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com/user/DrRabiulHaque

Dr. Rabiul Haque

Lecturer,
Department of Pathology,
Holy Family Red Crescent Medical College, Dhaka

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Definition
Causes
Morphologic Features
Major Cells
Roles of Macrophage
Products of Activated Macrophage
Roles of Other Cells
Granulomatous Inflamation
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Definition

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Definition
It is a response of prolong duration (weeks or months)

in which inflammation, tissue injury and attempts at

repair coexist in varying combinations.

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Definition
It is a response of prolong duration (weeks or months)

in which inflammation, tissue injury and attempts at

repair coexist in varying combinations.
Ref: Robbins & Cortan Pathologic Basis of Disease 9th Edition

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Stay calm and look at the teddy !

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Definition
It is a response of prolong duration (weeks or months)

in which inflammation, tissue injury and attempts at

repair coexist in varying combinations.
Ref: Robbins & Cortan Pathologic Basis of Disease 9th Edition

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Causes

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Causes
Persistent Infections

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Causes
Persistent Infections

Hypersensitivity Diseases / Immune Mediated

Inflammatory Diseases

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Causes
Persistent Infections

Hypersensitivity Diseases / Immune Mediated

Inflammatory Diseases
Prolonged Exposer to Toxic Agents

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Causes
Persistent Infections

Hypersensitivity Diseases / Immune Mediated

Inflammatory Diseases
Prolonged Exposer to Toxic Agents
Chronic inflammation following acute inflammation

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Causes
Persistent Infections

Hypersensitivity Diseases / Immune Mediated

Inflammatory Diseases
Prolonged Exposer to Toxic Agents
Chronic inflammation following acute inflammation
Recurrent attacks of acute inflammation

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Causes
Persistent Infections

Hypersensitivity Diseases / Immune Mediated

Inflammatory Diseases
Prolonged Exposer to Toxic Agents
Chronic inflammation following acute inflammation
Recurrent attacks of acute inflammation
Chronic inflammation starting de novo
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Causes
Persistent Infections

Hypersensitivity Diseases / Immune Mediated

Inflammatory Diseases
Prolonged Exposer to Toxic Agents
Chronic inflammation following acute inflammation
Recurrent attacks of acute inflammation
Chronic inflammation starting de novo
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Causes
Persistent Infections

Hypersensitivity Diseases / Immune Mediated

Inflammatory Diseases
Prolonged Exposer to Toxic Agents
Chronic inflammation following acute inflammation
Recurrent attacks of acute inflammation
Chronic inflammation starting de novo
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Causes
Persistent Infections

Hypersensitivity Diseases / Immune Mediated

Inflammatory Diseases
Prolonged Exposer to Toxic Agents
Chronic inflammation following acute inflammation
Recurrent attacks of acute inflammation
Chronic inflammation starting de novo
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Causes
Persistent Infections

Hypersensitivity Diseases / Immune Mediated

Inflammatory Diseases
Prolonged Exposer to Toxic Agents
Chronic inflammation following acute inflammation
Recurrent attacks of acute inflammation
Chronic inflammation starting de novo
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Causes
Persistent Infections

Hypersensitivity Diseases / Immune Mediated

Inflammatory Diseases
Prolonged Exposer to Toxic Agents
Chronic inflammation following acute inflammation
Recurrent attacks of acute inflammation
Chronic inflammation starting de novo
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Causes
Persistent Infections

Hypersensitivity Diseases / Immune Mediated

Inflammatory Diseases
Prolonged Exposer to Toxic Agents
Chronic inflammation following acute inflammation
Recurrent attacks of acute inflammation
Chronic inflammation starting de novo
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Morphology

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Morphology
Mononuclear cells Infiltration

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Morphology
Mononuclear cells Infiltration

Proliferative changes and attempts at healing

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Morphology
Mononuclear cells Infiltration

Proliferative changes and attempts at healing

Tissue destruction or necrosis

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Cells of Chronic Inflammation

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Cells of Chronic Inflammation

Macrophages are the dominant cells in most of the

chronic inflammation.

