I - Acute Inflammation - KSUMSC. Foundation Block/Femal… · Acute inflammation is a non-selective...

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Inflammation PRACTICAL I - Acute Inflammation Foundation Block Pathology 2019

Transcript of I - Acute Inflammation - KSUMSC. Foundation Block/Femal… · Acute inflammation is a non-selective...

Page 1: I - Acute Inflammation - KSUMSC. Foundation Block/Femal… · Acute inflammation is a non-selective process that can lead to tissue destruction Pathology Dept, KSU Foundation Block

Inflammation

PRACTICAL

I- AcuteInflammation

Foundation BlockPathology 2019

Page 2: I - Acute Inflammation - KSUMSC. Foundation Block/Femal… · Acute inflammation is a non-selective process that can lead to tissue destruction Pathology Dept, KSU Foundation Block

PathogenesisofExudation

Thediagramshownhereillustratestheprocessofexudation,aidedbyendothelialcellcontractionandvasodilation,whichtypicallyismostpronouncedinvenules.Collectionoffluidinaspaceisatransudate.Ifthisfluidisprotein-richorhas

manycellsthenitbecomesanexudate.

Foundation BlockPathology Dept, KSU

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ExudationintheAlveolarSpace

HereisvasodilationwithexudationthathasledtoanoutpouringoffluidwithfibrinintothealveolarspacesalongwithPMN'sindicativeofanacute

bronchopneumoniaofthelung,Foundation BlockPathology Dept, KSU

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ExudationofFibrininAcuteInflammation

HereisanexampleofthefibrinmeshinfluidwithPMN'sthathasformedintheareaofacuteinflammation.Itisthisfluidcollectionthatproducesthe

"tumor"orswellingaspectofacuteinflammation.Foundation BlockPathology Dept, KSU

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InflammationwithNecrosis- LPF

Thevasculitisshownheredemonstratesthedestructionthatcanaccompanytheacuteinflammatoryprocessandtheinterplaywiththecoagulationmechanism.Thearterialwallisundergoingnecrosis,

andthereisthrombusformationinthelumen. Thisisseeninconnectivetissuedisorderduetoautoimmunediseasee.g.rheumatoidarthritis

Foundation BlockPathology Dept, KSU

VasculitisArterialwallwithsevereinflammationandfibrinoid necrosis

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InflammationwithNecrosis- HPF

Athighermagnification,vasculitiswitharterialwallnecrosisisseen.Notethefragmentedremainsofneutrophilicnuclei(karyorrhexis).Acuteinflammationisa

non-selectiveprocessthatcanleadtotissuedestruction

Foundation BlockPathology Dept, KSU

Fibrinoid necrosis

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1- FibrinousPericarditis

Foundation BlockPathology Dept, KSU

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Here,thepericardialcavityhasbeenopenedtorevealafibrinouspericarditiswithstrandsofstringypalefibrinbetween

visceralandparietalpericardium

AcuteFibrinousPericarditis- Gross

Foundation BlockPathology Dept, KSU

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AcuteFibrinousPericarditis- Gross

Serousfluidatthebottomofthepericardialcavity(arrow)isvisible.Theepicardialsurfaceappearsroughened,comparedtoitsnormalglistening

appearance;duetothestrandsofpink-tanfibrinthathaveformed

Foundation BlockPathology Dept, KSU

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Thefibrinousexudateisseentoconsistofpinkstrandsoffibringuttingfromthepericardialsurfaceattheupperright . Theexudateonthesurfaceisshownenlargedintheinset. Noteaconsiderablenumberoferythrocytes

trappedinthemeshoffibrinthreads.

AcuteFibrinousPericarditis-Microscopically

Foundation BlockPathology Dept, KSU

Right

Left

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Thepericardiumisdistortedbythickirregularlayerofpinkishfibrinousexudatewithsomeredcellsandinflammatorycells

AcuteFibrinousPericarditis- LPF

Foundation BlockPathology Dept, KSU

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Thesubpericardiallayeristhickenedbyedemaandshowsdilatedbloodvessels,chronicinflammatorycellsandareasof

calcification.

AcuteFibrinousPericarditis- HPF

Foundation BlockPathology Dept, KSU

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AcuteFibrinousPericarditis- HPF

Meshwork of fibrin

Inflammatorycells(neutrophils andmonocytes)

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2- AcuteAppendicitis

Foundation BlockPathology Dept, KSU

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NormalAppendix- Gross

Thisisthenormalappearanceoftheappendixagainstthebackgroundofthecaecum.

