1. Lab 1 : Inflammation & Repair Lab 1 : Inflammation & Repair Pathology Department of Microbiology and Immunology - 2015 - Dr. Manal Maher Hussein

2. Signs of Inflammation

3. Dr. Manal Maher Hussein - 60-70% - 1-2% - 1% - Eccentric nucleus - Large - Granular cytoplasm - Granular cytoplasm - Granular cytoplasm and not lobed nucleus (red with eosin dye) (Blue with basic dyes) - Agranular cytoplasm - Agranular cytoplasm - trilobed nucleus - Biilobed nucleus - Bilobed nucleus -4-6% - Bean shaped nucleus - Monocytes in blood, Macrophages on migration to tissues -Agranular Cytoplasm - Can fuse forming giant cells Polymorphnuclear Leukocytes Lymphocytes Non Immune components Immune cells

4. Dr. Manal Maher Hussein 1 - Brain, purulent inflammation, meningitis 1 - Brain, purulent inflammation, meningitis Type of inflammation: Type of inflammation: Suppurative acute inflammation (meningitis) Causes: Causes: Haemophilus influenzae Haemophilus influenzae Characteristic pathological features Characteristic pathological features Foci of white-tan purulent exudate over the surface of the brain (acute meningitis).

5. 2 - Heart, fibrinous inflammation (pericarditis) Type of inflammation: Type of inflammation: Non-Suppurative acute inflammation Non-Suppurative acute inflammation Characteristic pathological features Characteristic pathological features –The pericardium should be shiny and smooth. –The pericardium is opaque, surface uneven –Exudation of fibrinogen- containing fluid from vessels, has led to fibrin deposition. Dr. Manal Maher Hussein

6. 3 - Larynx and trachea, pseudo- membranous inflammation. Type of inflammation: Type of inflammation: Pseudomembranous inflammation, Causes: Causes: Corynebacterium diphteriae Corynebacterium diphteriae Characteristic pathological features Characteristic pathological features – Pseudomembrane made up of a fibrin rich exudate combined with necrotic mucosa.

7. Dr. Manal Maher Hussein 4 - Colon, pseudomembranous inflammation, colitis. C difficile causes a pseudomembrane. C difficile causes a pseudomembrane. Pseudomembrane made up of a fibrin rich exudate combined with necrotic tissue. Pseudomembrane made up of a fibrin rich exudate combined with necrotic tissue. Notice the redness (vascular congestion) in the background. Notice the redness (vascular congestion) in the background. Type of inflammation:Type of inflammation: pseudomembranous inflammation Causes:Causes: Clostridium difficile producing exotoxins Characteristic pathological featuresCharacteristic pathological features

8. Dr. Manal Maher Hussein Q. Mention the name of bacteria, which may cause pseudomembranous inflammation? - Clostridium difficile - Corynebacterium diphteriae

9. Dr. Manal Maher Hussein Differences between acute and chronic inflammation ACUTE INFLAMMATION ACUTE INFLAMMATION More abundant fluid exudate More abundant fluid exudate Main inflammatory cells: neutrophils and macrophages Main inflammatory cells: neutrophils and macrophages Absent or mild fibrosis Absent or mild fibrosis CHRONIC INFLAMMA TION CHRONIC INFLAMMA TION Usually scanty fluid exudate Usually scanty fluid exudate Main inflammatory cells: macrophages, lymphocytes, plasma cells and giant cells. Main inflammatory cells: macrophages, lymphocytes, plasma cells and giant cells. Marked fibrosis Marked fibrosis

10. Dr. Manal Maher Hussein 5 - Normal lung the normal lung appears as mostly empty space. the normal lung appears as mostly empty space. Alveoli have thin walls--less than 1 micron. Alveoli have thin walls--less than 1 micron. The alveolar wall has a thin epithelial cell.. The alveolar wall has a thin epithelial cell..

11. Dr. Manal Maher Hussein 6.1 - Lung, fibrinous and haemorrhagic inflammation, pneumonia. In the lung parenchyma, the normally empty alveolar spaces are filled with leukocytes and pink fibrin. In the lung parenchyma, the normally empty alveolar spaces are filled with leukocytes and pink fibrin. Note: Note: The alveolar septal walls. The alveolar septal walls.

12. Dr. Manal Maher Hussein 6.2 - Lung, fibrinous and hemorrhagic inflammation, pneumonia- High power the inflammatory exudate consists of the inflammatory exudate consists of 1.Erythrocytes leaked out the permeable 2. and congested capillaries, 3.thin strands of fibrin derived from fibrinogen 4.leukocytes 1 3 4 2

13. Dr. Manal Maher Hussein What is the type of inflammation? Acute fibrinous, haemorrhagic inflammation

14. Dr. Manal Maher Hussein 9.1 - Lung, chronic inflammation Features that are characteristic of chronic inflammation: 1.infiltration by mononuclear cells, 2.fibrosis, and tissue destruction. 3.Lymphocytes have aggregated to form a lymphoid nodule. They are also scattered in the areas of fibrosis. 4.Fibrous tissue has replaced the normal lung parenchyma that has been destroyed. 5.Only a few alveolar spaces, separated by markedly fibrotic septa, remain. 1 2 3 4 5

15. Dr. Manal Maher Hussein 7- Normal cervix The non-keratinizing squamous epithelium 1. Endocervix lined by tall columnar cells 2. The endocervical glands underlying the endocervix. 3. The endocervical glands are also lined by tall columnar cells. 1 2 3

