CELL INJURY -4
PATHOLOGIC CALCIFICATION
• Pathologic calcification/ heterotopic
calcification is the abnormal tissue deposition
of calcium salts ,in tissues other than osteoid
or enamel.
• Types -Dystrophic
Metastatic
DYSTROPHIC CALCIFICATION
• Calcium deposition occuring locally in dying
and degenerating tissues is known as
dystrophic calcification.
• occurs in normal serum levels of calcium and
in normal calcium metabolism.
• Causes-Calcification in dead tissue.
Calcification of degenerated tissue.
Calcification in dead tissue:
Eg: 1. Caseous necrosis in tuberculosis is the
most common site for dystrophic calcification.
2. Liquefaction necrosis in chronic abscesses.
3. Fat necrosis following acute pancreatitis or
traumatic fat necrosis in the breast.
4. Infarcts may undergo calcification.
5.Thrombi, especially in the veins, may
produce phleboliths.
• Calcification in degenerated tissues
Eg: 1. Dense old scars may undergo hyaline
degeneration and subsequent calcification.
2. Atheromas in the aorta and coronaries.
3. Mönckeberg’s sclerosis shows
calcification in the degenerated tunica media of
muscular arteries in elderly people
Pathogenesis of dystrophic calcification
The process of dystrophic calcification is associated with formation of
normal hydroxyapatite of bone i.e. binding of phosphate ions with
calcium ions to form precipitates of calcium phosphate.
It involves phases of initiation and propagation:
Initiation: Following cell injury (i.e. degeneration or necrosis),
membrane damage release ofPhosphatases
phospholipids.
excess uptake of calcium
by injured mitochondria in
degeneration and necrosis phosphate ions.
+
calcium
calcium phosphate.
Propagation: further propagation of deposits and form mineral crystals.
MORPHOLOGY
• Gross- the calcium salts appear macroscopically as fine, white granules or
clumps or gritty deposits
• Micro- calcium salts have a basophilic, amorphous granular, sometimes
clumped appearance.
-They can be intracellular, extracellular, or in both locations.
heterotopic bone may form in the focus of calcification.
On occasion, single necrotic cells may constitute seed crystals that become
encrusted by the mineral deposits.
• The progressive acquisition of outer layers may create lamellated
configurations, called psammoma bodies because of their resemblance to
grains of sand.
(e.g., papillary thyroid carcinoma )
METASTATIC CALCIFICATION
• Metastatic calcification may occur in normal
tissues whenever there is hypercalcemia.
• Causes: 1.Excessive mobilisation of calcium
from the bone.
2.Excessive absorption of calcium
from the gut.
• Excessive mobilisation of calcium from the
bone :
• 1. Hyperparathyroidism which may be primary
such as due to parathyroid adenoma, or
secondary such as from parathyroid
hyperplasia, chronic renal failure etc.
• 2. Bony destructive lesions such as multiple
myeloma, metastatic carcinoma.
• 3. Hypercalcaemia as a part of paraneoplastic
syndrome e.g. in breast cancer.
• Excessive absorption of calcium from the gut:
1. Hypervitaminosis D
2. Milk-alkali syndrome caused by excessive oral intake of
calcium.
3. Idiopathic hypercalcaemia of infancy (Williams syndrome).
• Sites of metastatic calcification
May occur in any normal tissue of the body but preferentially
affects the following organs and tissues:
1.Kidneys, especially at the basement membrane of tubular
epithelium and in the tubular lumina causing nephro calcinosis .
2. Lungs, especially in the alveolar walls.
3. Stomach, on the acid-secreting fundal glands.
4. Blood vessels, on the internal elastic lamina
• Pathogenesis of metastatic calcification:
metabolic derangement
elevated calcium ions
binds with inorganic phosphate ions
precipitates of calcium phosphate at the preferential
sites, due to presence of acid secretions or rapid
changes in pH levels at these sites.
Metastatic calcifi cation is reversible upon correction of
underlying metabolic disorder.
