lecture 9-GRANULOMATOUS INFLAMMATION .ppt
- 1. Dr. Urfa Shafi. Assistant Professor histopathology
- 2. Acute inflammation Inflammation Neutrophils Macrophage Lymphocytes Plasma cells Chronic inflammation
- 3. ļ½ Inflammation of prolonged duration (weeks or months) in which active inflammation, tissue destruction, and attempts at repair are proceeding simultaneously. ļ½ Frequently begins insidiously, as a low-grade, smoldering, often asymptomatic response. ļ½ Cause of tissue damage in some of the most common and disabling human diseases, such as rheumatoid arthritis, atherosclerosis, tuberculosis, and chronic lung diseases.
- 4. ļ½ Persistent infections: ā¦ Certain microorganisms, such as tubercle bacilli, Treponema pallidum, and certain viruses, fungi, and parasites. ļ½ Prolonged exposure to potentially toxic agents, either exogenous or endogenous: ā¦ Silicosis, atherosclerosis. ļ½ Auto-immunity: ā¦ RA, SLE.
- 5. ļ½ Infiltration with mononuclear cells, which include macrophages, lymphocytes, and plasma cells. ļ½ Tissue destruction, induced by the persistent offending agent or by the inflammatory cells. ļ½ Attempts at healing by connective tissue replacement of damaged tissue, accomplished by proliferation of small blood vessels (angiogenesis) and, in particular, fibrosis.
- 9. ļ½ Lymphocytes, ļ½ Plasma cells, ļ½ Eosinophils, and ļ½ Mast cells.
- 11. Upon completion of this lecture, the student should: ļ Define Granulomatous inflammation. ļ Recognize the morphology of granulomas (tubercles) and list the cells found in granuloma along with their appearance. ļ Understands the pathogenesis of granuloma formation. ļ Identify the two types of granulomas, which differ in their pathogenesis. ļ Foreign body granulomas ļ Immune granulomas ļ List the common causes of Granulomatous Inflammation.
- 12. A form of chronic inflammation characterized by the formation of granulomas.
- 13. ļ½ Granuloma = Nodular collection of epithelioid macrophages surrounded by a rim of lymphocytes ļ½ Epithelioid macrophages: squamous cell-like appearance
- 14. ļ½ Granulomas are encountered in certain specific pathologic states. ļ½ Recognition of the granulomatous pattern is important because of the limited number of conditions (some life-threatening) that cause it.
- 15. ļ½ Neutrophils ordinarily remove agents that incite an acute inflammatory response. However, there are circumstances in which reactive neutrophils cannot digest the substances that provoke acute inflammation.
- 16. ļ½ What is the initiating event in granuloma formation? ļ deposition of a indigestible antigenic material. IFN-Ī³ released by the CD4+ T cells of the TH1 subset is crucial in activating macrophages. Type IV hypersensitvity
- 17. 1. When macrophages have successfully phagocytosed the injurious agent but it survives inside them. 2. When an active T lymphocyte-mediated cellular immune response occurs. Lymphokines produced by activated T lymphocytes inhibit migration of macrophages and cause them to aggregate in the area of injury and form granulomas.
- 18. Foreign body granuloma Immune granuloma are incited by relatively inert foreign bodies. Typically, foreign body granulomas form when material such suture are large enough to preclude phagocytosis by a single macrophage These material do not incite any specific inflammatory immune response. The foreign material can usually be identified in the center of the granuloma, by polarized light (appears refractile). are caused by insoluble particles, typically microbes, that are capable of inducing a cell-mediated immune response.
- 19. Immune granuloma: Non-immune granuloma ļ Bacteria ļ Tuberculosis ļ Leprosy ļ Actinomycosis ļ Cat-scratch disease ļ Parasites ļ Schistosomiasis ļ Leishmaniasis ļ Fungi ļ Histoplasmosis ļ Blastomycosis ļ Metal/Dust ļ Berylliosis ļ Foreign body ļ Suture ļ Graft material ļ talc (associated with intravenous drug abuse) unknown Sarcoidosis Crohnās disease
- 20. Caseous Necrosis Epithelioid Macrophage Langhans Giant Cell Lymphocytic Rim
- 24. Schistosomias is
- 25. Leishmaniasis
- 26. Lepros y
- 27. Leprosy
- 29. A B 1) The most important cell in granulomatous inflammation 2) A cytokines that is important in activating macrophages and transforming them into epithelioid cells 3) Multinucleated cell in TB 4) Antigen presenting cells 5) pathogenesis of immune type granulomatous inflammation 6) Microscopic finding of TB a. IFN-Ī³ b. Langhans cells c. Epithelioid histiocytes d. Cord factor e. Langerhanās cells f. Type IV hypersensitivity reaction g. Caseating granuloma
- 30. ļ Which of the following diseases does not cause granulomatous inflammation a) Cat-scratch disease b) Actinomycosis c) Sarcoidosis d) Leishmaniasis e) Staphylococcus infection
- 32. Types of multinucleated giant cells: Foreign body multinucleated giant cell/ foreign body Langhans multinucleated giant cell/ TB Touton multinucleated giant cell/ tumour
- 33. Q/ Identify the type of giant cell
- 37. ļ Granulomatous inflammation is a distinctive pattern of chronic inflammation characterized by aggregates epithelioid macrophages ļ Damaging stimuli which provoke a granulomatous inflammatory response include: Microorganisms which are of low inherent pathogenicity but which excite an immune response. ļ Granulomata are produced in response to: ā Bacterial infection ā parasitic infection: e.g. Schistosoma infection ā Certain fungi cannot be dealt with adequately by neutrophils, and thus excite granulomatous reactions. ā Non-living foreign material deposited in tissues, e.g. keratin from ruptured epidermal cyst. ā Unknown factors, e.g. in the disease 'sarcoidosis' and Crohn's diseas