CIII.O\IC Nr LArlMA llo,.. Lotrr.

i
Chronic inflammalion

. lt is an inflammation of long-term (weeks,

months), in which jl occurs simultaneoLtslyl
- active inflammai on
- tissue damage,
- repaif pfocesses.
. Chronic inflammation may be a resull of
acute inflammation, but often, chronic
inflammation starts insidiously.

tlistolog ca featJrer of cl ro,rr( i1!a-matof locLs

. ri.ontai 10 A (vasuhr

-:"".. - j":t't,J "

ymphoqiesandpasm:.es'

'r,"-, 11,'1'"' . ,,
(cl RePa r or nlur ss is made by
' o .'i' . ,"'
., o N..r

(d)
(anq'osenesis-and ibi.r6 9
h4 ns and s€nids rissu. .,."r..,.-., r." .:
 Types of chronic inflammation
Non-spec llc chronic infam.nat on is
characlerized by a focal or diffuse
Infl Emmatory infittraie composed of

- .
Ex.
innammaion from.hrcn c peptr. ukerfiom

specific chron c inftammat on. it rs

cnaractelzed by lesions specifc to a

-Ex
39#tr;:'iil6Pi5Jfl ;rilfl :TJ 5,:i.;f"?ia,,
 r\lon spec i c cir o,r c nflarnmatton

nnamm.r on is charaDterized by

Ex chron c pepl c u cer ross or

Varicose ulcer
Granulomatous chronic inflammation (lCG)

. aggr6qat6 ol aol,Eled

majnry lyhphodyl4 (1y)

 Classification of granulomas based on the
mechanism of production

. immune type (immune mechanism)

- caseous; ex. Tuberculosis
- non- caseous; ex. Sarcoidoss
. non-rmmune type:
- ex. foreign body granulomas

Etiological classifi cation of

granutoamas

. Koch bacillus "tuberculosis

. treoonema !allidum . svohiLis
. BGP (actindmyces lsra;ii) . actjnomicosis
. BGN -catscratch disease
- The pahsite (toxoplasma Gondi) - toioplasmosis

- Fungi (candida arbicans) " candidiasis

lll, the unknown aetiology:

 _iubercul.:iuc
inflammalion

rubercu oussranu oma {rB) wh'ch

l\4acroscopic types of tuberculous lesions

L Nodulaf lesions (tubercles)

Diffuse lesions

Itl Ulcefated lesions

 Nodular lesion

.i.
Nodura, iesions (tbercret

Nodular lesions

Poly.yclelubetle. lbcboncliopne!mnla

Pulmonary tuberculous nodule

Nodular lesions = milliary tubercles
Nodular lesions = milliary tubercles

Polycycle tubercles

10
 Noduiar rena tubefcLl osls
and ulcerative renal tuberculosls

Difusse lesions
ln pafenchymalorgans:
Pulmonary apical 1!berculous infillrate
- Caseous pneunronia
On Serols sufaces:
-tuberc!lous Pertonilis
- tubercurous p eures a
tuberculoLrs lePtomen ngltis
 Ulcerative lesions
Ln the caviiary organs or suriaces:
-Tbculceratons(cutaneous iniestna)

ln parenchyrnal organs - cavemae:

Renal ulcerative tuberculosis

O'ssem,nalon Mys ofrubercu ou5 infection

dn€d en€nsion of a mosl close/sl3p by

step/c ose to closeTnear by nearl
lynphaicmy'specmcway ii
Iobercurous pdma.ry nfecriod
h-"marosenous My (b Kocheniers nlhe

t:l
Acqurreo sYPirilis
Stage I

Syphilitic inflammation

tl
 Stage ll F;
si

\lrt
ri\\
Cutaneous-mucous leslons
Ski.les onste secono

rashes ilrat mav nave a lesLons[4ridIcandcela€

var ely of appearances

papub, les cns;syprrl de

Se|o og ca dragnosrs rs
te q condylomalala rfom

The rash often appears monihs w tholt neaLng

as red or feddish brown wth or wthout treatmeft
sools both on the Pahs
olihe hands and on the
 Tertiary or Late Syphilis
Stage ltl
srao€ llao@areto5r01s
v*is f.om th€ healinq of rh. rarent (hidd'n) shqe ot
ffiaiion of leriiary ls ons
mefrb.anes and oeep otgans
0t€r, b@n bon€, heanand wibourr.ahenq $e inraded

