Patho3b - Cdsa-chronic Inflammation

SITUATIONAL ANALYSIS TISSUE REACTIONS TO INJURY Part 2: Immune Reactions to Injury

The Acquired Immune Response and Chronic Inflammation

Prepared by EMMANUEL R. de la FUENTE, M.D.

Objectives 2. To recognize the essential morphologic features of chronic inflammation 3. To briefly discuss the following: - The relationship between the innate and acquired immune response and their differences - The different types of cells involved in the acquired immune response and their respective roles - The pathogenesis of the acquired immune response

Identify and describe the cells seen in this blood smear that are essential for the acquired immune response? Identify and describe the other cells.

These are two types of lymphocytes in the peripheral blood. Which of these lymphocytes constitute the majority in the blood? What immunohistochemical stains are useful to distinguish the two types?

This is a blood monocyte. Where does this cell originate from and where does it eventually go? What role does it play in the pathogenesis of the acquired immune response?

Identify this organ. What role does it play in the development of the immune system especially in the non-recognition of self-antigen?

Identify this organ. Indicate the areas where the T- and B-lymphocytes populate. What role does this organ play in the acquired immune response?

Identify this organ. Which areas are populated by the T- and B-lymphocytes? What role does it play in the acquired immune response?

Identify the organ. Identify the areas populated by the T- and B-lymphocytes.

1. Discuss briefly the following aspects in the pathogenesis of the acquired immune response: - Preprocessing of the antigen by the macrophage - Manner by which the antigen is presented to the lymphocyte - Manner by which the T- and B-lymphocytes neutralize the antigen - Control mechanisms.

SITUATION NO. 1 A 35 year-old woman developed jaundice accompanied by elevated liver enzymes. She was diagnosed to have acute viral hepatitis. She was managed accordingly. After 1 year her liver enzymes were still significantly elevated. She was diagnosed to have chronic hepatitis. A liver biopsy was performed.

Slide 1. Two lesions of the liver. Indicate which represents the acute and chronic phase of the disease. Describe.

There is significant necrosis of liver cells in the encircled area. Discuss the pathogenesis of necrosis.

1. Briefly discuss the pathogenesis of the chronic lesion with emphasis on the immunologic mechanisms, immune cells, and chemical mediators involved. 2. Discuss briefly the healing process that will most likely occur in the liver.

SITUATION NO. 2 The patient in situation no.1 was lost to follow-up. After 10 years, he again consulted because of jaundice. Liver function tests were all abnormal. He was diagnosed to have cirrhosis of the liver.

Two gross specimens of the liver. Describe each. Which of the 2 is more representative of the clinical diagnosis of cirrhosis?

Two microscopic sections of the cirrhotic liver. Describe the essential features.

1. Briefly discuss the healing process in this lesion. 2. Correlate the lesion with the situational events.

SITUATION NO. 3 A 57 year-old man while having his annual physical examination was radiologically diagnosed to have pulmonary tuberculosis.

Slide 1. Gross specimen of lung. Indicate the lesions and describe.

Slide 2. Two histologic lesions of the lung. Describe each lesion. Which of the 2 is more consistent with the gross and radiologic interpretation? Next slide for higher magnification of both lesions.

Slide 3. High magnification of the two lesions in slide 2 for greater appreciation of the details. How should these lesions be categorized?

1. Briefly discuss the pathogenesis of each lesion. 2. Discuss the healing process in each lesion

1. Study the following slides and classify each lesion as to whether it is acute or chronic inflammation or granulomatous inflammation. - LU-008 - LU-003 - GI-026