16. Dr. Manal Maher Hussein 8.1- Uterine cervix, chronic cervicitis, medium power Chronic inflammatory infiltrate reveals a lymphoid follicle, an indicator of chronic inflammation Chronic inflammatory infiltrate reveals a lymphoid follicle, an indicator of chronic inflammation

17. Dr. Manal Maher Hussein 8.2 - Uterine cervix, chronic cervicitis, chronic inflammation This high-power view demonstrates the mononuclear cells typical of chronic inflammation. This high-power view demonstrates the mononuclear cells typical of chronic inflammation. It consists of It consists of 1.lymphocytes, 2.plasma cells, and macrophages. 1 2 2

18. Dr. Manal Maher Hussein How do these tissue changes differ from those in acute inflammation? How do these tissue changes differ from those in acute inflammation? Characteristic features of chronic inflammation, infiltration by mononuclear cells, fibrosis, tissue destruction, lymphoid nodule. Characteristic features of chronic inflammation, infiltration by mononuclear cells, fibrosis, tissue destruction, lymphoid nodule.

19. Dr. Manal Maher Hussein Question: Under what conditions are eosinophils prominent in the inflammatory infiltrate? -Allergic inflammations

20. Dr. Manal Maher Hussein 12- Acute salpingitis 12.1 - Normal fallopian tube, Low power Note the delicate mucosal folds lined by epithelium, and their vascularized stroma. Note the delicate mucosal folds lined by epithelium, and their vascularized stroma. no inflammatory cells in the lumen or in the mucosa no inflammatory cells in the lumen or in the mucosa NB muscularized wall NB muscularized wall

21. Dr. Manal Maher Hussein 12.2 - Normal fallopian tube, Medium power: 1.The normal tubal mucosa can be seen better. 2.There are some darkly staining nuclei in the subepithelial layer. They are the normal resident lymphocytes and macrophages that can be found at many mucosal sites. 1 2

22. Dr. Manal Maher Hussein 12.3 - Uterus, fallopian tubes, and ovaries, acute inflammation Note: Note: 1. Uterus 2. Fallopian tube 3. Normal ovary 4. Inflamed tube-ovarian mass 5. Cervix Note that the fallopian tubes are hemorrhagic and edematous, so that the architecture of the right tube and ovary is obscured. The right fallopian tube and ovary have been converted into a single, irregular, inflamed mass. Note that the fallopian tubes are hemorrhagic and edematous, so that the architecture of the right tube and ovary is obscured. The right fallopian tube and ovary have been converted into a single, irregular, inflamed mass. 1 2 3 4 5

23. Dr. Manal Maher Hussein 12.3 - Uterus, fallopian tubes, and ovaries, acute inflammation Note: Note: 1. Uterus 2. Fallopian tube 3. Normal ovary 4. Inflamed tube-ovarian mass 5. Cervix What cardinal signs of inflammation can you see here?— What cardinal signs of inflammation can you see here?— Redness and swelling ; not seen are heat, pain, and loss of function. Redness and swelling ; not seen are heat, pain, and loss of function.

24. Dr. Manal Maher Hussein 12.4 - Fallopian tube, acute inflammation, Low power: There is a massive inflammatory infiltrate in both the mucosa and muscular wall of the fallopian tube. There is a massive inflammatory infiltrate in both the mucosa and muscular wall of the fallopian tube. Note that the lumen is virtually obscured by an outpouring of inflammatory cells. Note that the lumen is virtually obscured by an outpouring of inflammatory cells. Compare with the images of normal fallopian tube. Compare with the images of normal fallopian tube.

25. Dr. Manal Maher Hussein 12.5 - Fallopian tube, inflammatory disease, High power 1.Note the extensive neutrophils infiltrate in the lumen 2.Some neutrophils infiltration in the mucosa. What are the types of inflammatory cells in acute inflammation?- neutrophils, macrophages 2 1

26. Dr. Manal Maher Hussein

27. GRANULOMA CHRONIC SPECIFIC INFLAMMATION

28. Dr. Manal Maher Hussein Granuloma is a chronic specific inflammation characterized by focal accumulation of large number of macrophages with a mixture of lymphocytes, plasma cells, giant cells Granuloma is a chronic specific inflammation characterized by focal accumulation of large number of macrophages with a mixture of lymphocytes, plasma cells, giant cells What is a granuloma?

29. Dr. Manal Maher Hussein Types of granulomas Types of granulomas 1. Infective granuloma, 2.Foreign body granuloma, 3.Granuloma of unknown cause : Sarcoidosis

30. Dr. Manal Maher Hussein 11 - Lymph node, granulomas lymph node from a patient with sarcoidosis (unknown cause). lymph node from a patient with sarcoidosis (unknown cause). The granulomas are closely packed, often merging, with scant intervening lymphoid tissue. The granulomas are closely packed, often merging, with scant intervening lymphoid tissue. Each of these clusters of pink cells is a granuloma of connected epithelioid cells and Each of these clusters of pink cells is a granuloma of connected epithelioid cells and giant cells, surrounded by lymphocytes. giant cells, surrounded by lymphocytes.

31. Dr. Manal Maher Hussein - What is the origin of epithelioid cells? Transformed macrophage Transformed macrophage

32. Dr. Manal Maher Hussein See you Next lab