumatic disease).

Exodus. In most cases, unfavorable, but resorption of hyaline masses is also possible. So, hyaline in scars - the so-called keloids - can be loosened and resorbed. Let us reverse the hyalinosis of the mammary gland, and the resorption of hyaline masses occurs under conditions of hyperfunction of the glands. Sometimes the hyalinized tissue becomes mucilaginous.

functional value. It varies depending on the location, degree and prevalence of hyalinosis. Widespread hyalinosis of arterioles can lead to functional insufficiency of the organ (renal failure in arteriolosclerotic nephrocyrrhosis). Local hyalinosis (for example, heart valves with its defect) can also be the cause of functional organ failure. But in scars, it may not cause much distress.

Topic 2. Stromal-vascular dystrophies

2.1. Stromal-vascular protein dystrophies (dysproteinoses)

2.1.3. Hyalinosis

At hyalinosis (from Greek. hyalos- transparent, vitreous), or hyaline dystrophy, homogeneous translucent dense masses (hyaline) resembling hyaline cartilage are formed in the connective tissue.

Hyaline is a fibrillar protein. Immunohistochemical examination reveals not only plasma proteins, fibrin, but also components of immune complexes (immunoglobulins, complement fractions), and sometimes lipids. Hyaline masses are resistant to acids, alkalis, enzymes, PAS-positive, well accept acid dyes (eosin, acid fuchsin), picrofuchsin stains yellow or red.

Hyalinosis may develop in the outcome different processes:

- plasma impregnation;
- fibrinoid swelling (fibrinoid);
-sclerosis.

Classification. Distinguish:

-hyalinosis of vessels;
-hyalinosis of connective tissue proper.

Each of the two types of hyalinosis can wear systemic and local character.

Hyalinosis of vessels. Hyalinosis is predominantly small arteries and arterioles. It is preceded by damage to the endothelium, basement membrane and smooth muscle cells of the vessel wall and its impregnation with blood plasma proteins.

Causes systemic hyalinosis of vessels:

-hypertonic disease;
-hypertensive conditions, hypertension (kidney disease, tumors of the endocrine and sex glands);
-diabetes (diabetic arteriological disease);
- rheumatic diseases;
-atherosclerosis.

The leading mechanisms in its development are:

-destruction of fibrous structures;
- increased vascular tissue permeability (plasmorrhagia).

Associated with plasmorrhagia is the impregnation of tissue with plasma proteins and their adsorption on altered fibrous structures, followed by precipitation and the formation of a protein, hyaline.

Hyalinosis of small arteries and arterioles is systemic, but is most pronounced in the kidneys, brain, retina, pancreas, and skin.

Microscopically, with hyalinosis, arterioles turn into thickened vitreous tubules with a sharply narrowed or completely closed lumen.

Guided by the peculiarities of the pathogenesis of vascular hyalinosis, 3 types of vascular hyaline are distinguished:

1) simple , arising from little-changed components of blood plasma (more common in benign hypertension, atherosclerosis and in healthy people);

2) lipogyalin , containing lipids and beta-lipoproteins (found most often in diabetes mellitus);

3) complex hyaline , built from immune complexes, fibrin and collapsing structures of the vascular wall (typical for diseases with immunopathological disorders, for example, for rheumatic diseases).

Local hyalinosis of the arteries as a physiological phenomenon observed in the spleen of adults and the elderly, reflecting the functional and morphological features of the spleen as an organ of blood deposition.

Exodus. In most cases, unfavorable, since the process is irreversible. Hyalinosis of small arteries and arterioles leads to atrophy, deformation and wrinkling of the organ (for example, the development of arteriolosclerotic nephrocyrrhosis).

Meaning. It varies depending on the location, degree and prevalence of hyalinosis. Widespread hyalinosis of arterioles can lead to functional insufficiency of the organ (renal failure in arteriolosclerotic nephrocyrrhosis). Fragility of blood vessels leads to the development of hemorrhages (for example, hemorrhagic stroke in hypertension).

Hyalinosis of connective tissue proper.

Systemic hyalinosis of connective tissue and blood vessels usually develops as a result of fibrinoid swelling, leading to the destruction of collagen and impregnation of the tissue with plasma proteins and polysaccharides. This mechanism of development of systemic hyalinosis of the connective tissue is especially common in diseases with immune disorders (rheumatic diseases).