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Cells of Chronic Inflammation

Macrophages are the dominant cells in most of the

chronic inflammation.
Functions of Macrophages:

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Cells of Chronic Inflammation

Macrophages are the dominant cells in most of the

chronic inflammation.
Functions of Macrophages:
- Phagocytosis

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Cells of Chronic Inflammation

Macrophages are the dominant cells in most of the

chronic inflammation.
Functions of Macrophages:
- Phagocytosis
- Initiates Tissue Repair

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Cells of Chronic Inflammation

Macrophages are the dominant cells in most of the

chronic inflammation.
Functions of Macrophage:
- Phagocytosis
- Initiates Tissue Repair
- Secrets Inflammatory Mediators

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Cells of Chronic Inflammation

Macrophages are the dominant cells in most of the

chronic inflammation.
Functions of Macrophages:
- Phagocytosis
- Initiates Tissue Repair
- Secrets Inflammatory Mediators
- Displays Antigen to T Lymphocytes
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Cells of Chronic Inflammation

Macrophages are the dominant cells in most of the

chronic inflammation.
Functions of Macrophages:
- Phagocytosis
- Initiates Tissue Repair
- Secrets Inflammatory Mediators
- Displays Antigen to T Lymphocytes
- Responds to Signals from T Lymphocytes
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Cells of Chronic Inflammation

Macrophages are the dominant cells in most of the

chronic inflammation.
Functions of Macrophages:
- Phagocytosis
- Initiates Tissue Repair
- Secrets Inflammatory Mediators : TNF
- Displays Antigen to T Lymphocytes
- Responds to Signals from T Lymphocytes
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Cells of Chronic Inflammation

Macrophages are the dominant cells in most of the

chronic inflammation.
Functions of Macrophages:
- Phagocytosis
- Initiates Tissue Repair
- Secrets Inflammatory Mediators : TNF, IL 1
- Displays Antigen to T Lymphocytes
- Responds to Signals from T Lymphocytes
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Cells of Chronic Inflammation

Macrophages are the dominant cells in most of the

chronic inflammation.
Functions of Macrophages:
- Phagocytosis
- Initiates Tissue Repair
- Secrets Inflammatory Mediators : TNF, IL 1, Chemokines
- Displays Antigen to T Lymphocytes
- Responds to Signals from T Lymphocytes
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Origins of Macrophage

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Origins of Macrophage
Hematopoietic Stem Cells in the Bone Marrow

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Origins of Macrophage
Hematopoietic Stem Cells in the Bone Marrow

Progenitor Cells (In Embryonic Yolk Sac, Fetal Liver)

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Origins of Macrophage
Hematopoietic Stem Cells in the Bone Marrow

Progenitor Cells (In Embryonic Yolk Sac, Fetal Liver)

Circulating Cells from these origin are called

Monocytes.

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Origins of Macrophage
Hematopoietic Stem Cells in the Bone Marrow

Progenitor Cells (In Embryonic Yolk Sac, Fetal Liver)

Circulating Cells from these origin are called

Monocytes.
Upon migrating to tissue Monocyte differentiates into
Macrophages.

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Names of Macrophages in Specific Locations

Tissue

Name of Macrophage

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Names of Macrophages in Specific Locations

Tissue

Name of Macrophage

Liver

Kupffer Cells

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Names of Macrophages in Specific Locations

Tissue

Name of Macrophage

Liver

Kupffer Cells

Central Nervous System

Microglial Cells

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Names of Macrophages in Specific Locations

Tissue

Name of Macrophage

Liver

Kupffer Cells

Central Nervous System

Microglial Cells

Lungs

Alveolar Macrophages

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Names of Macrophages in Specific Locations

Tissue

Name of Macrophage

Liver

Kupffer Cells

Central Nervous System

Microglial Cells

Lungs

Alveolar Macrophages

Spleen and Lymph Nodes

Sinus Histiocytes

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Macrophage Activation

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Macrophage Activation
Two Major Pathways

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Macrophage Activation
Two Major Pathways

- Classical Pathway

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Macrophage Activation
Two Major Pathways

- Classical Pathway
- Alternative Pathway

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Macrophage Activation
Two Major Pathways

- Classical Pathway : Microbicidal Actions

- Alternative Pathway

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Macrophage Activation
Two Major Pathways

- Classical Pathway : Microbicidal Actions, Inflammation

- Alternative Pathway

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Macrophage Activation
Two Major Pathways

- Classical Pathway : Microbicidal Actions, Inflammation

- Alternative Pathway : Tissue Repair

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Macrophage Activation
Two Major Pathways

- Classical Pathway : Microbicidal Actions, Inflammation

- Alternative Pathway : Tissue Repair,
Anti-Inflammatory Effects

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Macrophage Activation

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Other Cells of Chronic Inflammation

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Other Cells of Chronic Inflammation

Lymphocytes

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Other Cells of Chronic Inflammation

Lymphocytes

Plasma Cells

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Other Cells of Chronic Inflammation

Lymphocytes

Plasma Cells
Eosinophils

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Other Cells of Chronic Inflammation

Lymphocytes

Plasma Cells
Eosinophils
Mast Cells

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Other Cells of Chronic Inflammation

Lymphocytes

Plasma Cells
Eosinophils
Mast Cells
Neutrophils

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Roles of Lymphocytes

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Roles of Lymphocytes
Mobilized in both antibody and cell mediated immune

responses.