Foundation BlockPathology Dept, KSU

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AcuteAppendicitis- Gross

Seenhereisacuteappendicitiswithyellowtotanexudateandhyperemia,includingtheperiappendicealfatsuperiorly,ratherthana

smooth,glisteningpaletanserosalsurfaceFoundation BlockPathology Dept, KSU

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AcuteAppendicitis– Longitudinalsection

Acaseofacuteappendicitis:Theorganisenlargedandsausage-like(botuliform).Thislongitudinalsectionshowstheangryredinflamedmucosawithitsirregularluminalsurface.Thisappendixdoesnotshowlatecomplications,liketransmuralnecrosis,perforation,and

abscessformation

Foundation BlockPathology Dept, KSU

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AcuteAppendicitis– LPFofthecutsection

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SmoothMusclelayer

AcuteAppendicitis– LPF

FibrosisofLaminapropriaScattered

Neutrophilsintheepithelium

LymphFollicle

LuminalDebris

Foundation BlockPathology Dept, KSU

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AcuteAppendicitis– HPF

ScatteredNeutrophilsinthecryptepithelium

Foundation BlockPathology Dept, KSU

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Thisslideshowsthemusclelayeroftheappendixwhichispermeatedwithnumerouspolymorphonuclearleukocytes

AcuteAppendicitis– Histopathology

Foundation BlockPathology Dept, KSU

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3- AcuteCholecystitis

Foundation BlockPathology Dept, KSU

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AcuteCholecystitis– Gross

Mucocele,stoneobstructedtheneck,distended,aspirationdoneandremovedbylapchole

Foundation BlockPathology Dept, KSU

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Theneutrophilsareseeninfiltratingthemucosaandsubmucosaofthegallbladderinthispatientwithacutecholecystitisandrightupper

quadrantabdominalpainwithtendernessonpalpation

AcuteCholecystitis– HistopathologyHPF

Foundation BlockPathology Dept, KSU

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4- SkinPilonidalSinus

Foundation BlockPathology Dept, KSU

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ForeignBodyReaction(PilonidalSinus)

Apilonidalsinusisasinustractwhichcommonlycontainshairs.Itoccursundertheskinbetweenthebuttocks(thenatalcleft)ashortdistanceabovetheanus.Usuallyrunsverticalbetweenthebuttocksandrarelyoccurring

outsidethecoccygealregion.

Foundation BlockPathology Dept, KSU

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ForeignBodyReaction(PilonidalSinus)

Surgicallyexcisedpilonidalsinustracts

Foundation BlockPathology Dept, KSU

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Thelumenofthesinusandwallcontainlargenumberofhairshaftswithforeignbodygiantcells,lymphocytes,macrophages&

neutrophils

PilonidalSinus– HistopathologyLPF

Foundation BlockPathology Dept, KSU

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ChronicInflammation

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1- Chroniccholecystitiswithstones

Foundation BlockPathology Dept, KSU

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Grossappearanceofgallbladderaftersectioninglongitudinally.Noticethicknessofgallbladderwall,abundantpolyhedricstones

andsmallpapillarytumorinthecysticduct.

ChroniccholecystitiswithGallStones

Foundation BlockPathology Dept, KSU

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Chroniccholecystitis- Histopathology

Irregularmucosalfoldsandfociofulcerationinmucosa.Wallispenetratedbymucosalglandswhicharepresentinmusclecoat(Rokitansky- Aschoffsinuses).Alllayersshowchronicinflammatorycellsinfiltrationand

fibrosis. Foundation BlockPathology Dept, KSU

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Themucosaisatrophic,withasinglelayerofflattenedepithelium.Thereisproteinaceousfluidadherenttothemucosalsurface,withsomebilestainedorange-browncrystalstowardtheupperleftinthelumen.Thelaminapropria

showsfibrosisandcontainsamononuclearcellinfiltrate(smalldarkbluenuclei).

Themuscleishypertrophiedcomparedtonormalgallbladder.

Chroniccholecystitis- Histopathology

Foundation BlockPathology Dept, KSU

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2- Brainabscess

Foundation BlockPathology Dept, KSU

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CTofacerebralabscess.Thereisaliquefactivecenterwithyellowpussurroundedbyathinwall.Abscessesusuallyresultfromhematogenousspreadofbacterialinfection,butmayalsooccurfromdirectpenetrating

traumaorextensionfromadjacentinfectioninsinuses

BrainAbscess- CT

Foundation BlockPathology Dept, KSU

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BrainAbscess- MRI

Thistrichromestaindemonstratesthelightblueconnectivetissueinthewallofanorganizingcerebralabscess.Normalbrainisattheleftandthe

centeroftheabscessattheright.Foundation BlockPathology Dept, KSU

Right

Left

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3- Granulationtissue

Foundation BlockPathology Dept, KSU

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GranulationTissue- LPF

Sectionoffragmentsofedematous,looseconnectivetissueshowsmanysmallnewlyformedcapillarieslinedbyplumpendothelial

cells.ProliferationoffibroblastsisseenFoundation BlockPathology Dept, KSU

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Inflammatorycellsincludingmacrophages,lymphocytes,plasmacellsandneutrophilsintheoedematousstroma.

Pinkhomogenouscollagenfibersmaybeidentified.

GranulationTissue- HPF

Foundation BlockPathology Dept, KSU


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