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1. Chronic Inflammation
•Inflammation of slow progress lasting for weeks ,
months or years
•Marked by formation of new connective tissue
•Characterized by infiltration with mononuclear cells
including lymphocytes, plasma cells and macrophages
•Type of inflammatory process in which active
inflammation ,tissue injury and healing proceed
simultaneously

2. Features of chronic inflammation
The three characteristic features of chronic inflammation (in the lung)
1. Chronic inflammatory cells infiltration* 2. destruction of the normal tissue
(normal alveoli are replaced by spaces lined by cuboidal cells (arrow heads)
3. Replacement by fibrosis (arrows)

3. Ingeneral,theinflammatoryinfiltrateofchronicinflammation
consistsmainlyofmononuclearcells:lymphocytes,plasma
cells,andmacrophages.

4. Chronicinflammationcangoonforalongtime.Seenherein
thesynoviumofapatientwithrheumatoidarthritisare
collectionsofdarkbluelymphocytes.

5. Chronicinflammationcanbeseeninconjunctionwithsome
degreeofscarring.Here,chronicinflammationofthe
bronchihasledtodilationandscarringwithincreasedtanto
whitecollagenoustissue.

6. Chronicinflammationwithdestructionofthebronchialwallis
seenhere.Aninflammatoryinfiltrateextendsfromthelumento
theleft.

7. Chronic cholecystitis with
cholelithiasis

8. Silicotic nodule mic
Asilicoticnoduleinlungisseenhere.Itiscomposedmainlyof
bundlesofinterlacingpinkcollagen.Thesilicaparticlesarecolorless
andsonotvisiblewiththisordinaryH&Estain

9. Rheumatoid arthritis
Thisdeformityofthehandisdue
torheumatoidarthritis(RA).
Thisautoimmunediseaseleads
tosynovialproliferationand
jointdestruction,typicallyina
symmetricalpatterninvolving
smalljointsofhandsandfeet,
followedbywrists,ankles,
elbows,andknees.
Chronicinflammationcango
onforalongtime.Seenherein
thesynoviumofapatientwith
rheumatoidarthritisare
collectionsofdarkblue
lymphocytes.

10. Granulomatous Inflammation
•Distinctive pattern of chronic inflammation
characterized by
-aggregation of activated macrophages (epithelioid)
-multinucleated giant cells .
•Examples
-Tuberculosis
-Foreign-body granuloma
-Syphilis.
-Sarcoidosis

11. Diagram of typical TB granuloma
Caseation
Epithelioid cells
Multinucleated GC
Lymphocytes
fibroblasts

12. Langhan’s Vs FB giant cells

13. Lung, granulomatous inflammation with caseation
Note the yellowish mottling
of lung tissue. These small,
yellow nodules are caseating
TB granulomas. Some have
fused together to form
larger areas of yellow
caeation (arrow)

14. Grossly,agranulomatendstobeafocallesion.Seenhereina
hilarlymphnodeisagranuloma.Granulomasduetoinfection
areoften"caseating"becausetheyhaveprominentcaseous
necrosis

15. TB granulomas lung
Thisisalowpowerview
showingtwo,adjacent,
well-defined, rounded
granulomas.Fromthis
powerthepresenceof
multinucleatedgiantcells
isobvious(arrow).
Thisisahighpowerview
showingaportionof
typicalTBgranuloma.
Notetheamorphous,
pinkishcentralcaseation,
whichissurroundedbya
rimofepithelioidcells.
caseation

16. Foreign body giant cells in suture granuloma
Two foreign body giant cells are seen, where there is a bluish
strand of suture material (arrow) from a previous operation

17. Sarcoidosis lymph node
Sarcoidosisisagranulomatous
inflammatory disease
whichaffectsmanytissues,
includinglymphoidtissue.
Thecapsuleofthenodeis
ontheleft.Thenormal
architectureofthenodehas
beenlargelydestroyed,
withsomeblue-staining
lymphoidtissuesurviving
beneaththecapsuleand
betweentheroundsarcoid
granulomas.Thelattervary
widelyinsize,fromafew
cellstoverylarge
collections(right)several
mmindiameter.They
consistofepithelioid
histiocytes.Thereisno
caseation,butsome
containcalcifiedlaminated
Schaumann bodies
(arrows).