Epithelioid Giant Cell Granulomas Research Articles

КЛИНИКО-МОРФОЛОГИЧЕСКАЯ ХАРАКТЕРИСТИКА ПРОЯВЛЕНИЙ ТУБЕРКУЛЕЗНОГО ПЛЕВРИТА У ЛИЦ С АЛКОГОЛЬНОЙ ЗАВИСИМОСТЬЮ

Goal of the study : to study specific features of detection, diagnostics, clinical, morphological manifestations and treatment efficiency of tuberculous exudative pleurisy in those with alcohol addiction. Materials and methods . 62 medical cases of those suffering from exudative tuberculous pleurisy were retrospectively studied, in whom alcohol addiction was diagnosed basing on the patient's history and examination by the substance abuse doctor. Tuberculous pleurisy was verified in 80.65% of cases. Results : Alcohol addiction was diagnosed in 15% of those suffering from tuberculous pleurisy. Among patients with alcohol addiction 47% were 30 years old and older, and they were single, 11% lived alone, 76% were the unemployed but within employable age, 27% had previous convictions, and 10% were homeless. More than 27% of patients had not have fluorography screening for 2 years and more. In 53% of cases pleurisy was combined with concurrent pulmonary lesions and in 27% of cases respiratory lesions were bilateral. Destruction of lung tissue was observed in 42% of cases, and in 35.5% tuberculosis mycobacteria were found in sputum. Caseous necrosis was found in 7.5% of cases, epithelioid giant-cell granulomas were found in 64% of cases, and caseous necrosis in granulemas was found in 44% of cases when examining the needle biopsy specimens. Poor treatment adherence and low treatment efficiency had been observed among those patients.

Tuberculosis and sudden death

According to information obtained from police a 45-yearold man was found dead near a bus stop in the early morning. The decedent was a manual worker and a heavy smoker. He appeared to have been in good health prior to his death, with no definite medical history apart from a recent cough. His shirt was blood stained. At autopsy, the body was that of a thin middle-aged man (Fig. 1), with no significant external injuries, apart from small abrasions on both knees. Dried blood stains were present over his nostrils, mouth, and chin. The most significant findings were limited to the chest cavity where there were bilateral fibrous adhesions. Both lungs were gray in color with prominent anthracotic discoloration (Fig. 2) and emphysematous bullae. Cut sections of the lungs revealed a gray-white tubercle in the upper lobe of right lung (Fig. 3) and confluent areas of necrosis within the left lung that contained foul smelling yellow material (Fig. 4). The hilar lymph nodes were grayishwhite in color and enlarged. Hemorrhagic frothy fluid was present within the tracheobronchial tree. The remainder of the autopsy examination was unremarkable. Histological examination of the lungs revealed large areas of caseous necrosis with numerous Langhan’s giant cells typical of Mycobacterium tuberculosis infection. Lesions manifested alveolar destruction with a mixed acute and chronic inflammatory cell infiltrate. Lymph node architecture was completely effaced with replacement by confluent areas of caseous necrosis, again with epithelioid giant cell granulomas. Tubercle bacilli were demonstrated in the lungs on Ziehl–Neelsen staining (further microbiological studies were not undertaken). Toxicological studies were negative. No other underlying natural diseases were present which could have caused or contributed to death, and there was no evidence of significant trauma to indicate assault (the minor abrasions of the knees most likely occurred at the time of collapse during the terminal episode). Death was due to acute upper airway hemorrhage complicating pulmonary tuberculosis.

In situ Rantes and interferon-gamma gene expression in pediatric small bowel Crohn's disease.

Rantes (regulated upon activation, normal T cell expressed and secreted) is a chemotactic cytokine for memory T lymphocytes, monocytes, and eosinophils. The cytokine interferon-gamma (IFN-gamma) plays a key in the immune response. Their distributions and possible roles in the selective accumulation of inflammatory cells in Crohn's disease (CD) were examined by determining the expression of Rantes and IFN-gamma genes in patients with CD using in situ hybridization (ISH) on frozen and paraffin-embedded tissue sections. Intestinal and mesenteric lymph node samples from 9 children who had undergone ileal resection for CD were examined for the presence of epithelioid-giant cell granulomas (EGCG) and Rantes and IFN-gamma messenger RNA (mRNA). Normal pediatric intestine (n = 5) and lymph nodes (n = 2) served as controls. Many cells in all CD specimens in the epithelial compartment, lamina propria, and the EGCG gave positive signal with the Rantes antisense probe. Labelled cells were identified on paraffin sections as lymphocytes, macrophages, and epithelioid cells. There were Rantes-positive cells in the control intestinal tissues, but many Rantes-positive cells in control lymph nodes that showed follicular hyperplasia. IFN-gamma-positive cells were present in all CD ileal and lymph node specimens, predominantly in close contact with EGCC. No positive signal was obtained with the Rantes and IFN-gamma sense control probes. These findings suggest that Rantes and IFN-gamma contribute to the selective accumulation of macrophages and memory T helper lymphocytes inside the granulomas and inflammatory infiltrates that are characteristic of CD.

IN SITU RANTES AND INTERFERON-γ GENES EXPRESSION IN PEDIATRIC SMALL BOWEL CROHN'S DISEASE

Aims: Rantes (regulated upon activation, normal T cell expressed and secreted) is a chemotactic cytokine for memory T lymphocytes, monocytes and eosinophils. Interferon-γ (IFN-γ) is a key cytokine responsible for immune response. To visualize their distribution and to understand their possible role in the selective accumulation of inflammatory cells in Crohn's disease (CD), we analysed the expression of Rantes and IFN-γ genes from patients with CD using in situ hybridization (ISH) on frozen and paraffin tissue sections. Méthods: We studied intestinal and mesenteric lymph node samples from 9 children who had undergone ileal resection for CD. The samples were examined for the presence of epithelioid-giant cell granulomas (EGCG). Normal pediatric intestine (n=5) and lymph nodes (n=2) served as controls. Radiolabelled Rantes and IFN-γ mRNA probes were used. Results: Positive signal with the Rantes antisense probe was present within numerous cells in all CD specimens in the epithelial compartment, lamina propria and within EGCG. Labelled cells were identified in paraffin sections as lymphocytes, macrophages, and epithelioid cells. Only scattered Rantes positive cells were present in the intestinal control tissues. Numerous Rantes positive cells were observed in control lymph nodes exhibiting follicular hyperplasia. IFN-γ positive cells were present in all CD specimens in ileal and lymph node specimens, predominantly in close contact with EGCC. No positive signal was obtained with Rantes and IFN-γ sense probes. Conclusions: These findings suggest Rantes and IFN-γ participation in the selective accumulation of macrophages and memory T helper lymphocytes inside granulomas and in the inflammatory infiltrate both of which are characteristics of CD.