what is granuloma?
DESCRIPTION
WHAT IS GRANULOMA?. What is granuloma? Mechanism? Why? Differential diagnosis?. Granuloma. A granuloma is a focal area of granulomatous inflammation. Macrophages that are transformed into epithelium like cells Mononuclear leukocytes (principally lymphocytes and plasma cells) Giant cells - PowerPoint PPT PresentationTRANSCRIPT
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WHAT IS GRANULOMA?
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What is granuloma? Mechanism? Why? Differential diagnosis?
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Granuloma
A granuloma is a focal area of granulomatous inflammation.
Macrophages that are transformed into epithelium like cells
Mononuclear leukocytes (principally lymphocytes and plasma cells)
Giant cells Two types- pathogenetically
Foreign body type Immune granulomas
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Epitheloid cells
Pale pink granular cytoplasm Indistinct cell boundaries The nucleus is oval or elongate, folding of the
nuclear membrane
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Giant cells
Fusion of the epitheloid cells Located at the center or periphery of
granulomas 40-50 milimicron 20 or more small nuclei Location of nuclei
Peripherically in Langhans-type Haphazardly in foreign-body type
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Foreign body granuloma
Material large enough to preclude phagocytosis, and do not incite either an inflammatory or an immune response
Talc, sutures ec. The foreign body can be identified
(with polarized light)
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Immune granuloma
Insolubl particles Cell- mediated ımmun response Macrophages T cells
cytokines (IL-2)
IFN-gamma Granuloma
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GRANULOMATOUS LESIONS OF THE LUNG
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GRANULOMATOUS LESIONS OF THE LUNG- CLASSIFICATION
1) INFECTIOUS
2) NON-INFECTIOUS
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Infectious granulomatous diseases Bacterial
Actinomycosis, botryomycosis, nocardiosis, Mycobacterial Fungal
Pnömosistis Protozoal
Dirofilaria Parasitic Aspiration pneumonitis
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NON-INFECTİOUSgranulomatous disease Wegener granulomatosis Rheumatoid nodule Bronchocentric granulomatosis Churg- Strauss Syndrome Sarcoidosis Necrotizing sarcoid granulomatosis Pulmonary hyalinizing granuloma Extrinsik allergic alveolitis Drug reaction
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Non infectious granulomatous diseases Eosinophilic pneumonitis Nodular amyloidosis Giant cell reaction Exogen lipoid pneumonia Intravenous drug reaction Pneuomoconiosis (Berylliosis) Localised bronchiectasis Lymphoma (Hodgkins’)
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Diagnostic approach
Clinical information Anamnesis Clinical findings
Acute, subacute, chronic
Radiologic findings Histopathological pattern analysis
Pattern analysis Components of granuloma
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Histopathological pattern analysis Angiosentrik Bronchocentric-bronchiolocentric Pleural-subpleural Lymphatic disttribution Peripheral acinar Septal changes Random distribution Airspace consolidation Diffuse interstitial infiltration
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Components of granuloma
Epitheloid histiocytes Giant cells Lymhoid cells Neutrophils Necrosis Abscess. Foreign body, cyrstal, infectious agent,
deposition of material
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Infectıous granulomas
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tbc
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Tuberculoid granuloma
Peribronchioler, interstitial, perivascular Cellular, necrotic Langhans type giant cell Lymphocytes, few neutrophiles No foreign body!
Clinical and microbiological investigation
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Fungal granuloma
Interstitial, perivascular Cellular, necrotic Foreign body type giant cell Lymhoid cells,neutrophils Grocott, PAS vs special stains
Microbiological investigation
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Non infectious granulomas
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Granuloma of immune response
Rective to tumor Draniage lymph nodes Lymphoproliferative diseases Underlying disease
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Sarcodosis
Interstitial, pleural, Lymphatic distribution perivacular
Cellular, small fibrinoid – coagulative necrosis Giant cells- asteroid body Schaumann body Lymphocytes Large necrosis-in necrotizing sarcoidosis
neutrophiles
Clinical information
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Bronchocentric granulomatosis Bronchiolocentric Necrotising Giant cell Lymphocytes- neutrophiles-eosinophiles Grocott, PAS
Asthma and aspergillosis
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Pneumoconiosis
Interstitial, lymphatic distribution Cellular, necrotic. Foreign body type giant cells Lymphocytes Crystal
Clinical story
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Wegener granuloma
Interstitial, vascular (rarely pleural, septal,bronchocentrically)
Cellular, necrotic (rarely fibrinoid) Giant cells İnflammatory backgroud, neutrophiles,
abscesses formation, geographic necrosis Absence of sarcoid type granuloma. Vascular dyes CLINICAL INFORMATION
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Churg-Strauss
Interstitial, vascular (small sized vessels) Cellular, necrotic Small granulomas Giant cells Eosinophils Vascular dyes
CLINICAL INFORMATION
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Collagen vascular diseases
Pleural, septal. Cellular, necrotic (Fibrinoid necrosis) Palisaded histiocytes-fibrosis- lymphocytes No inflammatory background
CLINICAL INFORMATION
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Interstitial diseases with granuloma Peribronchioler, interstitial, perivascular Cellular, necrotic Langhans type or foreign body type giant
cells
Additional features- Clinical information
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DIFFERENTIAL DIAGNOSIS
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PATTERN ANALYSIS
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tbc br
weg
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GRANULOMA
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tbc
sarkoidoz
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sarkoidoz
silikoz
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NECROSIS
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tbc
Br
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Kollagen doku has
tbc
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wegener
tbc
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INFLAMMATORY CELLS
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wegener
Eozinofil pnömoni
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wegener
Eks al
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GIANT CELLS
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tbc
sarkoidoz
weg
eks
weg
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Last words
Granuloma is a part of granulomatous inflammation Foreign type and immune granuloma Several reasons
Infectious Non-infectious
Two main group With necrosis Without necrosis
Clinical+ Radiological+Pathological
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