Chronic Inflammation😊

Chronic Inflammation

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Cells of Chronic Inflammation

  • Lymphocytes, Macrophages, Plasma Cells.
  • Macrophages are the most important cell.
    • A.k.a. histiocytes in tissues.
      • Macrophage Names in Tissues:
          • Tissue
          Macrophage Name
          Notes
          Brain
          Microglia
          —
          Lungs
          Dust cells → Alveolar macrophages
          Clara cells → non ciliated secretory cells in bronchioles on lung
          Liver
          Kupffer cells
          —
          Kidney
          Mesangial cells
          —
          Spleen
          Littoral cells
          —
          Placenta
          Hofbauer cells
          Zika virus residence
          Bone
          Osteoclast
          —
          Synovium
          Synoviocytes (Type A)
          —

Granulomatous Inflammation

  • A type of chronic inflammation.
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Caseating Granuloma
Caseating Granuloma
Components of a Granuloma
Features
Lymphocytic Collar (Periphery)
Made of Th1 cells  (release IFN γ for granuloma formation). 
Naked Granuloma:
Lymphocytic collar absent
↳ Sarcoidosis
Epithelioid Cells
Modified macrophages. 
Slipper-shaped nucleus. 
Most important cells of granuloma.
Multi-nucleated Giant Cells
Fusion of many macrophages

Granulomas

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Description / Features
Associated Conditions / Notes
Caseating Granuloma:
- Has necrosis. 

TB:
- Can be both, caseating more common. 

Non-Caseating Granuloma:
- No necrosis.
Sarcoidosis:
• Non-caseating > Caseating
• Naked granulomas.
• Asteroid bodies
• Schaumann bodies
Mnemonic: Saratha (Sarcoidosis) → Naked (Naked) Nun (Non caseating) Showing (Shaumann) Ass (Asteroid body)

Berylliosis
• Non caseating granuloma
• Monocytic infiltration
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Types of Multi-nucleated Giant Cells

Giant Cell / Appearance
Nuclear Pattern / Feature
Seen In
Mnemonic / Notes
Langhans Giant Cells
Horseshoe-shaped nuclei
Tuberculosis (TB)
Not Langerhans cells (skin)
Touton Giant Cells
Wreath-like /
round nuclei
Xanthoma
Tutory vach shanthayumayi (Xanthoma) liplock cheyth (lipid tumor)
Foreign Body Giant Cells
Haphazardly arranged nuclei
Foreign materials
(talc, suture)
—
Warthin-Finkeldey Giant Cells
Intranuclear & intracytoplasmic inclusions
Measles
After war, eat meals
Reed-Sternberg Cells
Owl-eye nuclei (pink/eosinophilic)
Hodgkin's Lymphoma
Reed → Red → pinkish owl eyes
CMV-infected Cells
Owl-eye nuclei (blue/basophilic)
Cytomegalovirus (CMV)
—
Herpes-infected Cells
Three M’s:
- Multi-nucleation
- Molding
- Margination
Herpes
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Aschoff giant cells
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Rheumatic Heart Disease
Heart burn cheyth ash eduthu
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Granuloma Shapes

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NOTE: donut cells → Anaplastic Large Cell Lymphoma → CD30
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Donut Granuloma
Donut Granuloma
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Granuloma Type
Associated Conditions
Donut Granuloma
• Q fever
• Allopurinol drug reaction
• Donut → Aalu Perotta (Allopurinol) vangan Q
Durck Granuloma
• Cerebral malaria by Plasmodium falciparum
• Special stain: Field stain
• Attaches to ICAM
• False (Falciparum) Truck (Duruk) in a Field ()
• got in camera (ICAM)
Stellate terms
Seen in
Stellate cells
• Cirrhosis
• NAFLD
• Chronic pancreatitis

• Young stella → alcoholic → liver and pancreas
Stellate Keratin Precipitates
• Herpetic uveitis
• Toxoplasmosis
• Fuchs Heterochromia Iridocyclitis

• Young stella → Fucked () by Toxic () Herpes () Guy
Stellate Granuloma
• Cat Scratch Disease
• LGV
• Leprosy
• Syphillis

• Stella granny → has a Cat, Lgtv, has leprosy and syphillis
Stellate scar
• Kidney → Oncocytoma, Chromophobe RCC
• Liver → Focal Nodular Hyperplasia, Fibrolamellar Carcinoma
• Pancreas → Serous Cystadenocarcinoma
• Breast → Radial Scar: Premalignant
Stellate Keratin Precipitates
Stellate Keratin Precipitates
  • Gumma
    • In tertiary syphilis
    • Granuloma with Histiocytes
    • rubbery ulcer with well-defined margins, heals with scar
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