Inflammation and Repair 1 Outline (part-4) In Pathologic Basis Of Disease

21 - Lymph node, sarcoidosis - Very low power (Glass slide 65)

The multiple small pink nodules that interpose themselves diffusely within the normal architecture of the lymph node are the granulomas.

22 - Lymph node, sarcoidosis - Medium power (Glass slide 65)

•  Giant cells

The granulomas are closely packed, often merging, with scant intervening lymphoid tissue. Scattered multinucleated giant cells are apparent.

23 - Lymph node, sarcoidosis - High power (Glass slide 65)

• Foreign body-type giant cell
• Langhans-type giant cell

This is a noncaseating granuloma, composed of epithelioid (activated) macrophages. A foreign body-type giant cell with dispersed nuclei and a Langhans-type giant cell with peripheral nuclei are seen. These are formed of fused macrophages.

24 - Lung, granulomatous inflammation, miliary tuberculosis - Gross, cut surface

Miliary TB is a disseminated TB infection. Innumerable tiny whitish nodules (granulomas) are visible.

25 - Spleen, granulomatous inflammation, miliary tuberculosis - Gross, cut surface

As seen in the previous image of the lung, this spleen contains numerous small foci of granulomatous inflammation. Note that this has a similar appearance to the spleen with sarcoidosis, shown in a previous image.

26 - Liver, miliary tuberculosis - Low power (Glass slide 52)

• Granulomas
• Normal liver

Two granulomas are apparent. Note that they have focally replaced the normal liver tissue.

27 - Liver, miliary tuberculosis - Medium power (Glass slide 52)

• Giant cell

A higher power view demonstrates that the granuloma is composed of epithelioid macrophages and multinucleated giant cells. Lymphocytes are also scattered through the granuloma. Note that the early granulomas in miliary TB may not yet have developed caseous necrosis.

28 - Liver, miliary tuberculosis with a focus of caseous necrosis - High power (Glass slide 52)

• Caseous necrosis

The center of this granuloma is pink with no visible cellular architecture - the characteristic appearance of caseous necrosis. Though granulomatous inflammation has a number of causes, caseous necrosis virtually always signifies an infectious process.

29 - Arm, healing surgical incision - Clinical presentation

This image demonstrates healing by first intention, which occurs in clean, uninfected wounds that have apposed edges.

30 - Skin, healing surgical incision - Very low power (Glass slide 18)

• Dermis
• New epithelium
• Locus of prior incision

This image is for orientation.

Inflammation and Repair 1 Outline (part-3) In Pathologic Basis Of Disease

11 - Brain, purulent inflammation, Haemophilus influenzae meningitis - Gross

Foci of white-tan purulent exudate are evident over the surface of the brain (acute meningitis).

12 - Brain, purulent inflammation, abscess - Gross, coronal cut surface

The destructive nature of the acute inflammatory reaction in the case of an abscess is apparent here.

13 - Larynx and trachea, pseudomembranous inflammation, diphtheria - Gross, cut and mucosal surfaces

• Epiglottis
• Pseudomembranous exudate in larynx
• Carina

The pseudomembrane is made up of a fibrinopurulent exudate combined with necrotic mucosa. It has a relatively tough consistency and, in this case, has caused suffocation.

14 - Colon, pseudomembranous inflammation, colitis caused by clindamycin - Gross, mucosal surface

Prolonged treatment with antibiotics can destroy the balance of normal intestinal flora, allowing overgrowth of Clostridium difficile. C difficile causes a pseudomembrane similar to that caused by Corynebacterium diphtheriae in the larynx. Notice the rubor (vascular congestion) in the background.

15 - Uterine cervix, chronic cervicitis - Very low power (Glass slide 131)

• Columnar mucosa of endocervix
• Area of chronic inflammation
• Cyst
• Squamous mucosa of ectocervix

Use this image for orientation. The chronic inflammation imparts a bluish hue to the stroma, though it is not well visualized at this power. A cyst has formed as a result of obstruction of an endocervical gland.

16 - Uterine cervix, chronic cervicitis - Medium power (Glass slide 131)

• Lymphoid follicle

A higher power view of the chronic inflammatory infiltrate reveals a lymphoid follicle, an indicator of chronic inflammation.

17 - Uterine cervix, chronic cervicitis - High power (Glass slide 131)

• Plasma cells

This high-power view demonstrates the mononuclear infiltrate typical of chronic inflammation. A mononuclear infiltrate typically consists of lymphocytes, plasma cells, and macrophages.

18 - Gallbladder, chronic cholecystitis and cholelithiasis - Gross, opened

• Gallstones removed from gallbadder lumen

In this case, cholelithiasis has led to chronic inflammation of the gallbladder with consequent fibrosis of the gallbladder wall, evidenced by thickening and firmness.

 

19 - Liver, chronic inflammation, postnecrotic cirrhosis - Gross, cut surface

Secondary to a prior episode of severe hepatitis, fibrosis has developed in this liver, altering its architecture.

20 - Spleen, granulomatous inflammation, sarcoidosis - Gross, cut surface

Granulomas are scattered diffusely throughout the splenic parenchyma. Sarcoidosis, a disease of unknown etiology, causes characteristic noncaseating granulomas in many tissues and organs (including the lung, lymph nodes, and spleen).

Inflammation and Repair 1 Outline (part-2) In Pathologic Basis Of Disease

6 - Lung, fibrinous and hemorrhagic inflammation, pneumonia - High power (Glass slide 41)

• Congested capillaries in alveolar walls
• Erythrocytes

At this higher power, the nature of the inflammatory exudate is clearer. It consists of erythrocytes that have leaked out of the very permeable and congested capillaries, thin strands of fibrin derived from fibrinogen in the exuded plasma, and leukocytes that have exited the vessels via diapedesis. 

7 - Hand, purulent inflammation, staphylococcal abscess - Clinical presentation

• Abscess

Inflammation involving a dense neutrophilic infliltrate is called purulent (referring to pus) or suppurative. A localized collection of neutrophils, necrotic cells, and edema fluid (pus) in tissue is an abscess. Collections of neutrophils tend to have a greenish-yellow or whitish-yellow color, as seen here.

8 - Trachea, bronchi and lungs, purulent inflammation, bronchopneumonia and abscess - Gross, cut surface

• Abscess
• Purulent inflammation 

Note the pale yellow color of the area of purulent inflammation. In one focus, this inflammation has formed an abscess.

9 - Lung, purulent inflammation, abscess - Very low power (Glass slide 46)

• Abscesses

In this section of the lung, the large, irregularly shaped defects lined by shaggy, basophilic material are abscesses. They appear empty, because the liquid purulent material washed away when the tissue was sectioned to prepare the slide. The remaining parenchyma appears consolidated.

10 - Lung, purulent inflammation, abscess - High power (Glass slide 46)

This high-power view of the wall of the abscess demonstrates the dense neutrophilic infiltrate.