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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?

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]. 

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