inflammation plenary

8/11/2019 Inflammation Plenary

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Inflammation


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ACUTE INFLAMMATION

Case 1


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Case 1

An 18-year old male presented with abdominal

pain of one day duration, initially felt at the

epigastric area and became localized at the right

lower quadrant. There was associated

intermittent cramping and one episode of

vomiting.


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Case 1

On admission, the temperature was 39.0oC,pulse rate was 104 per minute. There wastenderness and muscle guarding over the right

lower quadrant. The WBC count was 15 x 109/L.An appendectomy was performed.


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Gross Findings


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Gross Findings

The appendix was enlarged, indurated and

covered with a fibrinopurulent exudate. Cut

section showed softish wall with fecaloid and

purulent material filling its lumen.


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Microscopic Findings


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Questions

What is the histologic criterion for the diagnosis

of acute appendicitis?

What are the complications of appendicitis?


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ACUTE INFLAMMATION

Case 2


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Case 2

A middle-aged male, known alcoholic, was

admitted for difficulty in breathing and high

grade fever. He had been having cough,

productive of purulent sputum for the past five

days.


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Case 2

One week prior to admission, the patient was

allegedly found sprawled in front of their house

with vomitus all over his upper garments. The

patient died on the tenth hospital day.


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Gross Findings

Postmortem examination of both lungs showed

patchy areas of consolidation, with small

pockets of suppurative exudate within the right

lung.


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Questions

What are the possible outcomes of

bronchopneumonia? What in the history point

to an acute inflammatory condition?

What are the histologic features seen on the

slide that point to an acute inflammatory

process?


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ACUTE INFLAMMATION

Case 3


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Case 3

A 50-year old female, obese, and multiparous

was admitted for recurrent right hypochondriac

and epigastric pain, sometimes associated with

low grade fever of the last two years. The painwas noted especially after a heavy meal rich in

fat.


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Gross Findings


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Gross Findings

The gallbladder retained its normal pear shapedconfiguration, but there was remnants of fibrousadhesions on the serosal surface. The wall wasthickened. Several ovoid jet black calculi with

granular sufaces and brownish yellow cores werefound in the lumen. The mucosal surface was highlytrabeculated.


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Questions

What in the histology points to a chronic

inflammatory process?

What are the diseases where the presence of

lymphocytes connotes an acute inflammation?


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ACUTE INFLAMMATION

Case 4


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Case 4

A 40-year old male bank executive had been

having recurrent epigastric burning for several

months. Initial gastroscopy showed an ulcer at

the gastric antrum on the lesser curvature. Hewas given medications of three weeks.


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Case 4

There was no relief of symptoms and repeat

gastroscopy showed no reduction in the size of

the ulcer. Antrectomy with gastroduodenal

anastomosis was performed.


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Gross Findings


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Gross Findings

The antrectomy specimen showed a well

demarcated, oval shaped ulcer measuring 2.5

cm in its main diameter, with smooth slightly

rolled margin and clear base. The mucosaimmediately surrounding the ulcer is somewhat

edematous.


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Questions

What are the layers of a peptic ulcer?

What in the histology points o a chronic

inflammatory process?

What is the role of Helicobacter pylori in thepathogenesis of gastric ulcer?


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ACUTE INFLAMMATION

Case 5


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Case 5

A 10-year-old boy was described by his mother

as having been sickly for the last two years, with

recurrent cough and low grade afternoon fever.

Several physicians had treated him either as acase of simple upper respiratory infection or

pulmonary tuberculosis. Significant in the

history was that an aunt who took care of thechild in the past had at least two episodes of

frank hemoptysis during the past year.


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Case 5

A few weeks prior to admission, the patient

became apathetic and less active. Shortly

thereafter, the cough became more distressing

and occasionally productive of blood-streakedsputum. High fever and labored breathing

ensued. On admission, the child was cyanotic

and he died an hour later.


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Gross Findings

Post mortem examination showed that the lungs

were almost completely consolidated by

fibrocaseous lesions which included numerous

tiny grayish nodules and small cavitation. Theregional lymph nodes were enlarged and matted

together, cut section showed caseation necrosis.


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Questions

What is a granuloma?

Give other disease entities that cause

granulomatous inflammation.


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ACUTE INFLAMMATION

Case 6


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Case 6

A 25-year old female underwent excision of a 1-cmin diameter, firm, movable, non-tender, ill-definedleft breast mass. Four months before, she hadpreviously undergone excision of a benign breastmass in the same area. The case was diagnosed assuture granuloma.


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Questions

What are the two types of granuloma based on

inciting agent?


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Case 7

A 49-year old male complained of a polypoid,

ulcerated and bleeding mass on the left

forefinger. This mass started as a wound which

he got while doing carpentry work at home.Grossly, the mass was elevated, and ulcerated

with a hemorrhagic base. Histologic sections

showed granulation tissue.


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Questions

What is neovascularization? What factors induce

it?

What are the components of the repair process

of tissues subjected to chronic inflammation?

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