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

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

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

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

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

13.1 - 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

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

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

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+.

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

13.4 - 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

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

13 - Chronic hepatitis and cirrhosis Dr. Manal Maher Hussein

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

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

INFECTIOUS DISEASES Dr. Manal Maher Hussein

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

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

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

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

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

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

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

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

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

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