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CHRONIC INFLAMMATION

CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

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Page 1: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

CHRONIC INFLAMMATION

Page 2: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

CharactersCausesTypes

Persistent response to injury

Prolonged duration (weeks,months,years)

Chronic inflammation

Page 3: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

Chronic inflammation

Characters:1. Infiltration with mononuclear cells:

lymphocytes, microphages and plasma cells

2. Tissue destruction3. Repair,new vessel proliferation

(angiogenesis) and fibrosis

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COMMON CAUSES

Cause: continuous existence of inflammatory agents.

a. Persistent microbial infections

b. Prolonged exposure to potential toxic agents: foreign body that cannot be degradation

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c. Type Ⅳ allergic reaction caused by some special infection, e.g.TB et al.

d. Some autoimmune disease, e.g. rheumatoid arthritis, colitis, graves’ disease.

COMMON CAUSES

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Morphological patterns

Nonspecific proliferative inflammation

Granulomatous inflammation

TYPES

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Nonspecific proliferative inflammation

is characterized by coexist of many kind of inflammatory cells.

Pathological changes:mononuclear cells (lymphocytes, macrophages , plasma cells) infiltration and proliferation of fibroblasts and connective tissue, vessels , epithelial cells.

Page 8: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

Inflammatory polyp:an inflammatory mass formed by excess proliferation of local epithelial cells, glands and connective tissues, often with peduncle. Example : Cervical polyp, Nasal polyp

Nonspecific proliferative inflammation

Page 9: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

Cervical polyp

Page 10: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

Cervical polyp

Page 11: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

Nasal inflammatory polyp

Page 12: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

Inflammatory pseudo tumor: a clear tumor- like mass formed by local tissues and cells proliferation, it is rather difficult to distinguish with real tumor by X-ray or naked-eyes. it is located in lung and eye orbit.

Nonspecific proliferative inflammation

Page 13: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

tumor-like mass in lung with X-ray examination

Page 14: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

Inflammatory pseudo tumor

Page 15: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

Granulomatous inflammation

Granuloma:a distinct nodular lesion that is consisted of aggregation of macrophages or its derived cell.

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Conception of Granulomatous inflammation :

a distinctive pattern of chronic inflammation characterized by aggregation of activated macrophages.

Macrophages derived from blood monocytes.

Liver: Kupffer cells;Spleen and lymphnodes: sinus histiocytes;Nervous system: microglial cells;Lung: alveolar macrophages

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Classification of granuloma

1).Foreign body granuloma:Granuloma may occur in response to foreign body or T-cell mediated immune response to organism.silicosis

2).Infectious granuloma: it often acts as a diagnostic evidence.

tuberculosis, typhoid fever, rheumatic disease, schistosomiasis, leprosy etc.

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Note :some granulomatous inflammation

may be acute inflammation. Example : typhoid fever.

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Page 20: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

Morphology of granuloma:

In the usual condition, there are foreign body or necrosis in the central area and they were surrounded by epithelioid cells and multinucleated giant cells.

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granuloma : surrounding fiber, epithelioid cells and multinucleated giant cells

Page 22: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

Infectious/Immune Granuloma

TuberculosisRheumaticTyphoid feverLeprosy

Page 23: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

Typhoid fever (granulomatous inflammation)

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rheumatic myocarditis

Page 25: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

Langhans giant cellHorseshoe pattern

Epitheloid cell

Tuberculosis

Page 26: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

Foamy cells

Leprosy of skin (foam cells)

Page 27: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

Egg of Schistosom

schistosomiasi s Chronic egg nodule (pseudotubercle: eggs surrounded by epithelioid cell, multinucleated giant cell; eggs are often necrotic or calcified. This structure is like that of a tubercle.

Page 28: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

Foreign Body Granuloma

Page 29: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

Foreign body granuloma

Page 30: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

Foreign body granuloma multinucleated giant cell

Page 31: CHRONIC INFLAMMATIONm-learning.zju.edu.cn/G2S/eWebEditor/uploadfile/20161009234444730.pdf · Nasal inflammatory polyp. Inflammatory pseudo tumor: a clear tumor- like mass formed by

Difference of two basic patterns

Acute inflammation

Chronic inflammation

Duration Characters

Short, minutes up to a few days

longer, days to years

Fluid and plasma protein exudation, neutrophilis accumulation

Lymphocytes,plasma cells, macrophages, vascular, proliferation and scarring

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Influence factors to the inflammation

local factors:local circulation; inflammatory exudate

general factors:• Immunity • Nutrition • Endocrine

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OUTCOMES OF INFLAMMATION

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Outcome of acute inflammation

Resolution: restoration to histological and functional normalcy

Scarring or fibrosis: extensive fibrinous exudates; abscess formation—scarring

extensive neutrophilic infiltrates in certain bacterial or fungal infections, these organisms are said to be pyogenic, or pus forming

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the persistence of a fibrinosuppurative exudate into alveolar spaces

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the exudate in the alveolar spaces undergoes progressive enzymatic digestion, debris is resorbed, ingested by macrophages, coughed out.

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Fibrosis of pneumonia

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Progression to chronic inflammation:

last months or years

Spread:

• local spread

• lymphatic spread

• vascular spread

Death : result from toxemia ,e.g. endotoxic shock and its complication, such as encephalitis and myocarditis

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Vascular spreadbacteremia: bacteria are found within the blood

toxemia: bacteria are not found within the blood , while toxins are absorbed into blood and producing a systemic illness

septicemia: bacteria within the blood are proliferating and producing a systemic illness

pyemia: pyogenic bacteria within the blood are proliferating and producing multiple abscess in different organs and a systemic illness

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• Healing:

Complete resolution (complete Healing)

Scarring or fibrosis (incomplete Healing)

• Persistence and Delay

Outcome of Chronic inflammation

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complete Healing

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Scarring

Protruding, redness,

Irregular

incomplete Healing

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