1. CHRONIC SPECIFIC INFLAMMATION
GRANULOMA
CHRONIC SPECIFIC INFLAMMATION
Dr. Manal Maher Hussein

2. 35 - Coccidioides immitis, infective granulomatous inflammation (type of chronic specific inflammation)
The granuloma seen here demonstrates the typical rounded and focal nature of this type of inflammation.
A couple of spherules of C. immitis (fungi) are present in the giant cell in the center.
Dr. Manal Maher Hussein

3. 36- Schistosoma haematobium, urinary bladder
Inside the suppurative granuloma, paired dead flukes containing black pigment in the gut are observed.
Inflammation is pronounced in the surrounding tissue surrounded by a zone of epithelioid cells.
The dead flukes are infiltrated by neutrophils.
Dr. Manal Maher Hussein

4. 37 - Schistosoma mansoni ova, colon
Granuloma of Schistosoma mansoni ova in colon surrounded by a zone of epithelioid cells.
Dr. Manal Maher Hussein

5. INFLAMMATION AND REPAIR Chronic hepatitis and cirrhosis
Dr. Manal Maher Hussein

6. Normal liver
In the center is the portal triad, clearly bordered by the surrounding hepatocytes.
Note the small number of inflammatory cells.
The portal triad consists of portal vein,
bile ductule,
portal arteriole
Dr. Manal Maher Hussein

7. 33.5 - Liver, chronic viral hepatitis (Hepatitis B virus)
chronic inflammatory infiltrate is limited to the portal area.
It does not extend into the adjacent lobule
Dr. Manal Maher Hussein

8. 13.2 - Liver, initial biopsy specimen
mononuclear cells extending from the portal area
where it surrounds hepatocytes, leading to their degeneration and death (so-called piecemeal necrosis).
This predominantly portal pattern of mononuclear cell inflammation is the characteristic of chronic hepatitis.
Dr. Manal Maher Hussein

9. Liver, initial biopsy specimen
Hydropic degeneration (Ballooning).
Councilman body= hypereosinophilic cytoplasm & shrunken nucleus (pyknosis) with clumped chromatin of the dying hepatocyte
Are the enlarged and somewhat vacuolated hepatocytes seen in this biopsy specimen healthy? No; they are reversibly injured. The swelling and vacuolation are due to influx of water and Na+.

10. 13.3 - Liver, second biopsy specimen,
The portal-based inflammatory infiltrate persists.
Enough hepatocytes have been lost and replaced by fibrous connective tissue
Bridging necrosis with fibrosis
Dr. Manal Maher Hussein

11. Liver cirrhosis
With continuing liver cell necrosis and fibrosis,
dense bands of fibrous connective tissue are formed.
The surviving liver cells regenerate to compensate for the loss of liver cells.
This regeneration does not produce normal liver cell lobules.
Instead, dense bands of fibrous tissue separate nodules of regenerating hepatocytes.
Inflammatory activity is still apparent within the fibrous bands.
Dr. Manal Maher Hussein

12. What features that characterize chronic inflammation can you identify in this biopsy specimen?
Mononuclear cell infiltrate, tissue death, and fibrosis.

13. 13 - Chronic hepatitis and cirrhosis
Dr. Manal Maher Hussein

14. 33.8 - Liver, cirrhosis from chronic viral hepatitis - Gross, cut surface
Nodules of regenerative liver parenchyma
separated by bands of fibrous scar tissue, which appear as tan areas.
Dr. Manal Maher Hussein

15. Liver, cirrhosis from chronic viral hepatitis
Normal
Cut surface
Dr. Manal Maher Hussein

16. INFECTIOUS DISEASES
Dr. Manal Maher Hussein

17. DISEASES OF THE LIVER VIRAL HEPATITIS:
Hepatic inflammation caused by one of the following viruses:
Hepatitis A virus (HAV), : It causes acute hepatitis.
Hepatitis B virus (HBV), : Illness may be acute hepatitis, & or chronic hepatitis.
Hepatitis C virus (HCV), : It is the most common cause of chronic hepatitis in Egypt.
Hepatitis E virus (HEV): It causes acute hepatitis.
Dr. Manal Maher Hussein

18. 33 - Viral hepatitis and cirrhosis 33.1 - Liver, acute viral hepatitis
cellular infiltrate throughout the hepatic lobule obscures the normal-appearance..
Dr. Manal Maher Hussein

19. 33.2 - Liver, acute viral hepatitis (Hepatitis B virus)
Regenerating hepatocytes
inflammatory cellular infiltrate
The hypercellularity is due to infiltration by inflammatory cellular infiltrate and Kupffer cell.
Hepatocytes necrosis and ongoing hepatocytes regeneration.
Regenerating hepatocytes are large, frequently containing multiple nuclei.
Dr. Manal Maher Hussein

20. 33.3 - Liver, acute viral hepatitis (Hepatitis B virus)
Sinusoidal inflammation
Hydropic degeneration (Ballooning). of hepatocytes
In this less severe case of acute hepatitis (hepatitis B), there is less sinusoidal inflammation.
Ballooning of the cytoplasm in degenerating hepatocytes is demonstrated.
Dr. Manal Maher Hussein

21. 33.4 - Apoptosis, acute viral hepatitis
Councilman bodies are individually apoptotic hepatocytes.
They appear as small cells with eosinophilic cytoplasm and a dark pyknotic nucleus.
lobular disorder
sinusoidal inflammation.
Dr. Manal Maher Hussein

22. 33.5 - Liver, chronic viral hepatitis (Hepatitis B virus)
chronic inflammatory infiltrate is limited to the portal area.
It does not extend into the adjacent lobule
Dr. Manal Maher Hussein

23. 33.6 - Liver, chronic viral hepatitis (Hepatitis B virus)
chronic inflammation in the portal areas that extends into the adjacent lobule,
This is the morphologic correlate of progressive active liver damage .
No cirrhosis
Dr. Manal Maher Hussein

24. 33.7 - Liver, chronic viral hepatitis C
Portal inflammatory infiltrates with lymphoid follicles
Steatosis, in contrast to HBV infection.
Dr. Manal Maher Hussein

25. Dr. Manal Maher Hussein acute viral hepatitis chronic viral hepatitis
chronic viral hepatitis, progressive active liver damage
chronic viral hepatitis C
Dr. Manal Maher Hussein

26. 34 - Helicobacter pylori, stomach
Gastritis = Imflammation of gastric mucosa.
Gastritis is accompanied by infection with Helicobacter pylori.
This small curved to spiral rod-shaped bacterium is found in the surface epithelial mucus of most patients with active gastritis.
The rods are seen here black.
Dr. Manal Maher Hussein