形态学 7、心脏的比较形态学标本

Here is an Aschoff nodule at high magnification. The most characteristic component is the Aschoff giant cell. Several appear here as large cells with two or more nuclei that have prominent nucleoli. Scattered inflammatory cells accompany them and can be mononuclears or occasionally neutrophils.
Here is a valve with infective endocarditis. The blue bacterial colonies on the lower left are extending into the pink connective tissue of the valve. Valves are relatively avascular, so high dose antibiotic therapy is needed to eradicate the infection.
急性细菌性心内膜炎（Acute bacterial endocarditis, NO.40 ）
急性细菌性心内膜炎（NO.40 ）
瓣膜上有大而不规则血栓附着，有菌丛，有急性 化脓性炎症
易发生败血性梗死
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紧密相连； 4. 三尖瓣增厚，不透明，形态未明显改变，无粘连、融合等，其闭锁缘上可清楚发
现多个赘生物呈单行排列，约粟粒大小，与瓣膜紧密相连。
The heart has been sectioned to reveal the mitral valve as seen from above in the left atrium. The mitral valve demonstrates the typical "fish mouth" shape with chronic rheumatic scarring. Mitral valve is most often affected with rheumatic heart disease, followed by mitral and aortic together, then aortic alone, then mitral, aortic, and tricuspid together.
风湿细胞
在纤维素样坏死的基础上，附近组织细胞增生、聚集，吞 噬纤维素样坏死物，是细胞变形转变成风湿细胞，或称 Aschoff细胞
1.体积大，圆形，多边形，胞界清而不整齐; 2.胞质丰富，均质，略嗜酸; 3.核大，圆形，卵圆形，核膜清晰，染色质集中于中央，并呈细丝
状向核膜放射，横向面像枭眼，纵向面像毛虫，大多数为单核， 少数为双核多核，Aschoff巨细胞； 4.单核吞噬细胞来源。
Another peculiar cell seen with acute rheumatic carditis is the Anitschkow myocyte. This is a long, thin cell with an elongated nucleus.
风湿性心肌炎（Rheumatic myocarditis, NO. 39 ）
This left ventricle is very thickened (slightly over 2 cm in thickness), but the rest of the heart is not greatly enlarged. This is typical for hypertensive heart disease. The hypertension creates a greater pressure load on the heart to induce the hypertrophy.
The small verrucous vegetations seen along the closure line of this mitral valve are associated with acute rheumatic fever. These warty vegetations average only a few millimeters and form along the line of valve closure over areas of endocardial inflammation. Such verrucae are too small to cause serious cardiac problems.
高血压性心脏病（代偿期） Hypertensive heart disease
（95）
Here is an example of renal vascular disease known as benign nephrosclerosis. The smaller arteries in the kidney have become thickened and narrowed. Hyaline arteriolosclerosis with hypertension or diabetes mellitus is usually present. This leads to patchy ischemic atrophy with focal loss of parenchyma that gives the surface of the kidney the characteristic granular appearance as seen here.
风湿性心瓣膜病伴亚急性细菌性心内膜炎 Rheumatic valvular disease with subacute bacteria endocarditis （93）
① 主动脉瓣瓣叶增厚、不透明， 互相粘连；
② 瓣膜上有不规则的米粒至蚕豆 大小灰黄色赘生物，质地松脆、 粗糙、暗红，与瓣膜粘附不牢；
风湿性心瓣膜病伴二尖瓣狭窄和关 闭不全（92）
风湿性心瓣膜病伴亚急性细菌性心 内膜炎（93）
急性细菌性心内膜炎伴二尖瓣穿孔 （94）
亚急性细菌性心内膜炎伴赘 生物形成（41，示教）
急性细菌性心内膜炎伴赘生 物形成（40，示教）
高血压
高血压性心脏病（代偿期）（95） 或高血压性心脏病失代偿期（21）*
风湿病
全身结缔组织和血管的变态反应炎症
变质渗出期：粘液样变、纤维素样坏死 增生期（肉芽肿期）：Aschoff小体（诊断风湿活动） 纤维化期（愈合期）：风湿细胞转变成成纤维细胞，瘢痕
形成
Microscopically, acute rheumatic carditis is marked by a peculiar form of granulomatous inflammation with so-called "Aschoff nodules" seen best in myocardium. These are centered in interstitium around vessels as shown here. The myocarditis may be severe enough to cause congestive heart failure.
③ 整个心脏体积增大，左心室腔 明显扩张，左心室壁增厚。
急性细菌性心内膜炎伴二尖瓣穿孔 acute bacterial endocarditis with mitral valve perforation （94）
① 心脏二尖瓣处有一个直径约1cm大小的灰 黄色病灶，质地脆，表面粗糙不平，中 央已穿孔；
实验目的与要求
1．掌握正常心脏的位置、外形、大小。心包及心脏各腔（右心房、右 心室、左心房、左心室）的结构特点及心壁的组织结构。疾病（风湿 性心脏病、高血压性心脏病、肺源性心脏病和冠状动脉硬化性心脏病 等）情况下心脏大体观及显微结构的改变。如风湿小体及风湿细胞的 形态特点。
2. 了解心瓣膜的结构，掌握风湿性心内膜炎和感染性心内膜炎时及疣状赘生物 位置、大小、色泽等特点。
比较
93号标本——风心伴亚急性细菌性心内膜炎：原有病变基 础上，草链
94号标本——急性细菌性心内膜炎伴二尖瓣穿孔：原来无 病变基础上，金葡
The left ventricle is markedly thickened in this patient with severe hypertension that was untreated for many years. The myocardial fibers have undergone hypertrophy.
② 瓣膜其他部位光滑菲薄而半透明； ③ 心外膜见纤维组织增生呈絮状。
The more virulent bacteria causing the acute bacterial form of infective endocarditis can lead to serious destruction, as shown here in the aortic valve. Irregular reddish tan vegetations overlie valve cusps that are being destroyed. Portions of the vegetation can break off and become septic emboli.