CYTOPATHOLOGY- 6 DR. MAHA AL-SEDIK

Objectives: 1- Granulomatous inflammation. 2- Cytologic patterns of inflammation 3- Cells involved in inflammation. 4- Cytology of acute inflammation 5- Cytology of chronic inflammation. 6- Neutrophilic inflammation. 7- Eosinophilic inflammation. 8- Lymphocytic inflammation.

Granulomatous Inflammation :  A distinct pattern of chronic inflammation characterized by formation of granulation tissue.  It is a protective response to chronic infection or foreign material, preventing dissemination and restricting inflammation.

What is a Granuloma ?  A granuloma is a microscopic aggregation of macrophages that are surrounded by a collar of mononuclear leukocytes, principally lymphocytes and occasionally plasma cells and surrounded by fibrous cuff.

Granuloma

Causes of Granulomatous Inflammation:  Bacteria: Tuberculosis, Leprosy, Syphilis, Actinomycosis.  Parasites: Schistosomiasis.  Fungi: Histoplasmosis, Blastomycosis.  Foreign body Granulomas : (wood, silica, asbestos, silicone).

Mechanism of Granuloma Formation: 1.Bacilli are inhaled by droplets. 2.Then phagocytosed by alveolar macrophages. Macrophages fail to digest the phagocytosed bacteria and accumulate at the site of injury. 3. A localized inflammatory response recruits more macrophage and mononuclear leucocytes. 4.The granuloma consists of a group of infected macrophages surrounded by foamy macrophages and a ring of lymphocytes and a fibrous cuff.

Cytologic patterns of inflammation The cytologic diagnosis of inflammation involves two initial steps:  1) identifying a population of inflammatory cells.  2) correctly assessing whether or not that population is abnormal for the specimen being evaluated. Depending on the type of predominant nucleated cells present, specific diagnoses are suggested.

Who will answer?

Features of acute inflammation:  Neutrophils predominate.  Eosinophils may be present.  Red blood cells if hemorrhage has occurred.  Fibrinous material in the background.  Bacteria or other microorganisms.

voided urine – Numerous acute inflammatory cells are seen in the background

Features of chronic inflammation:  Cells of Chronic Inflammation 1.Lymphocytes 2.plasma cells 3.Macrophages 4.Eosinophils 5.Basophils  Bacteria, fungi, crystals, other microorganisms

Cytologic features of various types of breast lesions as seen in FNA specimens

 Any organisms present should always be reported, since they are often a significant cause of inflammation.  The morphology should be described, such as bacilli or cocci, and whether they are single, in chains or pairs.  A notation should be made as to the location of the organisms, that is, if the organisms are intracellular, extracellular, or on the surface of the cell.  When there are organisms such as bacteria present, the inflammation is said to be septic.

Bacteria You should write extracellular cocci

The most common inflammatory cell pattern will be neutrophilic (suppurative) and the least common is lymphocytic.

Neutrophilic inflammation:  the most common pattern of inflammation seen in most preparations.  The most common cause is bacterial infection, but there are other causes.  Key to the differentiation of septic vs. non-septic suppurative inflammation is the ability to recognize degenerative neutrophils (indicates sepsis) from nondegenerative neutrophils (non septic inflammation).

Degenerative features of neutrophils:  Degenerate neutrophils support a bacterial cause.  Degenerative changes in neutrophils consist of swollen, blurry nuclei and foamy cytoplasm.  These changes are due to the toxins produced by the bacteria and cytotoxic substances released by the neutrophils themselves. (these changes can also be induced by letting samples sit for a day before slides are prepared). So, make films as soon as possible (<24 hours from collection; preferably in the first 30 minutes after collection).

Sputum septic inflammation

 If the neutrophils are “healthy looking,” non degenerate, then other causes of neutrophilic inflammation should be considered: chemical, immune-mediated, traumatic tissue injury, or other types of infectious agents (actinomycoses, viral or fungal).

Neutrophils  Degenerative = septic = bacterial  Nondegenerative = nonseptic = immune mediated foreign body trauma viral

Eosinophilic inflammation: Highly cellular smears that have a large proportion of eosinophils (more than 20% of the inflammatory cells) are indicative of eosinophilic inflammation. Causes:  parasitic cause.  immune/allergic e.g. asthma.  fungal infections.

Lymphocytic inflammation: This is an uncommon to rare inflammatory pattern. Causes: Most common is chronic inflammation.  Immune mediated diseases.  Tick borne diseases.  Gastroenteritis.  Injection reaction i.e. Rabies vaccine.

Chronic inflammation - Lymphocytes. [CHRONIC INFLAMMATION].

lymphocytic thyroiditis