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Tuberculosis. General morphology of tb.
Relevance. TB is one of the leading diseases among chronic infectious diseases of man, it is leading in lose of working ability, disablement, and death of patients. Knowledge of morphologic changes in organs and tissues when infected with mycobacterium tuberculosis is essential for understanding the mechanism of development and well-timed diagnosis, choosing the right tactics of treatment and prevention. Well-timed diagnosis and right treatment ensures complete healing for the patient. Knowing the morphology of TB will help you learn this disease on other departments and during your future practice.
Objective (general): To know how to determine the morphologic manifestations of TB depending of the responsiveness of the organism. The morphologic signs of primary TB, and its outcomes.
Specific objective Goals of primary state
To know how:
Here are some questions to test your initial knowledge
Q.№1. A patient died of a progressive cardiac failure. The autopsy showed that the heart is dilated in diameter, flabby consistency, on the cut-set the muscle is unevenly perfused, multicolored. The histological exam showed that the myocardium is hyperemic, the stroma contains lots of small cells with one nucleus that distend the cardiomyocytes. What pathologic process is in this case?
1. Venous hyperemia.
2. Adipose dystrophy of myocardium.
4. Non purulent interstitial myocarditis.
5. Myocardial infarction.
Q№2. A histological exam of the lungs of a patient who had died of cardiac failure, were found areas of inflammation with filling alveoli with fluid, light pink colour, locally with thin pink fibers, which make a fine looped net. A large amount of small, round, mononuclear cells, with a hyperchromic nucleus, and a small drafted margin of cytoplasm. What type of exudation is in the lungs?
Q.№3. On a histological exam of a surgically removed kidney were found areas of inflammation, containing of flat, slightly prolonged cells with a bright nucleus. A small amount of large, oval cells with peripheral nucleuses in the shape of horseshoe, and small, round cells with hyperchromic nucleus with a small drafted margin. What type of inflammation is in this case?
Q.№4. On an autopsy of a young man, who had died in a result of a MVA (motor-vehicle accident), the lymphatic nodes on the tracheal bifurcation are 0.4-0.8cm and less, flabby. On the cut-set they are homogeneous, bright pink colour, and a glistening surface. What process has all these features?
5. Tumor metastasis.
Q.№5. It is known, that in an inflammation, reactive and inflammatory changes primary appear in the regional lymphatic nodes. There is an inflammatory process in the 3ed segment of the lung. In which of the following lymphatic nodes the changes will appear first?
1. Upper tracheobroncheal.
2. Lower tracheobroncheal.
The correct answers: 1-4; 2-5; 3-3; 4-2; 5-3.
You can find the necessary information in the following textbooks:
Basic theoretic questions which will help you to prepare for class.
1. Specific inflammation: essence, examples. Concept on granulomatosis.
2. Etiology of TB, ways of infection.
3. Morphology of TB inflammation: Alterative, Exudative, Proliferative types of tissue reaction. 4. Connection between the morphology of TB inflammation and responsiveness of the organism.
5. Clinical-morphologic classification of TB.
6. Primary TB: localization, the components of a primary TB complex. Outcomes.
7. Types of progression of a primary TB, morphology of different types of progression.
8. Lymphoglandular form of TB.
1. Strukov A.I., Serov V.V. "Pathologic Anatomy" 1995
2. Lecture on "Infectious granulomatous diseases. TB. Syphilis. Scleroma. Actinomycosis."
3. Graph of logical structure (supplement № 1,2).
4. Algorithm of morphologic diagnosis of primary TB (supplement № 3).
1. Additional literature.
Here are some questions to test what you have learned.
Q.№1. On a histological exam of a rectum pararectal fistula, which was surgically removed from a 36 year old woman, a chronic inflammation was found, was suspected a TB etiology. What form of chronic prolifarative inflammation allowed suspecting TB?
Q.№2. During a biopsy of mucous tunic of the mouth, a Granulomatous inflammation was found. Which cells are more common in a TB granuloma?
Q.№3. On an autopsy of a 47 year old male, who had died of suprarenal glandular failure, were found large suprarenal glands, on the cut-set they are white-yellow crumbling tissue with a grayed out surface. A histological exam showed that the cortex and medullar layers are homogenous, coloured with eosin in pink with fragments of nucleuses. Suprarenal TB was diagnosed. Which of TB components was leading?
Q.№4. On an autopsy of drug addict, who had died of a severe intoxication and cachexia, in lots of organs (liver, kidney, spleen, etc.) were found lots of miliary and sub miliary foci of cheesy necrosis. Which type of body responsiveness attest these changes?
Q.№5. On a histological exam of a scrape from a uterus of a young woman, who is suffering from sterility, a TB with granulomas was found. What type of body resistance attest these changes?
Q.№6. On an autopsy of a 43 year old female who had died from an acute anemia, induced by postnatal uteri hemorrhaging, sub pleural in the 3ed segment of the right lungб was found an area petrosal thickness, 2x3mm, the pleura above is thickened, white colour. What type of outcome of primary TB is in this case?
Q.№7. On an autopsy of a 2.5 year old chilled, a primary pulmonary TB complex was found. The affect is 3x4cm with uneven margins, yellow colour on a cut-set, in the center it is soft, around it merged foci of thickened pulmonary tissue grey-white, grey-yellow colour and grayed out surface. What type of outcomes of primary TB is in this case?
Q.№8. On an autopsy of an 11 year old child, who had suffered from primary TB and died of TB meningoencephalitis, was found a primary pulmonary TB complex, bifurcational and paratracheal lymphatic nodes are enlarged, tight, and yellow. On a cut-set grayed out surface, the soft brain tunics in the basis and lateral surfaces of the brain were found nodes 0.5-1mm in diameter. What type of outcome of primary TB is in this case?
Methodic instructions for the class.
For a more efficient work, first read this till the end. In the beginning of class your homework will be checked. Later you will be tested on how well you prepared for class.
Individually you should study the macro and microscopic specimens, answer the question. Types of tissue reaction are studied on microphotographs, tables and micro specimens. You should pay attention to an inclination of exudates and TB granulomes to cheesy necrosis. When studying this notice supplement №1. Primary TB is studied on microslides "Primary pulmonary TB complex", "Primary pulmonary TB complex with progression", Encapsulated TB affect in the lung", "TB affect in the lung". Use tables and supplements №2 and №3.
The class if finished by you describing the specimens and testing you in order to know how much you have learned.
Graph of logical structure "General morphology of TB"
Graph of logical structure "Primary TB"
Algorithm of morphologic diagnostics of primary TB.
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