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ЗмістSpecific goals Purpose of initial level To be able to
Tasks for self-examination of initial level of knowledge-abilities.
SYPHILIS. SCLEROMA. ACTINOMYCOSIS. LEPROSY.
Theme urgency. The knowledge of morphological changes in tissues and organs under the influence of infectious agents of syphilis, scleroma, actinomycosis, leprosy, patterns of a specific inflammation course, process localisation at different stages of these diseases will be necessary during studying of these illnesses on department of dermatology and venereology, obstetrics and gynecology, infectious, nervous, ENTs-illnesses and others, and also in practical work of doctors of many specialities. Especially the great value has studying of syphilis morphology and pathogenesis in connection with its increase last years; it is logical to expect the next years increase of a visceral syphilis cases.
The purpose (general). To be able to classify and define morphological changes, characteristic for syphilis, scleroma, actinomycosis, leprosy; to represent their pathogenesis, complications, an outcome.
To define the initial level of your knowledge-abilities, we suggest you to solve a number of tasks.
Task № 1. At histological research of the enlarged axillary lymph node of a 28-year-old man a lot of centres of epithelioid cells' clumps with separate huge multinuclear Langerhans cells are found, there is shaft from lymphocytes on periphery of clumps; the diagnosis of tubercular lymphadenitis is established. What inflammation is established in a lymph node?
5. Proliferative, granulomatous.
Task № 2. On dissecting of a 46-year-old man: aorta is elastic, intima of pale yellow colour, smooth, shining; at histological research - intima is thin, the subendothelial layer is weakly expressed, the media layer is presented by fascicles of in parallel located elastic fibers, adventitia vessels are thin-walled with a wide lumen. What is your diagnosis?
2. Idiopathic hypertensia
3. Rheumatic diseases
4. Septic lesion
5. Normal structure.
Standards of answers: 1-5, 2-5.
The information necessary for replenishment of necessary knowledge-abilities can be found in following references:
1. Prives M.G., Lysenkov N.K., Bushkevich V. I - Human anatomy. / St.-Petersburg. Gippokrat. - 1998. - p. 405-406.
2. Afanaseva J.I., Yurina N.A. - Gistologija./Moscow, "Medicine". 1999. - p. 380-382, 637-646.
The basic theoretical questions:
1. Etiology of syphilis, an infection way, the illness periods.
2. Morphology of primary and secondary syphilis.
3. Morphology of tertiary syphilis, localisation, structures, an outcome of gummas, gummatous infiltrates.
4. Morphology of syphilitic mesaortitis, complications.
5. Forms and morphology of neurosyphilis.
6. Morphology of congenital syphilis.
7. Etiology, localisation, lesions and morphology of scleroma.
8. Etiology and morphology of actinomycosis, its forms.
9. Etiology and morphology of leprosy.
The literature for mastering of knowledge-abilities:
1. Strukov A.I., Serov V.V. Pathological anatomy / Moscow, "Medicine". 1995. - p. 140-143, 488-493, 503-506.
2. Department lectures on a theme: «Syphilis and other granulomas».
3. The graph of logic structure of a theme «Syphilis, scleroma, actinomycosis, leprosy» (the appendix №1).
4. Algorithm of morphological diagnostics of syphilitic mesaortitis (the appendix №2).
The additional literature:
1. Serov V.V., Jarygin N.E., V.O. Pathological anatomy / Atlas. - М "Medicine". 1986. - p.
2. Shlopov V. G “The basis of pathological human anatomy”. / Kyiv. - 1999. - p. 678-690, 731-732.
After material studying on the given theme carry out following target tasks for self-examination:
Task № 1. 28-years-old woman has addressed to the doctor concerning an ulcer on a mucosa of a bottom of a mouth; the biopsy is made; at histological research: in the edges and bottom there is the clump of lymphoid, plasmatic, epithelioid cells, mainly perivascular, a proliferative endangiitis is revealed; growth of a fibrous connective tissue. What is the most probable etiology of an ulcer?
1. Nonspecific ulcer stomatitis
Task № 2. At histological research of the enlarged submandibular lymph node of a 32-years-old man the proliferative inflammation with presence of the granulomas consisting of randomly located lymphoid, plasmatic, epithelioid and huge multinuclear cells with nuclei located on periphery in the form of a horseshoe is revealed; in the centre of some granulomas - an incomplete caseous necrosis. What is the most probable etiology of lymphadenitis?
2. Nonspecific proliferative inflammation
Task № 3. At a woman with relapsing, polymorphic rash the skin biopsy is made; histological research reveals the inflammation in derma with presence of the different sized infiltrates consisting of lymphoid, plasmatic, epithelioid cells, located mainly perivascular, signs of exudative-proliferative inflammation in vessels. What is the most probable etiology of rash?