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Roles of Lymphocytes
Mobilized in both antibody and cell mediated immune

responses.
Lymphocytes and macrophages interact in a bidirectional way.

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Bi-directional interaction of T Lymphocyte and Macrophage

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Antigen Presenting Cells

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Antigen Presenting Cells

Macrophages

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Antigen Presenting Cells

Macrophages

B Lymphocytes

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Antigen Presenting Cells

Macrophages

B Lymphocytes
Dendritic Cells

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Plasma Cells

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Plasma Cells
Terminally differentiated B Lymphocytes

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Plasma Cells
Terminally differentiated B Lymphocytes

Produces Antibody

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Eosinophils

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Eosinophils
Granules contain Major Basic Protein (MBP )

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Eosinophils
Granules contain Major Basic Protein (MBP )

Toxic to parasites

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Eosinophils
Granules contain Major Basic Protein (MBP )

Toxic to parasites
Abundant in IgE mediated immune reactions

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Mast Cells

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Mast Cells
Found in both acute and chronic inflammation

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Mast Cells
Found in both acute and chronic inflammation

Express surface receptors that bind to Fc portion of IgE

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Mast Cells
Found in both acute and chronic inflammation

Express surface receptors that bind to Fc portion of IgE

Mast cell degranulation releases Histamines

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Neutrophils

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Neutrophils
Chronic Osteomyelitis

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Neutrophils
Chronic Osteomyelitis

Chronic Lung Damage in Smokers

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Granulomatous Inflammation

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Granulomatous Inflammation
A form of chronic inflammation that is characterized

by collections of activated macrophages, often with T

lymphocytes and sometimes associated with central
necrosis.

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Granulomatous Inflammation
A form of chronic inflammation that is characterized

by collections of activated macrophages, often with T

lymphocytes and sometimes associated with central
necrosis.
Ref: Robbins & Cortan Pathologic Basis of Disease 9th Edition

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Epithelioid Cells

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Epithelioid Cells
Activated Macrophage with abundant cytoplasm

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Epithelioid Cells
Activated Macrophage with abundant cytoplasm

Resemble epithelial cells

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Epithelioid Cells
Activated Macrophage with abundant cytoplasm

Resemble epithelial cells

May fuse and form multinucleate giant cells

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Types of Granuloma

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Types of Granuloma
Foreign Body Granuloma

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Types of Granuloma
Foreign Body Granuloma

Immune Granuloma

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Types of Granuloma
Foreign Body Granuloma : With Talc, Sutures, Fibers

Immune Granuloma

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Morphology of Granuloma

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Morphology of Granuloma
Activated Macrophages with pink granular cytoplasm

and indistinct boundaries in H&E stain.

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Morphology of Granuloma
Activated Macrophages with pink granular cytoplasm

and indistinct boundaries in H&E stain.

Surrounded by Lymphocytes.

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Morphology of Granuloma
Activated Macrophages with pink granular cytoplasm

and indistinct boundaries in H&E stain.

Surrounded by Lymphocytes.
Older granuloma may show rim of fibroblasts as well.

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Morphology of Granuloma
Activated Macrophages with pink granular cytoplasm

and indistinct boundaries in H&E stain.

Surrounded by Lymphocytes.
Older granuloma may show rim of fibroblasts as well.
Multinucleate Giant Cells.

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Diseases with Granulomatous Inflammation

Disease

Cause

Tuberculosis

Mycobacterium tuberculosis

Leprosy

Mycobacterium leprae

Cat-scratch Disease

Gram Negative Bacillus

Syphillis

Treponema pallidum

Sarcoidosis

Unknown Cause

Crohn Disease

Immune reaction

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Thank you for watching this video !

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Thank you for watching this video !

If you like my videos do subscribe, share, comment

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Thank you for watching this video !

If you like my videos do subscribe, share, comment

and let me know !

Best wishes from Bangladesh.

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