2. Chronic inflammation
It can occur in two ways:
acute inflammation may follow
from the very beginning it has the character of
Often, harmful agents that cause chronic
inflammation are less toxic than those that
cause acute inflammation.
3. Chronic inflammation
Persistent infections with low-toxic intracellular
microorganisms that cause a late-type immune
reaction (TB bacillus, Treponema pallidum, some
types of fungi).
Prolonged exposure to some undecomposed
inanimate material (silicon crystals, asbestos in the
lungs, other pneumoconioses).
Immune reactions against own tissues resulting in
autoimmune diseases (systemic connective tissue
Component of the mononuclear-phagocytic system-
MFS (formerly reticulo-endothelial-RES).
MFS - related cells of bone marrow origin including
blood monocytes and tissue macrophages.
Tissue macrophages are diffusely scattered in the
connective tissue or gathered in certain organs
(Kupffer cells in the liver, alveolar macrophages in
the lungs, sinus histiocytes in the spleen and lymph
nodes). They all originate from a common precursor
in the bone marrow.
The half-life of blood monocytes is about one day,
and tissue macrophages live for several months,
Besides phagocytosis, macrophages have a
number of important roles in inflammation.
They can be activated, indicated by:
increase in cell size,
an increase in the amount of lysosomal
significantly more active metabolism and
greater possibility of phagocytosis.
8. Macrophage activation signals
Lymphokines, the most important ϒ-
interleukin, are secreted by sensitized T-
contact with fibronectin coated surfaces
different chemicals that can be produced
during acute inflammation
9. ACTIVATED MACROPHAGES SECRETE
enzymes (neutral or acid proteases)
plasma proteins (complement system and
reactive oxygen metabolites
lipid mediators (products of arachidonic acid
metabolism and TAF)
cytokines (IL-1, TNF)
growth factors (proliferation of various cells).
They have a reciprocal relationship with
macrophages in chronic inflammation.
They are most often activated in contact
with an antigen, whereby the
lymphocyte secretes lymphokines.
Activated macrophages activate
lymphocytes, closing the circle and
creating conditions for chronic
13. Plasma cells
they create antibodies directed
against persistent antigens or against
altered tissue components.
16. Proliferation of fibroblasts and
accumulation of extracellular matrix
it is a common occurrence in many
chronic inflammations and is the
cause of permanent loss of function.
The mechanisms of inflammatory
fibrosis are similar to the mechanisms
during the reparation process.
22. FORMS OF PRODUCTIVE
Parasitic inflammations with granuloma
Proliferative inflammations in which
proliferate elements of other importance
Proliferative inflammation in which there is
proliferation of parenchyma and stroma
23. INTERSTITIAL INFLAMMATION
It is characterized by cellular infiltration
that affects the interstitial supporting
tissue, that is, the stroma of the organ.
The cellular infiltrate consists of cells
of chronic inflammation.
A complete cure is possible, but often
there is a fibroblastic reaction and
sclerosis of the organs.
Causes: viruses, rickettsiae, diphtheria
bacillus, TBC bacillus and treponema.
27. TYPES OF GRANULOMA
Granuloma in sarcoidosis
Granuloma in TBC
Syphilis granuloma (gumma)
Granuloma in actinomycosis
Granuloma in rheumatic fever
Granuloma in rheumatoid arthritis (Bang's
Granuloma around protozoa
Granuloma around animal parasites
Granuloma around the foreign body
Granuloma composed of epithelioid
cells, giant multinucleated cells of the
Langhans type, lymphocytes and
plasmocytes on the periphery, without
necrosis in the center of the
Similar granulomas are found in the
intestines in Crohn's disease
33. Langhans cell
A giant cell with several nuclei around
the periphery of the cell in the form of
a wreath or horseshoe.
In the cytoplasm of giant cells in
sarcoidosis, inclusion Schaumann
corpuscles are found, important in the
differential diagnosis with TBC.
35. Tuberculous granuloma
In the center of the granuloma, there
is often a structureless, necrotic
mass, similar to cheese or dry plaster
(cheesy or caseous necrosis).
Around the caseous necrosis, a band
of epithelioid and giant cells of the
Langhans type, and on the periphery
a non-specific part of granulation
tissue or mature connective tissue.
43. Reticuloabscessing granuloma
A central zone with a mass of leukocytes,
i.e. an abscess, and around the central
part initially reticular cells, and later
epithelioid cells arise from them.
It is found in brucellosis, tularemia,
pseudotuberculosis, inguinal granuloma,
cat scratch disease.
44. A: Liver fragment with brucellosis granuloma
B and C: histological images of granulomas
51. An irregular granulomatous structure with a star-shaped abscess and central necrosis
surrounded by an inner layer of palisade-arranged histiocytes (arrows), a row of
lymphocytes in the middle (arrowhead) and on the outside a zone of fibrosis (asterisks) in
the middle stage of the development of "cat-scratch disease" (H-E x100 ).
52. The inflammatory and necrotic region is replaced and surrounded by spindle-
shaped collagen-producing cells, fibroblasts, and fibrocytes (asterisks), in late-
stage "cat-scratch disease" (H-E, ×100).
55. Actinomycosis granuloma
It is made up of epithelioid cells, small
round cells, giant and xanthoma cells.
In the center of the granuloma, there is
often an abscess, where there are fibers
or micelles of acinomycetes.
It appears in three forms:
62. Rheumatic fever granuloma
Aschoff bodies in the myocardium, usually
around blood vessels and subendocardial.
In the center there is fibrinoid necrosis,
Anichkov's myocytes (cells that are not of
muscle origin even though they are called
myocytes) and Aschoff's giant cells
proliferated around the necrosis.
On the periphery of the granuloma are
69. Rheumatoid subcutaneous nodule with a field of necrosis surrounded by
macrophages in a palisade arrangement and scattered cells of chronic inflammation
70. Protozoa granuloma
Necrosis with precipitated calcium salts
around which macrophages are located,
and parasites in them.
Some macrophages turn into pseudocysts.
At the very periphery, there is non-specific
74. Granuloma around the foreign body
It is created around exogenous (most often surgical
thread) or endogenous material (gout and
In the center of the granuloma there is a foreign
Around the foreign body is a band of macrophages,
tissue histiocytes and giant multinucleated cells of
the "foreign body" type, which have multiple nuclei
diffusely scattered throughout the cytoplasm or
clustered in the center of the cell.
On the periphery of the granuloma there is
granulation and connective tissue.
78. INFLAMMATION WITH SECOND ORDER ELEMENTS
They occur in lymphatic organs, lymph nodes,
tonsils, spleen, that is, in organs that contain
lymph follicles. The tissue that multiplies in
this case is lymphatic tissue and there is no
proliferation of connective tissue.
Proliferated lymphoid elements, sinus
histiocytes, reticular cells, lead to an increase
in the organ as a whole or individual
lymphatic structures. This is why these
inflammations are hyperplastic.
80. PROLIFERATIVE INFLAMMATIONS IN WHICH THE STROMA AND
PARENCHYMA PROLIFERATE AT THE SAME TIME
Lymphoplasmacytic infiltration in the stroma and
simultaneous proliferation of parenchymal
elements, mainly epithelium.
On mucous membranes lined with cylindrical
epithelium, growths with a stalk, inflammatory
On mucous membranes lined with squamous
epithelium of papillomatous structure
These changes should be distinguished from
true tumor proliferations.