Pathology lab 4 DONE BY : MORAD ABU QAMAR

Transcription

1 Pathology lab 4 DONE BY : MORAD ABU QAMAR

2 Chronic interstitial inflammation, lung Certain etiologic agents such as viruses are more likely to lead to chronic inflammation, as seen here in the lung of a patient with influenza A. Note also that the inflammatory infiltrates of chronic inflammation are more likely to be interstitial (within tissues) rather than exudative (above surfaces or in spaces) like acute inflammation. *Thick alveolar wall due to inflammatory cells : -infection lymphocytes viral *bacteria intra-alvelor neutrophils *viral wall lymphocytes

3 Granulation tissue, healing myocardial infarction (very important ) Healing of inflammation often involves ingrowth of capillaries and fibroblasts. This forms granulation tissue. Here, an acute myocardial infarction is seen healing. There are numerous capillaries, and collagen is being laid down to form a scar. Non-infarcted myocardium is present at the far left. Granulation tissue : proliferation of fibroblasts, deposition of connective tissue, abundant vessels(new thin-walled, delicate capillaries) and interspersed leukocytes and macrophages. **** these scar NOT regeneration because myocardium cant divide

4 Scarring, lung. The end result of inflammation can be scarring. Here, the alveolar walls are thickened and filled with pink collagen following an autoimmune disease lasting for decades. Chronic diseases the causes persist end result is Fibrosis ع ى الرغ من انه خايا الرئة تنقس اا انه بصير Scar

5 -granuloma is very important topic.

6 Granulomatous inflammation, extensive Granulomatous disease can become quite extensive. Here are numerous confluent granulomas in a case of pulmonary tuberculosis. TB caseating nercrosis

7 Granuloma, caseating, hilar lymph node Grossly, a granuloma tends to be a focal lesion. Seen here in a hilar lymp node is a granuloma. Granulomas due to infection are often "caseating" because they have prominent caseous necrosis TB Involve Hilar LNs

8 Granulomatous inflammation, lung, low power microscopic The focal nature of granulomatous inflammation is demonstrated in this microscopic section of lung in which there are scattered granulomas in the parenchyma. This is why the chest radiograph with tuberculosis or other granulomatous diseases is often described as "reticulonodular". A biopsy could miss such lesions from sampling error, too. Granuloma : 1-macrophages (abundant amount of cytoplasm) 2-lymphoctes (less amount) 3-giant cell (multinucltaed) 4-fibrosis 5-plasma cells * To wall of Microorganism

9 Granulomatous inflammation Here are two pulmonary granulomas. Granulomatous inflammation typically consists of epithelioid macrophages, giant cells, lymphocytes, plasma cells, and fibroblasts. There may be some neutrophils.

10 Granulomatous inflammation Granulomatous inflammation occurs in response to some agents which persist for a long time and require a more orchestrated immune response to fight them. The granuloma seen here demonstrates the typical rounded and focal nature of this type of inflammation. A couple of spherules of C. immitis are present in the giant cell in the center. spherules of C. immitis (wall of microorganism,)

11 Langhans giant cells in granuloma Giant cells are a "committee" of epithelioid macrophages. Seen here are two Langhans type giant cells in which the nuclei are lined up around the periphery of the cell. Additional pink epithelioid macrophages compose most of the rest of the granuloma. Langhans giant cells

12 Epithelioid cells in granuloma. These are epithelioid cells around the center of a granuloma. They get their name from the fact that they have lots of pink cytoplasm similar to squamous epithelial cells. Their nuclei tend to be long and stringy. Epithelioid cell

13 Caseous necrosis. This is a caseating granuloma. Epithelioid cells surround a central area of necrosis that appears irregular, amorphous, and pink. Grossly, areas of caseation appear cheese-like If no necrosis --Non caseating granuloma Caseous necrosis (caseating granuloma.) TB is the differential diagnosis

14 Caseous necrosis in granuloma Caseous necrosis in granuloma Granulomas caused by tuberculosis and by dimorphic fungi such as H. capsulatum or C. neoformans are often caseating. Here, the area of caseation is seen at the upper right.

15 Miliary granulomas With a poor immune response to the agents producing granulomatous inflammation, there is extensive spread of infection with the production of a "miliary" pattern of granulomas as seen here in the lung of a patient with miliary tuberculosis. The 1 to 2 mm granulomas are scattered around like millet seeds.