Histological examination of the heart at autopsy of a person who died after months of severe starvation shows small, atrophic myocardial fibers with granular golden-brown pigment concentrated around the nuclei at the pole ends of the cells. This pigment is:

• A Hemosiderin derived from extravasated red cells
• B Lipofuscin derived from lipid peroxidation of subcellular membranes ✓
• C Melanin transferred from adjacent epicardial nerve sheaths
• D Bilirubin pigment deposited secondary to hepatic failure

Explanation

Prolonged undernutrition produces brown atrophy of the heart, in which shrunken myocytes accumulate lipofuscin, an insoluble wear-and-tear pigment formed by free radical injury and lipid peroxidation of lysosomal membranes, classically perinuclear at the fiber poles. Hemosiderin stains blue with Prussian blue and reflects old hemorrhage, bilirubin does not deposit inside myocytes in this pattern, and melanin is not produced by cardiac muscle.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.