Chronic inflammation

Dr suvarna nalapat

Cellular interactions with chronic inflammation

endometrium
Chronic inflammation is more difficult to understand, because it is so variable. Seen here is chronic endometritis with lymphocytes and plasma cells in the endometrial stroma. In general, the inflammatory infiltrate of chronic inflammation consists mainly of mononuclear cells: lymphocytes, plasma cells, and macrophages.

cervix
chronic cervicitis. Prolonged acute inflammation or repeated bout of acute inflammation may lead to the presence of more mononuclear cells and chronic inflammation.

synovium
Chronic inflammation can go on for a long time. Seen here in the synovium of a patient with rheumatoid arthritis are collections of dark blue lymphocytes.

Viral-interstitial
Certain etiologic agents such as viruses are more likely to lead to chronic inflammation, as seen here in the lung of a patient with influenza A. Note also that the inflammatory infiltrates of chronic inflammation are more likely to be interstitial (within tissues) rather than exudative (above surfaces or in spaces) like acute inflammation.

Acute and chronic

You can find both acute and chronic inflammation here. This type of mixed inflammation is typical of repeated or recurrent inflammation. Thus, a diagnosis of "acute and chronic cholecystitis" or "acute and chronic cervicitis" can be made

scarring
Chronic inflammation can be seen in conjunction with some degree of scarring. Here, chronic inflammation of the bronchi has led to dilation and scarring with increased tan to white collagenous tissue

Destruction of bronchial wall

Chronic inflammation with destruction of the bronchial wall is seen here. An inflammatory infiltrate extends from the lumen to the left.

Chronic abscess
An abscess may have elements of chronic inflammation if it persists for some time. Thus, it is possible to have a "chronic abscess" with elements of both acute and chronic inflammation. Seen here in the right middle lung lobe is jus such a chronic abscess

organisation
the abscess has a mixture of inflammatory cells, but the wall of the abscess is "organizing" with ingrowth of capillaries (filled with red blood cells) and fibroblasts

Granulation tissue
Healing of inflammation often involves ingrowth of capillaries and fibroblasts. This forms granulation tissue. Here, an acute myocardial infarction is seen healing. There are numerous capillaries, and collagen is being laid down to form a scar. Noninfarcted myocardium is present at the far left.

Organisation with granulation tissue

wall of an abscess that is organizing has granulation tissue, seen here at the left. The purulent exudate with some hemorrhage is seen at the right in the abscess center.

Granulation tissue
At high magnification, granulation tissue has capillaries, fibroblasts, and a variable amount of inflammatory cells (mostly mononuclear, but with the possibility of some PMN's being present).

Endresult-scarring
The end result of inflammation can be scarring. Here, the alveolar walls are thickened and filled with pink collagen following an autoimmune disease lasting for decades

resolution
Resolution of inflammatory processes in body cavities may result in the formation of adhesions, which are thin bands of collagenous connective tissue, as seen here between the right lung and the chest wall at autopsy. Adhesions, if extensive can restrict motion or cause retraction to an abnormal position of internal organs.

Healing in surgical wound

healing biopsy site on the skin seen a week following the excision, The skin surface has reepithelialized, and below this is granulation tissue with small capillaries and fibroblasts forming collagen. After a month, just a small collagenous scar will remain.

Pulmonary tuberculosis
Granulomatous disease can become quite extensive. Here are numerous confluent granulomas in a case of pulmonary tuberculosis.

Caseation-hilar node
Grossly, a granuloma tends to be a focal lesion. Seen here in a hilar lymph node is a granuloma. Granulomas due to infection are often "caseating" because they have prominent caseous necrosis.

Granulomatous inflammation
focal nature of granulomatous inflammation is demonstrated .there are scattered granulomas in the parenchyma. This is why the chest radiograph with tuberculosis or other granulomatous diseases is often described as "reticulonodular". A biopsy could miss such lesions from sampling error, too

granuloma
two pulmonary granulomas. Granulomatous inflammation typically consists of epithelioid macrophages, giant cells, lymphocytes, plasma cells, and fibroblasts. There may be some neutrophils.

c.immitis granuloma
Granulomatous inflammation occurs in response to some agents which persist for a long time and require a more orchestrated immune response to fight them.Typical rounded and focal granulomas.. A couple of spherules of C. immitis are present in the giant cell in the center.

Langhans giant cell

Giant cells are a "committee" of epithelioid macrophages. Seen here are two Langhans type giant cells in which the nuclei are lined up around the periphery of the cell. Additional pink epithelioid macrophages compose most of the rest of the granuloma.

Epitheliod cells
These are epithelioid cells around the center of a granuloma. They get their name from the fact that they have lots of pink cytoplasm similar to squamous epithelial cells. Their nuclei tend to be long and stringy

caseation
caseating granuloma. Epithelioid cells surround a central area of necrosis that appears irregular, amorphous, and pink. Grossly, areas of caseation appear cheese-like.

Caseating granuloma
Granulomas caused by tuberculosis and by dimorphic fungi such as H. capsulatum or C. neoformans are often caseating. Here, the area of caseation is seen at the upper right.

Miliary granulomas
With a poor immune response to the agents producing granulomatous inflammation, there is extensive spread of infection with the production of a "miliary" pattern of granulomas as seen here in the lung of a patient with miliary tuberculosis. The 1 to 2 mm granulomas are scattered around like millet seeds.

Foreign body giant cell

Here is a foreign body type giant cell at the upper left of center adjacent to a segment of vegetable material aspirated into the lung. Such foreign body giant cells have nuclei scattered haphazardly about the cell.

Foreign body giant cell

Two foreign body giant cells are seen just to the right of center where there is a bluish strand of suture material from a previous operation.

Talc xals-polarised light

Seen under polarized light are numerous bright white crystals of talc in a patient who was an intravenous drug user. The injected drug was diluted with the talc. Such foreign material can produce a granulomatous reaction

Silicotic nodule
Sometimes the inflammatory reaction is mainly one of scarring, as seen here with a silicotic nodule of the lung. The inhaled silica persists indefinitely and produces an inflammatory reaction that is marked by prominent fibrosis. Dense pink collagen is seen in the center of the nodule