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Tissue Reactions as Aid to

Histopathological Diagnosis

KP Aravindan

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Case 11

49 year old farmer. Autopsy material

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The process

Destruction of alveolar lining.

Cells in the alveoli what are they?

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The process

Destruction of alveolar lining.

Cells in the alveoli what are they?

Fibroblasts. Where from? Provoked by what?

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The process

Alveolar destruction

Fibrin, Macrophages, Fibronectin in alveolar lumen

Migration of fibroblasts from alveolar wall

Intra-alveolar fibrosis

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Intra-alveolar fibrosis

Hypersensitivity pneumonitis

Bronchiolitis obliterans organizing pneumonia

(BOOP)

Acute Fibrinous organizing pneumonia

Paraquat poisoning

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Hypersensitivity pneumonitis Acute Fibrinous OP

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BOOP

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PARAQUAT POISONING

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Intra-alveolar fibrosis

Hypersensitivity pneumonitis

Bronchiolitis obliterans organizing pneumonia

(BOOP)

Acute Fibrinous organizing pneumonia

Paraquat poisoning

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The Cellular response

One or two cell types may predominate

Neutrophils

Macrophages

Eosinophils

Plasma cells

Lymphocytes

The type of response may yield clues regarding theclinical condition or cause

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MCQ

Which of the following is NOT a tissue cell?

A. Eosinophil

B. Lymphocyte

C. Macrophage

D. Neutrophil

E. Plasma cell

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Neutrophils in tissues - Mechanisms

Acute inflammation due to various modes of injury

Increase of pro-inflammatory cytokines

Vascular damage

Inciting foci like persistent organisms or immunecomplexes

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Neutrophils in tissues - examples

Frank suppuration (abscess, Lobar pneumonia) Microabscesses

Epidermal

Deep dermal

Mucosal (active gastritis & colitis)

Dermal without leukocytoclasia (Neutrophilic

dermatosis)

Dermal with leukocytoclasia (vasculitis)

In papillary dermis or along the basement membrane

(Dermatitis herpeteformis, Linear IgA dermatosis)

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Case 1

Female 55. Erythematous plaque on the

forearm

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Case 2

Palapabe erythematous rash on the legs and

buttocks

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Case 1 & 2- Diagnosis

Case 1: Sweet syndrome

Case 2: Leukocytoclastic vasculitis

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Case 3

No history

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Case 3 - Diagnosis

Eumycotic mycetoma

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Increase of tissue eosinophils

Parasitic infections

Allergens

External

Internal

Some autoimmune diseases

Some tumors

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Increase of tissue eosinophils

Parasitic infections

Allergens

External

Internal

Some autoimmune diseases

Some tumors

Th2 pathway - Il-5 - Eotaxin

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Case 4

No history

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Case 4 - Diagnosis

Pemphigus foliaceus

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Case 5

Churg Strauss syndrome

Heterogeneity of macrophages

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Heterogeneity of macrophages

h l l f

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Macrophages - Functional classification

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Heterogeneity of macrophages

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Heterogeneity of macrophages

Granuloma

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Epithelioid Non Epithelioid

Granuloma

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Granuloma with eosinophils

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Granuloma with eosinophils

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Parasites? Churg Strauss?

Epithelioid ran lomas

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Epithelioid granulomas

Caseous granulomas (TB)

Naked granulomas (Sarcoid, Crohn)

Pyogranulomas (Fungal)

Stellate granuloma (Cat scratch)

Granulomas with eosinophils (Parasitic)

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Nasal mass

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Non Epithelioid macrophages

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Non-Epithelioid macrophages

Palisading granuloma (Fungal, parasitic)

Necrobiotic granulomas (Rheumatoid arthritis)

Foam cells (Lepromatous leprosy)

Activated macrophages (MAS)

Case 6

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Case 6

Lesion forehead

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Case 6 - Diagnosis

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Case 6 - Diagnosis

Sarcoidosis

Case 7

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Case 7

Swelling on the back of elbow

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Case 7 - Diagnosis

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Case 7 Diagnosis

Fungal bursitis

Case 8

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Case 8

Cervical lymph node

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Case 9 - Diagnosis

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g

Rheumatoid nodule

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Case 10

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50 year old male

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Case 10 - Diagnosis

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Syphilis