1. Allergy rash
Task № 4. At a diagnostic laparotomy in a 60-years-old patient nodules in a liver 0,5х1,5cm are revealed; the biopsy of one of them is made. At histological research: the granulomas consisting of plasmatic, epithelioid, lymphoid and individual huge Langerhans cells are revealed. In small vessels of granulomas there is a picture of endo - and a perivasculitis; there are centres of an incomplete caseous necrosis. For what disease such structure of granulomas is characteristic?
Task № 5. On dissection of a 53-years-old man: intima of ascending part, an arch and descending part of an aorta (up to level of renal arteries) is rough, rugosity. At histological research: in the media layer of aorta there are infiltrates of plasmatic, epithelioid and lymphoid cells, the necrosis centres, cicatrixes; walls of vasa vasorum are thick, lumens are narrowed owing to a proliferation of endothelial and adventitious cells. What etiology of pathological process in an aorta?
2. Rheumatic disease
4. Idiopathic hypertensia
Task № 6. On dissection of a 58-years-old man with the tertiary syphilis, died in a psychoneurological dispensary: there are reduction of brain mass, a thinning of gyruses, expansion of sulcuses, mainly in frontal lobes; at histological research: dystrophy and atrophy of nervous cells, proliferation of glia cells, perivascular muffs, deposits of gemosiderin grains are revealed. For what form of neurosyphilis the revealed changes are characteristic?
1. Brain gummas
2. Gummatous encephalitis
3. Lesion of brain vessels
4. General paralysis
5. Tabes dorsalis ?
Task № 7. At examination of a child the Hutchinson's triad is revealed: Hutchinson's teeth, sight depression (interstitial keratosis) and deafness; «sabre legs», radial scars around the mouth; the diagnosis of a congenital syphilis is established. For what form of congenital syphilis the revealed changes are characteristic?
1. Early syphilis
2. Late syphilis
3. Tertiary syphilis
4. Primary syphilis
5. Secondary syphilis
Task № 8. At histological research of the biopsy from tumorous formation of a mucosa of a larynx infiltrates from plasmatic, lymphoid, epithelioid and large oval-roundish cells with a light vacuolated cytoplasma (Mikulich cells) are revealed; «hyaline balls». For what disease the revealed changes are characteristic?
Task № 9. At histological research of removed lung concerning chronic inflammatory process with thorax fistulas: granulomatous inflammation with presence of plasmatic, xanthoma, young connective tissue cells, macrophages, lymphocytes and segmented leucocytes round the infectious agent is revealed. For what disease the cellular structure of granulomas is characteristic?
Task № 10. At histological research of the biopsy of a skin: the granulomas consisting of clumps of epithelial cells, lymphocytes, plasmocytes are found. There are large macrophages with fatty vacuoles (Virchow cells); granulation tissue is well vacuolated. For what disease such structure of a granuloma is characteristic?
Methodical instructions for students' work on practical lessons on a theme: «Syphilis and other granulomas».
In the beginning of the lesson check up correctness of a homework decision by the standards of answers. Then control your preparation for the lesson will be checked up by the test.
You should study macro- and micropreparations to solve situational problems by yourself; use tables, microphotographs on the given theme. At studying of syphilis morphology use a micropreparation «Syphilitic inflammation»; find the infiltrates of different sizes in a derma, consisting of lymphoid, plasmatic and young connective tissue cells, a proliferative inflammation in small vessels with narrowing of a lumen. Study a tertiary syphilis on a macropreparation «Syphilitic mesaortitis»; pay attention to a sharp aortectasia and presence of a saccular diverticulum of a wall (aneurysm), roughness of an intima, places looking like «a shagreen skin»; at microphotograph studying «Syphilitic mesaortitis», pay attention to presence of gummatous infiltrates in media layer, the centres of necrosis, the cicatrixes blasting elastic fibers. Use the graph of logic structure of a theme «Syphilis and other granulomas» (the appendix № 1) and «Algorithm of morphological diagnostics of a syphilitic mesaortitis» (the appendix № 2). At scleroma studying use microphotograph and a scleroma micropreparation; find plasmatic, lymphoid and large oval-roundish cells with a vacuolated cytoplasma (Mikulich cells), «hyaline balls». At actinomycosis studying use microphotograph and an actinomycosis micropreparation; find the druses of actinomycosis painted by a hematoxylin in violet colour with a zone of an enlightenment around, surrounded by neutrophils.
The lesson comes to the end with the analysis of each student independent work results, by checking of the preparations description and the test control of knowledge.
The appendix №1.
The graph of logic structure of a theme «Syphilis, scleroma, actinomycosis, leprosy».
Continuation of the appendix №1
Algorithm of syphilitic mesaortitis diagnostics.