cytopathology- 6 dr. maha al-sedik. objectives: 1- granulomatous inflammation. 2- cytologic patterns...
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CYTOPA
THOLO
GY-
6
DR
. M
AH
A A
L -SED
IK
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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.
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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.
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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.
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Granuloma
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Causes of Granulomatous Inflammation:
Bacteria: Tuberculosis, Leprosy, Syphilis,
Actinomycosis.
Parasites: Schistosomiasis .
Fungi: Histoplasmosis, Blastomycosis.
Foreign body Granulomas : (wood, silica, asbestos,
silicone).
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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.
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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.
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Who will answer?
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Who will answer?
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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.
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voided urine – Numerous acute inflammatory cells are seen in the background
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Features of chronic inflammation: Cells of Chronic Inflammation
1.Lymphocytes
2.plasma cells
3.Macrophages
4.Eosinophils
5.Basophils
Bacteria, fungi, crystals, other microorganisms
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Cytologic features of various types of breast lesions as seen in FNA specimens
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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.
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Bacteria
You should write extracellular cocci
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The most common inflammatory cell
pattern will be neutrophilic
(suppurative) and the least common is
lymphocytic.
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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).
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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).
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Sputum septic inflammation
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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).
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Neutrophils
Degenerative = septic = bacterial
Nondegenerative = nonseptic = immune
mediated
foreign
body
trauma
viral
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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.
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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.
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Chronic inflammation - Lymphocytes. [CHRONIC INFLAMMATION].
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lymphocytic thyroiditis
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