SITUATIONAL ANALYSIS

TISSUE REACTIONS TO INJURY

Part 2: Immune Reactions to Injury

The Acquired Immune Response and

Chronic Inflammation

Prepared by
EMMANUEL R. de la FUENTE, M.D.
 Objectives
2. To recognize the essential morphologic features
of chronic inflammation
3. To briefly discuss the following:
- The relationship between the innate and
acquired immune response and their differences
- The different types of cells involved in the
acquired immune response and their respective
roles
- The pathogenesis of the acquired immune
response
Identify and describe the cells seen in this blood
smear that are essential for the acquired immune
response? Identify and describe the other cells.
These are two types of lymphocytes in the peripheral
blood. Which of these lymphocytes constitute the
majority in the blood? What immunohistochemical
stains are useful to distinguish the two types?
This is a blood monocyte. Where does this cell
originate from and where does it eventually go?
What role does it play in the pathogenesis of
the acquired immune response?
Identify this organ. What role does it play in the
development of the immune system especially
in the non-recognition of self-antigen?
Identify this organ. Indicate the areas where the
T- and B-lymphocytes populate. What role does
this organ play in the acquired immune response?
Identify this organ. Which areas are populated by
the T- and B-lymphocytes? What role does it play
in the acquired immune response?
Identify the organ. Identify the areas populated by
the T- and B-lymphocytes.
1. Discuss briefly the following aspects in the
pathogenesis of the acquired immune
response:
- Preprocessing of the antigen by the
macrophage
- Manner by which the antigen is presented
to the lymphocyte
- Manner by which the T- and B-lymphocytes
neutralize the antigen
- Control mechanisms.
 SITUATION NO. 1

A 35 year-old woman developed jaundice

accompanied by elevated liver enzymes. She was
diagnosed to have acute viral hepatitis. She was
managed accordingly. After 1 year her liver enzymes
were still significantly elevated. She was diagnosed
to have chronic hepatitis. A liver biopsy was
performed.
Slide 1. Two lesions of the liver. Indicate which
represents the acute and chronic phase of the
disease. Describe.
There is significant necrosis of liver cells in the
encircled area. Discuss the pathogenesis of
necrosis.
1. Briefly discuss the pathogenesis of the
chronic lesion with emphasis on the
immunologic mechanisms, immune cells,
and chemical mediators involved.

2. Discuss briefly the healing process that will

most likely occur in the liver.
 SITUATION NO. 2

The patient in situation no.1 was lost to follow-up.

After 10 years, he again consulted because of
jaundice. Liver function tests were all abnormal.
He was diagnosed to have cirrhosis of the liver.
Two gross specimens of the liver. Describe each.
Which of the 2 is more representative of the clinical
diagnosis of cirrhosis?
Two microscopic sections of the cirrhotic liver.
Describe the essential features.
1. Briefly discuss the healing process in
this lesion.
2. Correlate the lesion with the situational
events.
 SITUATION NO. 3

A 57 year-old man while having his annual

physical examination was radiologically
diagnosed to have pulmonary tuberculosis.
Slide 1. Gross specimen of lung. Indicate the
lesions and describe.
Slide 2. Two histologic lesions of the lung. Describe
each lesion. Which of the 2 is more consistent with
the gross and radiologic interpretation? Next slide
for higher magnification of both lesions.
Slide 3. High magnification of the two lesions in
slide 2 for greater appreciation of the details. How
should these lesions be categorized?
1. Briefly discuss the pathogenesis of
each lesion.
2. Discuss the healing process in each
lesion
1. Study the following slides and
classify each lesion as to whether it
is acute or chronic inflammation or
granulomatous inflammation.
- LU-008
- LU-003
- GI-026