Gumma is a o€ zed area of

charadtetsl c nllamnatory

m msumma 1m'u6.op d

t5
 Gumma
dld!iiglkh.lodof'pii|i!
. ;;;"-r, ; -."'.",*,"
6n o*cbrcv (d' ordsbd)
u,'J.ffI",*. *.* " " ""'. '"io
vidr

a,
::gtiiltisitrr$i: fiiirulfr v$*\i'll,lilf
(3)
*Hii*.*Strg;"1?$*€fi l,i3*i#*r3**',s,'r;]:lfjj"',t'$:1l.
{4) Fi&di. 4nnc qrcslod b ! redabt nuiht $45

s:rx"ii,'si'3lh.9,:[Tii
- ?p i]i $;'J;i:8f x!*"""'"
r' aloaoowo' -pho1re5"-a
"i.i,i:" ',"q",,."t.
":
[.?"llJii:[-. iln-'.:"r ;':r,v p " 3 "'-*'

L6
 Congenital sYPhilis
Lranem *rcn rrm moiherro tbe let

nest€m. *dd e nose debnry

Ihe (onsen la nphr s.ouLd beeadYorr.te

'e ts a ab'o n: ire

'ooq

Actinomycosis
BGP (actinomYces lsraeli)
Actinomycosis (A) is a bacte al
inflammation produced by actlnomyces
Israeli. a qram positive, anaefoDlc,
filamentoils bacteria (BGP), that ls a
saprophyt in the o|al cavity and checum
Bacteria enters into the adjacent soft
tissues, using a solutio"'l of contin.lity ard
prod,Jces a chrot'c purulent irflam'natlon
and fistula.
 Actinomycosis-A

Macfoscopically, A is

fistule which drains as

yelow granules (the
color of the sulPhur
ye low gra.ules (the colorol

Actinomycosis
M croscopnany actLnomycos's
is a drron csuPUEtron vnrh

6l *diion oi the
On a rilstolog
purue^lo€iuere.*ea 3
puruentetudale made up or

altered and nt€nse basoplr rD

 Cat scratch disease-CSD
CSD s a. inflammairon

negaiive bacteria (BGN)

sc.aich, whLch produces

.nammation drarnina in

lyriph nodes whrdr are

Cat scratch disease-CSD

Microscopically itdeverops

GEnulonauft bndency lo
supuraton h @opdsed of Ec

supr?fveaLAa appet n9 as a
Du,uent siar (sranuLoma wit[
 Toxoplasmosis
the parasite (toxoPlasma Gondi)

a a? pamsile, toxoplasma Gondi a

tl s jghtinlecton s manlfest€d

{.:i;{L M croscopicalLy torop asm c

agqreqates or llfs3nd Mfwih

I

Toxoplasmosls
(toxoplasmic limfadenitis)
 Helminthiasis
. ls an inflammation caused bY
he minthvworms as a reactionlothe
tissue incLusion orrcm |6Nae:
' cvElicec (dEease=cvslicetcosis), larya
orienia solium is localEed h periskeleton
sofltissues or in the braLn
. hydalic c'st (dFease=hvdal dosis) .lhe
lada ol Ech nococcls qranulGu3, wncr
Locales in the liver, lung, hearl, kidnev6

2l
Disease=cysticercosist larva=cysticerc

Hydatic cyst

Macroscopically hydalic
cyst js a cysljclesion or
vaiable size (5-10 cm),

. an exienalnbrcus

. an internalwa I-
the germlnallayef

2)
 Foreign body granuloma
Foreign body qranu oma 3$e
an und'cested iorc qn bdy

The thre reaclron a chronic ' ::''(.

non-n€crot c 's
g€nuLomatous

GEnd oma is composed ot :. ,... !i -

, .'ti
nodueorvdousdmension
"-

Foreign body granuloma

- Lipogranuloma -

,$#
Lioooranuoma s produced as reaciron agaL.sI
endcellula r llplds acc!mu!ated aier a liss!e lra!ma
somelimes, areJormed n lhe a€a otmammary g and
and are looking as pseudo_tumora masses

_l
 5a rcoidosis

Crohn's disease

21