Chronic Inflammation✅ (transfer 1-9 to granulomatous)

1. Identify

2. What is the pointed structure?

3. What cells compose most of the rest of the structure?

1. Langhans giant cells in granuloma

2. Langhans-type cell

3. Macrophages

1. Identify

2. What cells are pointed?

3. What bone marrow-derived cell can become this cell?

1. Epithelioid cells in granuloma

2. Epithelioid cells

3. Monocytes

1. Identify cellular process

2. Identify pointer area

1. Caseous necrosis in granuloma

2. Area of necrosis

1. Identify cellular process

2. Identify pointer area

1. Caseous necrosis in granuloma

2. Area of necrosis

1. Identify cellular process

2. What is patter of the structures seen?

1. Caseous necrosis in granuloma

2. Milary pattern of granulomas

1. Identify

2. What is the pink structure below that arrow?

1. Foreign body giant cell in granuloma

2. Vegetable material (foreign body)

1. Identify

2. Identify the pointed structure

1. Foreign body giant cells in suture granuloma

2. Suture material

1. Identify

2. Identify the white crystals

3. What type of microscopy is used?

1. Talc granulomatosis

2. Talc crystals

3. Polarized light microscopy

1. Identify

1. Silicotic nodule

Type of cells that are typically present in the inflammatory infiltrate of chronic inflammation.

In chronic endometritis (picture), which mononuclear cells are observed in the endometrial stroma?

Why is chronic inflammation considered more variable and difficult to understand compared to acute inflammation? (Wa ni sa webpath ang answer but textbook)

Mononuclear cells

Lymphocytes and plasma cells

Diverse and persistent inflammatory response (unlike acute that is prediminated by neutrophils)

The composition of the epithelium when acute inflammation becomes chronic?

In chronic cervicitis, what tissue changes indicate severe inflammation?

How can prolonged or repeated bouts of acute inflammation lead to mucosal damage?

More mononuclear cells

Mucosal damage

Extravasation of rbcs (hemorrhage)

1. Chronic interstitial inflammation, lung

2. Certain etiologic agents such as viruses are more likely to lead to chronic inflammatory cell infiltration, as seen here in the lung of a patient with influenza A viral infection. Note also that the inflammatory infiltrates of chronic inflammation are more likely to be interstitial (within tissues) rather than exudative (above epithelial surfaces or within spaces such as alveoli or body cavities) like acute inflammation.

1. Acute and chronic inflammation

2. This type of mixed inflammation is typical of repeated or recurrent inflammation

3. Examples of this process include diagnoses such as "acute and chronic cholecystitis" or "acute and chronic cervicitis

1. Chronic inflammation with scarring, bronchus

1. Granulation tissue, healing myocardial infarction

2. Healing of inflammation often involves ingrowth of capillaries (yellow) filled with RBCs and accompanied by fibroblasts producing collagen. This forms granulation tissue

3. Here, an acute myocardial infarction is seen healing, with residual normal myocardial fibers at the far left. There are numerous capillaries, and collagen (green) is being laid down to form a scar. Non-infarcted myocardium is present at the far left.

1. Granulation tissue, organizing abscess

2. The wall of an abscess that is organizing has granulation tissue, seen here at the left

3. The purulent exudate with some hemorrhage is seen at the right in the abscess center.

1. Granulation tissue

2. At high magnification, granulation tissue has capillaries (yellow), fibroblasts (green), and a variable amount of inflammatory cells (mostly mononuclear, but with the possibility of some PMNs still being present).

1. Scarring, lung

2. 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. Airspaces are irregularly dilated

1. Adhesions of pleura

2. Resolution of inflammatory processes in body cavities may result in the formation of adhesions, which are thin bands of collagenous connective tissue, as seen here between the right lung and the chest wall at autopsy. Adhesions, if extensive can restrict motion or cause retraction to an abnormal position of internal organs

1. Healing scar, skin

2. The skin surface (blue)has re-epithelialized, and below this is granulation tissue (green) with small capillaries and fibroblasts forming collagen

1. IgG4-related disease

2. IgG4-related disease is a cause for chronic inflammation with fibrosis and organ dysfunction. Multiple tissues may be involved. Shown here is a fibrous proliferation with infiltrates of plasma cells, typical of the inflammatory reaction

3. The diagnosis of IgG4-RD can be made with the following 3 criteria:

   1. Organ involvement

   2. Serum IgG4 level exceeding 135 mg/dL

   3. Microscopic finding of more than 10 IgG4+ plasma cells per high-power field and an IgG4:IgG-positive plasma cell ratio of at least 40%

1. ID pathology

2. What infectious disease is most likely is present here?

1. IgG4-related disease

2. Tuberculosis

3. Granulomatous disease can become quite extensive. Here are numerous confluent granulomas in upper lung fields in a case of active pulmonary tuberculosis. Recall that granulomatous inflammation can lead to caseous necrosis.

1. Granuloma, caseating, hilar lymph node

2. Grossly, a granuloma tends to be a focal lesion. Seen here in a hilar lymph node is a granuloma

1. Granulomatous inflammation

2. Here is a pulmonary granuloma involving a bronchiole.

3. Granulomatous inflammation typically consists of mixtures of cells including epithelioid macrophages, Langhans giant cells, lymphocytes, plasma cells, and fibroblasts. There may even be some neutrophils.

1. Granulomatous inflammation

2. The granuloma seen here demonstrates the typical rounded and focal nature of this type of inflammation.

3. A couple of spherules of the fungus known as Coccidioides immitis are present in the giant cell in the center

1. Chronic abscess, lung