Local hyalinosis as an outcome of sclerosis develops in scars, fibrous adhesions of serous cavities, vascular wall in atherosclerosis, involutional sclerosis of arteries, in the organization of a blood clot, infarction, healing of ulcers, wounds, in capsules, tumor stroma, etc. At the heart of hyalinosis in these cases are metabolic disorders of the connective tissue. A similar mechanism has hyalinosis of necrotic tissues and fibrinous deposits in the pleura, pericardium, etc. Hyalinosis can complete fibrinoid changes in the bottom of a chronic stomach ulcer, in the appendix in appendicitis.

Microscopic examination. Bundles of collagen fibers lose fibrillation and merge into a homogeneous dense cartilage-like mass; cellular elements are compressed and undergo atrophy.

macroscopic picture. With severe hyalinosis, the fibrous connective tissue becomes dense, cartilaginous, whitish, translucent.

Exodus. In most cases, unfavorable due to the irreversibility of the process, but resorption of hyaline masses is also possible. So, hyaline in scars - the so-called keloids - can be loosened and resorbed. Let us reverse the hyalinosis of the mammary gland, and the resorption of hyaline masses occurs under conditions of hyperfunction of the glands. Sometimes the hyalinized tissue becomes mucilaginous.

Meaning. It varies depending on the location, degree and prevalence of hyalinosis. Local hyalinosis can be the cause of functional organ failure. In scars, it may not cause any particular disturbance, with the exception of a cosmetic defect.

Hyalinosis is a proteinaceous extracellular dystrophy, which is characterized by the formation of homogeneous, translucent, dense masses resembling hyaline cartilage. This pathological process can manifest itself as an independent disease, or it can occur with the main ailment and be one of the symptoms of its severe course.

Dystrophy can spread and capture most tissues and organs of the human body. The disease occurs quite often in adults, regardless of gender. The reasons for the appearance have a different nature of origin.

The disease is diagnosed after a comprehensive study, and in severe cases of the disease, the prognosis is unfavorable.

Etiology

This pathological process is a collective concept that combines various biological processes.

The main causes of pathological processes in tissues or organs are:

• systemic diseases (diabetes, diseases of blood vessels, heart, joints);
• protein metabolism disorders.

Pathology can manifest itself in local form, and may affect the entire system.

Hyalinosis of the spleen capsule, as well as another form, causes destruction of the fibrous structures of the connective tissues, and also leads to changes:

• in metabolism;
• V immune system;
• impermeability of tissues is broken;
• causes accumulation of proteins;
• leads to an increase in the fibrous structure of tissues.

In the process of dystrophy, a hyaline-fibrillar protein is formed, which accumulates in tissues and is stable:

• to the effects of alkalis;
• not susceptible to oxidation;
• it is not affected by enzymes.

However, under the influence of eosin and fuchsin, it changes color to yellow or red.

The disease can be asymptomatic and not manifest in any way, or it can have a severe course and cause various disorders in the tissues or organs where it is localized. Excessive formation of hyaline causes compaction, pallor, and can lead to deformation changes and wrinkling of organs.

Classification

Pathology has two forms of existence in the connective tissue and blood vessels, it can be both local (focal) and systemic. The local character includes hyalinosis of the heart valves, which contributes to an increase in the organ, expands the ventricles, mitral valve becomes dense, with a whitish tint, deformed.

There are three types of vascular hyalinosis:

• simple - is formed due to the release of plasma from its channel due to the expansion and decrease in the density of the vascular walls, often this picture is observed at and;
• lipogyalin - its structure contains lipids and beta-lipoproteins, occurs with;
• complex - consists of immune complexes, fibrin and collapsing components, occurs in rheumatic immunological diseases.

The pathological process in the vessels develops due to an increase in blood pressure and a decrease in vascular permeability or with prolonged vasospasm.

Connective tissue pathology occurs after its damage and disorganization under the influence of immune complexes. It manifests itself in rheumatic lesions of the valves of the heart valves, their patency, mobility decreases, they become denser. The accumulation of a homogeneous substance causes an increase in the distance between cells.

Hyalinosis of the stroma is quite common. The stroma consists of connective tissue, which performs the supporting function of the supporting structures of the organ, and if it is damaged, the functional abilities and functioning of the organ are impaired.

