Inflammation

ACUTE INFLAMMATION
Case 1
Case 1
An 18-year old male presented with abdominal
pain of one day duration, initially felt at the
epigastric area and became localized at the right
lower quadrant. There was associated
intermittent cramping and one episode of
vomiting.
Case 1
On admission, the temperature was 39.0
o
C,
pulse rate was 104 per minute. There was
tenderness and muscle guarding over the right
lower quadrant. The WBC count was 15 x 10
9
/L.
An appendectomy was performed.

Gross Findings
Gross Findings
The appendix was enlarged, indurated and
covered with a fibrinopurulent exudate. Cut
section showed softish wall with fecaloid and
purulent material filling its lumen.

Microscopic Findings
Questions
What is the histologic criterion for the diagnosis
of acute appendicitis?

What are the complications of appendicitis?

ACUTE INFLAMMATION
Case 2
Case 2
A middle-aged male, known alcoholic, was
admitted for difficulty in breathing and high
grade fever. He had been having cough,
productive of purulent sputum for the past five
days.
Case 2
One week prior to admission, the patient was
allegedly found sprawled in front of their house
with vomitus all over his upper garments. The
patient died on the tenth hospital day.

Gross Findings
Postmortem examination of both lungs showed
patchy areas of consolidation, with small
pockets of suppurative exudate within the right
lung.
Microscopic Findings
Microscopic Findings
Questions
What are the possible outcomes of
bronchopneumonia? What in the history point
to an acute inflammatory condition?

What are the histologic features seen on the
slide that point to an acute inflammatory
process?

ACUTE INFLAMMATION
Case 3
Case 3
A 50-year old female, obese, and multiparous
was admitted for recurrent right hypochondriac
and epigastric pain, sometimes associated with
low grade fever of the last two years. The pain
was noted especially after a heavy meal rich in
fat.
Case 3
Physical examination revealed slight tenderness
and muscle guarding over the right
hypochondrium. A cholecystogram reveal
rounded filling defects in the gallbladder. A
cholecystectomy was performed.

Gross Findings
Gross Findings
The gallbladder retained its normal pear shaped
configuration, but there was remnants of fibrous
adhesions on the serosal surface. The wall was
thickened. Several ovoid jet black calculi with
granular sufaces and brownish yellow cores were
found in the lumen. The mucosal surface was highly
trabeculated.

Microscopic Findings
Questions
What in the histology points to a chronic
inflammatory process?

What are the diseases where the presence of
lymphocytes connotes an acute inflammation?

ACUTE INFLAMMATION
Case 4
Case 4
A 40-year old male bank executive had been
having recurrent epigastric burning for several
months. Initial gastroscopy showed an ulcer at
the gastric antrum on the lesser curvature. He
was given medications of three weeks.
Case 4
There was no relief of symptoms and repeat
gastroscopy showed no reduction in the size of
the ulcer. Antrectomy with gastroduodenal
anastomosis was performed.

Gross Findings
Gross Findings
The antrectomy specimen showed a well
demarcated, oval shaped ulcer measuring 2.5
cm in its main diameter, with smooth slightly
rolled margin and clear base. The mucosa
immediately surrounding the ulcer is somewhat
edematous.

Microscopic Findings
Questions
What are the layers of a peptic ulcer?

What in the histology points o a chronic
inflammatory process?

What is the role of Helicobacter pylori in the
pathogenesis of gastric ulcer?

ACUTE INFLAMMATION
Case 5
Case 5
A 10-year-old boy was described by his mother
as having been sickly for the last two years, with
recurrent cough and low grade afternoon fever.
Several physicians had treated him either as a
case of simple upper respiratory infection or
pulmonary tuberculosis. Significant in the
history was that an aunt who took care of the
child in the past had at least two episodes of
frank hemoptysis during the past year.
Case 5
A few weeks prior to admission, the patient
became apathetic and less active. Shortly
thereafter, the cough became more distressing
and occasionally productive of blood-streaked
sputum. High fever and labored breathing
ensued. On admission, the child was cyanotic
and he died an hour later.
Gross Findings
Post mortem examination showed that the lungs
were almost completely consolidated by
fibrocaseous lesions which included numerous
tiny grayish nodules and small cavitation. The
regional lymph nodes were enlarged and matted
together, cut section showed caseation necrosis.
Microscopic Findings
Questions
What is a granuloma?

Give other disease entities that cause
granulomatous inflammation.
ACUTE INFLAMMATION
Case 6
Case 6
A 25-year old female underwent excision of a 1-cm
in diameter, firm, movable, non-tender, ill-defined
left breast mass. Four months before, she had
previously undergone excision of a benign breast
mass in the same area. The case was diagnosed as
suture granuloma.

Microscopic Examination
Questions
What are the two types of granuloma based on
inciting agent?
ACUTE INFLAMMATION
Case 7
Case 7
A 49-year old male complained of a polypoid,
ulcerated and bleeding mass on the left
forefinger. This mass started as a wound which
he got while doing carpentry work at home.
Grossly, the mass was elevated, and ulcerated
with a hemorrhagic base. Histologic sections
showed granulation tissue.

Microscopic Findings
Microscopic Findings
Questions
What is neovascularization? What factors induce
it?

What are the components of the repair process
of tissues subjected to chronic inflammation?