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Hematogenic tb. Secondary pulmonary tb.
Relevance. The increasing number of TB patients in the last years, mostly its pulmonary forms, the rising cases of late diagnostics, gain a special relevance.
Knowing the pathogenesis and morphology of Hematogenic and secondary TB, that develop in adults due to some endogenous and exogenous infection and characterize with special features, is essential for learning this nosological unit in different departments and in your future practice.
Objective (general): To know how to classify and recognize the morphologic manifestations of Hematogenic and secondary TB, to see their pathogenesis, complications, and outcomes.
Concrete objective Objectives of initial state
To know how to:
Here are some questions to test your initial state.
Q.№1. On a histological exam of a scrape of endometrium of a young woman, who had suffered of infertility, an inflammation was found that contained areas of accumulation of epithelioid, lymphoid and gigantic cells of Pirogov-Langhance with cheesy necrosis in the center. An endometric TB was diagnosed. What type of tissue reaction is in this case?
Q.№2. A 45 year old man died of TB meningoencephalitis. On the autopsy of the cerebrum, the tunics are thickened, semitransparent, locally not transparent, yellow. The histological exam showed that the tunics are hyperemic, thickened, diffuse infiltration of lymphoid cells, slightly pink liquid with fine pink fibers that make a grid, large areas of cheesy necrosis. What type of tissue reaction is in this case?
Q.№3. On an autopsy of an oncology patient, that went threw several courses of radiation and chemotherapy, in the lungs were found areas lobule pneumonia and lobule exhaust pneumonia, yellow in colour, with a grayed out, dull surface. The histological exam sowed that those areas are cheesy necrosis, with karyorrhexis. What type of tissue reaction is in this case?
The correct answers: 1-3, 2-2, 3-1.
You can find the necessary information in the following textbooks.
Basic theoretical question, that will help you prepare for class:
You can find all the information on this topic in these textbooks:
After gaining the necessary knowledge, try answering the following questions:
Q.№1. On an autopsy of a 52 year old male, who had suffered from TB prostatitis, and died of meningoencephalitis, in the soft tunic on the basis and lateral surfaces of frontal lobe, spleen, kidneys and liver, was found a large amount of thick, grey nodules 1mm in diameter. The histological exam showed that they are made of epithelioid, lymphoid and gigantic cells of Pirogov-Langhance. What form of hematogenic TB do these changes belong to?
Q.№2. On an autopsy of a 20 year old HIV+ drug addict, in the lungs, liver, soft brain tunics were found a lot of foci of yellow colour 1mm in diameter. The histological exam showed that these foci are areas of caseous necrosis. What form of TB is in this case?
Q.№3. On an autopsy of a 44 year old male, who had died of liver cirrhosis, an enlarged right testicular appendix was found, thick to the touch, on a cut-set is thick, crumbling yellow tissue with grayed out surface. The histological exam showed a TB inflammation with foci of caseous necrosis. What form of TB is in this case?
Q.№4. On an autopsy of a 28 year old male, in the 1-2 segments of his right lung, were found 3 thick areas 1x1.5cm, grey-yellow colour, with grayed out surface. A histological exam showed TB endo- and mesoperibronchitis, foci of cheesy bronchopneumonia, surrounded by epithelioid, lymphoid and gigantic cells of Pirogov-Langhance. What form of secondary TB is in this case?
Q.№5. On an autopsy of a 40 year old male, who had died of AIDS, both lobes of the left lung were enlarged, thick to the touch, airless, yellow colour on a cut-set with grayed out surface, on the pleura were fibrous applications. On a histological exam, in the alveoli was serofibrinous and fibrous exudation with large areas of caseous necrosis of exudation and pulmonary tissue. What form of TB is in this case?
Q.№6. A 42 year old male, who had died of an acute anemia, in consequence of pulmonary hemorrhaging, in the 2 segment of his right lung was found a space of incorrectly orbicular shape, 3x5cm filled with blood. The inner surface is uneven, covered with flabby structureless yellow tissue, the walls are thin, made of thickened and changed by an inflammation pulmonary tissue. The histological exam showed that the inner layer is made of melted caseous masses with a large amount of neutrophilic segmentated cells. What form of TB is in this case?
Q.№7. A 47 year old woman had died of a progressive heart failure. On the autopsy the lungs are small, thick. The upper lobes deformed, penetrated with scar tissue with encapsulated foci of caseous necrosis 0.2-0.5cm in diameter. In the upper and middle lobes of the right lung, spaces sized 4x4cm and 4x5cm with thick walls and тяжистой inner surface, containing unclear yellow-green liquid, the surrounding pulmonary tissue is sclerosed. The heart is enlarged because of a hypertrophied right ventrical, heart mass is 360,0grams. What form of secondary pulmonary TB is in this case?
Q.№8. On an autopsy of a 30 year old woman, that had been ill will a severe form of influenza, in the 2 segment of her right lung, an area of caseous pneumonia size 3x4cm with a large zone of non specific serofibrinous inflammation around it. What form of secondary TB is in this case?
Q.№9. On an autopsy of a 35 year old male, in the 2nd segment of his right lung, a thick, round locus 4cm in diameter was found, it was made of thick, dry, crumbling, yellow tissue with a grayed out surface surrounded by a thin connective tissue capsule. What form of pulmonary TB is in this case?
Methodic instructions for class work on a topic:
«Hematogenic TB. Secondary pulmonary TB».
In the beginning of the class your how work will be checked and then, you will be tested to see how well have you prepared for class.
Individually you should study the macro and the micro preparations, using the algorithm of preparation study (supplement No.2 of the previous lesson), algorithm of morphologic diagnostics of miliary TB and pulmonary фибринозно-кавернозного TB (supplement № 3), answer the questions above. Hematogenic TB is studied on the following preparations: "Miliary pulmonary TB", "Miliary TB of spleen", "Large focal TB of spleen". You should pay attention to the size of the defect and its colour, "TB leptomeningitis", "Cavernous TB of kidney", "TB spondylitis". When studying "TB leptomeningitis", pay attention to localization of the defect, its thickness, transparency, and colour of the tunics. While studying hematogenic TB, use the graph of logical structure "Hematogenic TB" (supplement № 1). Secondary pulmonary TB is studied on the following preparations: "Caseous pneumonia", "Pulmonary Фиброзно-кавернозный TB". When studying "Miliary pulmonary TB" you need to find TB tubercles with caseous necrosis in the center, "Fibronodular pulmonary TB" you need to find encapsulated foci of caseous necrosis different sizes, pneumosclerosis, фиброзно превращенные бугорки. "Caseous pneumonia" you should see parenchymatous, serofibrinous pneumonia with area of necrosis of exudation and pulmonary tissue. While studying secondary TB use the graph of logical structure "Secondary pulmonary TB" (supplement № 2).The class ends with you being tested on the acquired knowledge.
Graph of logical structure "Hematogenic TB"
Continuation of supplement №1.
Graph of logical structure "Secondary pulmonary TB"
Continuation of supplement №2.
Algorithm of morphologic diagnostics of miliary TB and pulmonary fibrocavernous (фиброзно-кавернозного)
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