PIGMENTATION

• Deposition of pigments within the cells and

tissues of the body.
• Pigments are coloured substances some
of which are normal constituents of cells
whereas others are produced abnormally.

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 TYPES OF PIGMENTS

Two Types:
• Exogenous – Coming from outside the cell
body. e.g. Carbon.
• Endogenous – Synthesized within the
body itself.

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EXOGENOUS PIGMENTATION

• Deposition of Exogenous Pigments.

• Examples:
 Anthracosis.
 Tattooing.

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EXOGENOUS PIGMENTATION (Contd.)
ANTHRACOSIS:
• Carbon or coal dust- most commonly found
air pollutant.
• Enters the body through inhalation.
• Picked up by macrophages within the lungs.
• Transported through lymphatic channel to the
regional lymph nodes.
• Causes chronic obstructive lung disease.

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EXOGENOUS PIGMENTATION (Contd.)

TATTOOING:
• Localized exogenous pigmentation of the skin
• Various coloured substances are injected into
the skin.
• Phagocytosed by the dermal macrophages.
• Reside for the remainder of life.
• Does not elicit any inflammatory response.

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 ENDOGENOUS PIGMENTATION
• Deposition of endogenously produced pigments.
• Endogenous Pigments:
 Two types:
 Non-Haemoglobin derived
 Lipofuscin
 Melanin
 Haemoglobin derived
 Haemosiderin
 Bilirubin
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ENDOGENOUS PIGMENTATION (Contd.)
LIPOFUSION PIGMENTATION:
• Derived from Latin word FUSCUS meaning brown.
• Also known as wear and tear or Aging pigment.
• Formed as a result of lipid peroxidation of poly
unsaturated lipids.
• Seen in cells undergoing slow regressive changes.
• Practically prominent in:
 Liver and hearts of aging person.
 Patients with severe malnutrition.
 Cancer patients.
• Appears microscopically as yellow brown fine
intracytoplasmic granules. 7
ENDOGENOUS PIGMENTATION (Contd.)
MELANIN PIGMENTATION:
• Derived from Greek word Melas meaning black.
• Produced in melanocytes.
• Oxidation of tyrosine by tyrosinase.
• Appears brown black.
• CONGENTIAL:
 Peutz-Jegher’s Syndrome
 Albright’s Syndrome
 Melanocytic Naevi
• ACQUIRED:
 Pregnancy – Melasma
 Lentigo senilis
 Lentigo maligna
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ENDOGENOUS PIGMENTATION (Contd.)

HAEMOSIDERIN PIGMENTATION:
• A Hb derived Iron containing pigment.
• Appears golden yellow to brown.
• Produced as a result of Iron excess.
• Haemosiderosis
• Two forms:
 Local
 Systemic
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ENDOGENOUS PIGMENTATION (Contd.)

HAEMOSIDERIN PIGMENTATION:
Local Haemosiderosis:
• Results from gross haemorrhages or
rupture of small vessels.
• Macrophages take up haemoglobin and
lysosomal enzymes convert it to
haemosiderin.
• Best example is local Bruise.
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ENDOGENOUS PIGMENTATION (Contd.)
HAEMOSIDERIN PIGMENTATION:
Systemic Haemosiderosis:
• Due to systemic overload of Iron as seen in:
 Increased absorption of dietary Iron.
 Impaired use of Iron.
 Excessive breakdown of RBCs.
 Multiple blood transfusion.
• Deposited in many organs and tissues like
lever, bone marrow, spleen, pancreas,
kidneys.
• Small amount – No damage.
• Large amount – Parenchymal damage
• Haemochromatosis. 11
ENDOGENOUS PIGMENTATION (Contd.)

BILIRUBIN PIGMENTATION:
• Hb derived pigment.
• Metabolized and detoxified in liver.
• Breakdown products are re-utilized in
RBC Synthesis.
• When liver function is disturbed due to
disease excess Bilirubin deposits.
• Jaundice.
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PATHOLOGIC CALCIFICATION

• Abnormal deposition of Calcium salts.

