granulomatous diseases - ksumsc...granulomatous diseases practical foundation block pathology 2019....
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GranulomatousDiseases
PRACTICALFoundation BlockPathology 2019
1- Tuberculosisofthelung
Foundation BlockPathology Dept, KSU
Thegranulomashaveareasofcaseousnecrosis.Thispatternofmultiplecaseatinggranulomas
PulmonaryTB– CaseousNecrosis– Gross
Foundation BlockPathology Dept, KSU
Primarytuberculosisisthepatternseenwithinitialinfectionwithtuberculosisinchildren.Reactivation,orsecondarytuberculosis,ismoretypicallyseeninadults.
PulmonaryTB- Ghon’sComplex– Gross
Foundation BlockPathology Dept, KSU
Initial(primary)infectionwithT.B.producingasub-pleurallesioncalledaGhon’s focus.TheearlyGhon’s focustogetherwiththelymphnodelesionconstitutetheGhon’s complex..
CAVITARY TUBERCULOSIS: Extensive necrosis with cavitation, usually occurring in the upper lung or apex, is a characteristic feature of "secondary" or "adult tuberculosis”
Secondary tuberculosis
• MiliaryTBcanoccurwhenTBlunglesionserodepulmonaryveinsorwhenextrapulmonary TBlesionserodesystemicveins.
• Thisresultsinhematogenousdisseminationoftuberclebacilliproducingmyriadsof1-2mm.lesionsthroughoutthebodyinsusceptiblehosts.
• Miliary spreadlimitedtothelungscanoccurfollowingerosionofpulmonaryarteriesbyTBlunglesions.
MiliaryTBoftheLungs
Foundation BlockPathology Dept, KSU
Well-definedgranulomasareseenhere.Theyhaveroundedoutlines.TheonetowardthecenterofthephotographcontainsseveralLanghan’sgiantcells.
Granulomasarecomposedoftransformedmacrophagescalledepithelioidcellsalongwithlymphocytes,occasionalPMN's,plasmacells,andfibroblasts
TuberculousGranulomas
Foundation BlockPathology Dept, KSU
Thepyknoticnucleiofepithelioidcellsinthecenterofthegranuloma(apoptoticbodies)areaprecursorofnecrosis.
PulmonaryTB- Granulomawithcentralearlynecrosis
Foundation BlockPathology Dept, KSU
Theedgeofagranulomaisshownhereathighmagnification.Attheupperisamorphouspinkcaseousmaterial[1]composedofthenecroticelementsofthe
granulomaaswellastheinfectiousorganisms.Thisareaisringedbytheinflammatorycomponent[2]withepithelioidcells,lymphocytes,andfibroblasts.
1
2
TuberculousGranulomas
Foundation BlockPathology Dept, KSU
AstainforAcidFastBacilliisdone(AFB stain)tofindthemycobacteria.Themycobacteriastainasredrods,asseenhereat
highmagnification.
AcidFastbacilliofMycobacteriumTBintheLung
Foundation BlockPathology Dept, KSU
2- TuberculousLymphadenitis
Foundation BlockPathology Dept, KSU
Foundation BlockPathology Dept, KSU
TuberculousLymphadenitis- Gross
TuberculousLymphadenitis– CutSection
Sectionofalymphnodewithconnectivetissuecapsuleandlymphoidtissue
Foundation BlockPathology Dept, KSU
Manyroundandovaltubercles/granulomaswithorwithoutcentralcaseationthatappearsstructureless,homogenousandpinkincolour.
TuberculousLymphadenitis
Foundation BlockPathology Dept, KSU
Thegranulomasconsistsofepithelioidcells,fewlanghan’sgiantcells(largecellwithmultiple
peripheralnuclei)andperipheralrimoflymphocytes
TuberculousLymphadenitis
Foundation BlockPathology Dept, KSU
3- BilharzialGranulomas
Foundation BlockPathology Dept, KSU
ColonicBilharziasis- HPF
Colonbiopsyofbilharziasis.Fibrosingforeignbodygranulomaagainstthemiracidium-containingovumofS.mansoniisobservedinthesubmucosallayer
(H&E). Foundation BlockPathology Dept, KSU
Schistosomahaematobium.UrinaryBladderbiopsyshowingbilharziasis eggs– granulomawitheosinophils
BilharziasisoftheUrinaryBladder
Foundation BlockPathology Dept, KSU
S.japonicumeggsinhepaticportaltract
S.japonicumintheHepaticportaltract
Foundation BlockPathology Dept, KSU
4- CutaneousLeishmaniasis
Foundation BlockPathology Dept, KSU
CutaneousLeishmaniasis
Leishmaniasisiscausedbyparasiticinfection,mainlybyparasitesoftheLeishmaniagenuswhicharecarriedbyablood-suckinginsectknownasthe
sandfly.Foundation BlockPathology Dept, KSU
Histologicalviewshowsmarkedcellularinfiltrationandparasites(Leishmanbodies)withinmacrophages
CutaneousLeishmaniasis
Foundation BlockPathology Dept, KSU
CutaneousLeishmaniasis
ThebloodfilmshowsmacrophagescontainingLeishmaniaamastigotes,eachwithaprominentkinetoplast(seenasadarkenedspotnexttothelargernucleus)and
noflagella(incontrastwiththepromastigoteform).
Foundation BlockPathology Dept, KSU
GOODLUCK