The pathological process of serous membranes is one of the options for the outcome of fibrous inflammation, which is typical for,. In this case, fibrin is deposited on the membrane. Most often, hyalinosis of the spleen capsule is observed, which manifests itself locally, causes a milky-white thickening of the capsule: it seems to be covered with glaze. The same picture is observed in the liver, heart, lungs. The distance between the shell increases due to the accumulation of matter.

Symptoms

The signs of the disease will directly depend on the organ or tissues in which pathological processes are observed:

• vascular hyalinosis - patency and elasticity are impaired, bleeding, frequent headaches and inflammation are possible, vascular patency may be impaired, which reduces the supply of oxygen and nutrients to organs and tissues;
• pleural hyalinosis - causes a chronic process of lung adhesions due to a violation of protein metabolism or as a result of a tuberculosis disease, in this case pulmonary ventilation is limited, but when the process is mild, the course of the disease does not manifest itself;
• protein dystrophy in organs - causes their deformation and wrinkling, contributes to pain, sclerosis, partial loss of functionality, nutrition deteriorates and supply is disrupted useful substances and oxygen;
• pathology of the mammary gland - causes compaction and heaviness in the chest, can resolve itself and not cause any complications due to failures in protein formation;
• hyalinosis in the myoma - observed in inflammatory processes or tumor-like formations, can be manifested by painful sensations, secretions from the genital organs.

Local hyalinosis is amenable to therapeutic measures, while systemic hyalinosis has adverse consequences.

When hyalinosis of the spleen capsule appears, its functionality is most often violated, which leads to terrible consequences: blood flow, metabolism are disturbed, and infected blood cells are filtered.

In this case, a person experiences severe ailments, pain, bleeding occurs, immunity deteriorates.

Diagnostics

The diagnosis is made only after a comprehensive examination.

The patient is referred for the following studies:

• a general and biochemical blood test is given;
• urine is examined;
• appoint ultrasonography vessels, internal organs or fabrics;
• magnetic resonance imaging may be prescribed;
• smears are taken and ultrasound of the female genital organs is performed;
• x-ray studies of the lungs.

A macropreparation may have adhesions, seals, a whitish enveloping of the organ is observed. After research, the cause and type of the disease are established, and depending on the diagnosis, treatment will be prescribed.

Treatment

After establishing the main diagnosis, the doctor determines the tactics of therapeutic measures. First of all, the main pathological process is eliminated.

Improvements may be made to:

• spleen;
• hearts;
• vessels;
• liver;
• lungs.

In inflammatory processes, antibiotics and non-steroidal anti-inflammatory drugs are prescribed. In very severe cases, it is prescribed surgical intervention, which is aimed at eliminating the pathological process.

Possible Complications

Such a disease can be provoked by an existing disease, being one of its symptomatic manifestations and aggravating the clinical picture.

The consequences of the pathology are as follows:

• the functioning of organs, systems, tissues is disrupted;
• deformation occurs in the places of localization of hyalines;
• contributes to the appearance of heart disease, aggravation of diabetes, impaired vascular patency;
• causes inflammatory processes.

At the first deviations from the norm and the appearance of the above symptoms, you should contact the clinic for help, since hyalinosis of the spleen capsule, like any other form, leads to serious consequences.

Prevention

The best prevention is to lead a healthy lifestyle, timely treatment all diseases, proper nutrition and preventive medical examination.

Hyalinosis is one of the types of protein metabolism disorders. It leads to the accumulation in the tissues of homogeneous, dense and translucent masses of organic matter hyaline - a complex protein that is resistant to alkalis, acids, and enzymes.

What is hyalinosis

Hyalinosis is characterized by increased permeability of the vascular walls and tissues of the body, due to which they are impregnated with plasma proteins. Normally this should not be the case. As a result, the vessels narrow and become like dense tubes. The phenomenon is considered irreversible, however, in some cases, partial resorption of hyaline accumulations is possible.

Classification

There are three forms of pathology that differ in the mechanism of development and other features:

1. Hyalinosis of vessels. It develops when arterial pressure, and the walls become excessively permeable.
2. Connective tissue hyalinosis. This species occurs on the basis of mucoid or fibrinoid swelling, when tissue is impregnated with plasma proteins and polysaccharides;
3. Hyalinosis of the serous membranes. Its cause is the appearance on the surface of the shell of an organizing inflammatory fluid with a high content of fibrinogen.

