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WHAT IS GRANULOMA?

WHAT IS GRANULOMA?. What is granuloma? Mechanism? Why? Differential diagnosis?. Granuloma. A granuloma is a focal area of granulomatous inflammation. Macrophages that are transformed into epithelium like cells Mononuclear leukocytes (principally lymphocytes and plasma cells) Giant cells

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WHAT IS GRANULOMA?

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  1. WHAT IS GRANULOMA?

  2. What is granuloma? • Mechanism? • Why? • Differential diagnosis?

  3. Granuloma • A granuloma is a focal area of granulomatous inflammation. • Macrophages that are transformed into epithelium like cells • Mononuclear leukocytes (principally lymphocytes and plasma cells) • Giant cells • Two types- pathogenetically • Foreign body type • Immune granulomas

  4. Epitheloid cells • Pale pink granular cytoplasm • Indistinct cell boundaries • The nucleus is oval or elongate, folding of the nuclear membrane

  5. Giant cells • Fusion of the epitheloid cells • Located at the center or periphery of granulomas • 40-50 milimicron • 20 or more small nuclei • Location of nuclei • Peripherically in Langhans-type • Haphazardly in foreign-body type

  6. Foreign body granuloma • Material large enough to preclude phagocytosis, and do not incite either an inflammatory or an immune response • Talc, sutures ec. • The foreign body can be identified (with polarized light)

  7. Immune granuloma • Insolubl particles • Cell- mediated ımmun response • Macrophages T cells cytokines (IL-2) IFN-gamma Granuloma

  8. GRANULOMATOUS LESIONS OF THE LUNG

  9. GRANULOMATOUS LESIONS OFTHE LUNG- CLASSIFICATION 1) INFECTIOUS 2) NON-INFECTIOUS

  10. Infectious granulomatous diseases • Bacterial • Actinomycosis, botryomycosis, nocardiosis, • Mycobacterial • Fungal • Pnömosistis • Protozoal • Dirofilaria • Parasitic • Aspiration pneumonitis

  11. NON-INFECTİOUSgranulomatous disease • Wegener granulomatosis • Rheumatoid nodule • Bronchocentric granulomatosis • Churg- Strauss Syndrome • Sarcoidosis • Necrotizing sarcoid granulomatosis • Pulmonary hyalinizing granuloma • Extrinsik allergic alveolitis • Drug reaction

  12. Non infectious granulomatous diseases • Eosinophilic pneumonitis • Nodular amyloidosis • Giant cell reaction • Exogen lipoid pneumonia • Intravenous drug reaction • Pneuomoconiosis (Berylliosis) • Localised bronchiectasis • Lymphoma (Hodgkins’)

  13. Diagnostic approach • Clinical information • Anamnesis • Clinical findings • Acute, subacute, chronic • Radiologic findings • Histopathological pattern analysis • Pattern analysis • Components of granuloma

  14. Histopathological pattern analysis • Angiosentrik • Bronchocentric-bronchiolocentric • Pleural-subpleural • Lymphatic disttribution • Peripheral acinar • Septal changes • Random distribution • Airspace consolidation • Diffuse interstitial infiltration

  15. Components of granuloma • Epitheloid histiocytes • Giant cells • Lymhoid cells • Neutrophils • Necrosis • Abscess. • Foreign body, cyrstal, infectious agent, deposition of material

  16. Infectıous granulomas

  17. tbc

  18. Tuberculoid granuloma • Peribronchioler, interstitial, perivascular • Cellular, necrotic • Langhans type giant cell • Lymphocytes, few neutrophiles • No foreign body! • Clinical and microbiological investigation

  19. Fungal granuloma • Interstitial, perivascular • Cellular, necrotic • Foreign body type giant cell • Lymhoid cells,neutrophils • Grocott, PAS vs special stains • Microbiological investigation

  20. Non infectious granulomas

  21. Granuloma of immune response • Rective to tumor • Draniage lymph nodes • Lymphoproliferative diseases • Underlying disease

  22. Sarcodosis • Interstitial, pleural, Lymphatic distribution perivacular • Cellular, small fibrinoid – coagulative necrosis • Giant cells- asteroid body • Schaumann body • Lymphocytes • Large necrosis-in necrotizing sarcoidosis neutrophiles • Clinical information

  23. Bronchocentric granulomatosis • Bronchiolocentric • Necrotising • Giant cell • Lymphocytes- neutrophiles-eosinophiles • Grocott, PAS • Asthma and aspergillosis

  24. Pneumoconiosis • Interstitial, lymphatic distribution • Cellular, necrotic. • Foreign body type giant cells • Lymphocytes • Crystal • Clinical story

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