• Two types:
 Dystrophic Calcification.
 Metastatic Calcification.

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PATHOLOGIC CALCIFICATION (Contd.)

DYSTROPHIC CALCIFICATION:
• Occurs in nonviable or dying tissues
in the presence of normal serum
Calcium level.
• Pathogenesis involves two steps
 Initiation
 Propagation
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PATHOLOGIC CALCIFICATION (Contd.)

DYSTROPHIC CALCIFICATION:
Pathogenesis – Initiation
• Occurs extracellularly & intracellularly
• Extracellularly in membrane bound
vesicles derived from dead or dying cells.
• Acidic phospholipids in their membranes
attract Calcium salts.
• Phosphates accumulate as a result of
action of membrane bound phosphatases.
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PATHOLOGIC CALCIFICATION (Contd.)
DYSTROPHIC CALCIFICATION:
Pathogenesis – Initiation (Contd.):
• Normal cell membrane ensures low
concentration of Ca and PO4 in the cytosol.
• Following membrane damage Ca and PO4
enter cells.
• Taken up by mitochondria.
• Formation of hydroxyapatite crystals.
• Formation of Ca-Salts – reliable indicator of
impeding cell death.
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PATHOLOGIC CALCIFICATION (Contd.)
DYSTROPHIC CALCIFICATION:
Pathogenesis – Propagation:
• Facilitated by structural components of the
extracellular matrix.
• Matrix protein available in the dying tissue
as a result of cell injury and death also
contribute.
 Osteopontin – An acidic Ca binding
phosphoprotein
 Osteonectin – Ca binding protein that inhibits
cell spreading and migration 17
DYSTROPHIC CALCIFICATION (Contd.):

Examples:
• In the Caseous material of TB lesions.
• Areas of fat necrosis in the breast and mesentery.
• Haematomas.
• Old Scars.
• Atheroma.
• Degenerate colloid goiters.
• Degenerate tumours.

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DYSTROPHIC CALCIFICATION (Contd.):

MORPHOLOGY:
• Macroscopic:
 Appears as fine, white granules or clumps often
felt as gritty deposits.
• Microscopic:
 Appears as a basophilic, amorphous sometimes
clumped material intracellularly or extracellularly.
 Psammoma bodies – lamellated configuration.

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 METASTATIC CALCIFICATION

• Occurs in living tissues and is always

associated with hypercalcaemia.
• Caused by a disordered metabolism of Ca
and phosphate.
• Ca derived either from bone or excessive
absorption from gut.

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METASTATIC CALCIFICATION (Contd.)
CAUSES:
• Increased secretion of PTH.
 Parathyroid tumour.
 Ectopic secretion by other malignant tumours
like lung cancer.
• Destruction of bone tissue.
 Primary tumours of bone marrow – multiple
myeloma.
 Metastatic deposits of other tumours in bone.
 Vitamin D Excess
 Renal failure- Secondary hyperparathyroidism.
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METASTATIC CALCIFICATION (Contd.)

ORGANS INVOLVED:
• Kidneys – around the tubules.
• Lungs – in the alveolar walls.
• Stomach – around the fundal glands.
• Blood Vessels – internal elastic lamina.
• Ca deposits appear as amorphous
basophilic densities.
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Psommoma Bodies
 Dystrophic calcification in skeletal muscle

The green areas point to two

foci of dystrophic
calcification in this muscle
biopsy.
Dystrophic calcification is a
result of tissue necrosis.
Calcium salts get deposited
among necrotic cells,
resulting in the appearance
of white, chalky deposits on
gross examination, and
purple acellular lesions on
routine histology.
 Pathologic Calcification

Dystrophic (intracellular or Metastatic

extracellular)
Normal calcium level Increased calcium level
Abnormal tissue Normal tissue
Examples: Usually no clinical sequela (unless
Atherosclerosis , may involve valves massive)
Areas of necrosis

Must determine the cause of elevated

calcium:
1. Increased secretion of PTH
2. Increased destruction of bone