By prevalence, hyalinosis is divided into:

• systemic (common);
• local.

At the same time, the pathology of the vessels and the connective tissue occurs in both variants, and the hyalinosis of the serous membranes is exclusively local.

Causes of the appearance of pathology

The reason for the development of pathology associated with the accumulation of hyaline in the vessels and tissues are:

• diabetes;
• diseases of the cardiovascular system;
• joint damage;
• violations of protein metabolism;
• inflammatory pathologies.

Vessel hyalinosis in most cases is systemic, but more often affects:

• structures of the kidneys;
• brain;
• organs of vision;
• pancreas;
• skin tissues.

It is one of the following:

• hypertension;
• diabetic lesions of microvessels;
• immune disorders.

Hyalinosis of the connective tissue occurs as a result of its violation due to the action of immune complexes. This happens, for example, with rheumatic changes in the valves of the heart.

Hyalinosis of the serous membranes is considered one of the likely outcomes of a fibrous inflammatory process, for example, when:

• peritonitis (inflammation of the peritoneum);
• pericarditis (inflammation of the pericardial sac);
• pleurisy (inflammation of the lung membranes).

Among the causes of hyalinosis are not only pathological, but also physiological processes that are considered the norm, for example, in an aging organism.

Symptoms

The set of signs of pathology is determined by the place of its localization:

1. Hyalinosis of the vessels narrows their lumen, impairs patency and reduces the elasticity of the wall, which is why bleeding and recurrent headaches are likely. Arteries with a broken structure lead to a deficiency of oxygen, as well as nutritional components in tissues and organs.
2. Hyalinosis of the pleura triggers adhesions in the lungs. Ventilation becomes worse, but when the disease proceeds in mild form the person doesn't notice it.
3. Hyalinosis, which affects the organs, leads to their deformation and sclerosis, as well as a partial loss of working capacity. Among other things, it causes discomfort and pain. So:
   • with symptoms of protein dystrophy in the mammary gland, the organ thickens, causing a feeling of heaviness;
   • with hyalinosis in the uterine myoma, it is manifested by pain in the lower abdomen, which is accompanied by discharge from the vagina.

In pathology affecting the capsule of the spleen, against the background of pain syndrome general malaise develops, bleeding is possible.

What is the danger

Hyalinosis is the result and one of the symptoms various diseases, therefore, its main danger is that it is able to aggravate the course of pathologies. As a result:

• the work of organs is disrupted;
• tissues are deformed in places of hyaline deposits;
• heart disease develops;
• the course of diabetes is aggravated;
• the patency of blood vessels worsens;
• inflammation develops.

Hyalinosis in pregnant women can lead to a halt in fetal development. This occurs when, due to pathology, blood clots form in the capillaries, through which oxygen and nutrition are delivered to the tissues. As a result, the blood flow is disturbed, and the embryo dies.

Hyalinosis in children can take dangerous forms. For example, there is an infantile variety of systemic hyalinosis, which is considered a rare but dangerous condition. Babies with this congenital pathology die before the age of two, and the survivors become severely disabled.

Diagnostics

Hyalinosis is detected after the complex diagnostic measures, which includes:

• general and biochemical analysis blood;
• urine test;
• ultrasound scanning of blood vessels, as well as organs and tissues;

Depending on the likely causes of the disease, the doctor may additionally prescribe:

• smears and ultrasound of the female genital organs;
• lung radiography.

According to the results of the diagnosis, the cause of hyalinosis and its variety are revealed, and then therapy is prescribed.

Treatment

The development of hyalinosis can be influenced in the process of eliminating the pathologies that have become its causes. So, in diseases of internal organs and systems, medicines to improve their performance. Inflammatory processes eliminated by antibacterial and non-steroidal anti-inflammatory drugs. As a radical measure in especially severe cases, a surgical method is used.

Forecast

The prognosis largely depends on the localization and degree of development of the process. For example, hyaline accumulations in scars are not dangerous for serious disorders and can be absorbed. The systemic variant of the disease, on the contrary, leads to serious malfunctions in the body and is dangerous with adverse consequences, as happens, for example, with rheumatic lesions, hypertension, diabetes and other diseases.

Hyalinosis is sometimes asymptomatic, so it is not immediately detected. To avoid illness and related disorders, it is recommended to healthy lifestyle life, periodically check health and timely treat identified pathologies.