75. Nonspecific granulomas: definition of the concept, conditions of formation, causes. Macro- and microscopic structure, outcomes, complications, clinical significance.

Nonimmune granulomas have no characteristic features. They arise around foreign bodies as a result of the action of dust, smoke, aerosols, and suspensions on the body. In this case, either phagocytomas or giant cell granulomas are formed.Their mandatory element is a macrophage, which carries out phagocytosis, a small number of leukocytes, including eosinophils, and giant cells of foreign bodies.As a rule, there are no epithelioid cells in such granulomas, and there are many vessels. These granulomas form the essence of a number of occupational diseases.

76. Granulomatous inflammation in tuberculosis: etiology, pathogenesis, conditions of development. Morphological characteristics, outcomes, complications, clinical significance.

Tuberculous granuloma has a necrosis focus in the center, and a shaft of epithelioid cells and lymphocytes with an admixture of macrophages and plasma cells along the periphery. Pirogov–Langhans giant cells typical of tuberculous granuloma are located between epithelioid cells and lymphocytes (Fig. 5-12, 5-13). When impregnated with silver salts, a network of argyrophilic fibers is found among granuloma cells. A small number of blood capillaries are found only in the outer areas of the tubercle. When stained according to Zil–Nielsen, Mycobacterium tuberculosis is detected in epithelioid and giant cells.

77. Granulomatous inflammation in syphilis: etiology, pathogenesis, conditions of development. Morphological characteristics, outcomes, complications, clinical significance.

Syphilitic granuloma (gumma) has an extensive focus of coagulation necrosis, to which hydrolases of neutrophilic leukocytes impart adhesive properties. The necrosis zone is surrounded by lymphocytes, plasma cells, macrophages, neutrophilic leukocytes and fibroblasts, single epithelioid cells and giant Pirogov–Langhans type cells. Connective tissue is intensively formed around the granuloma, forming a capsule, near which many small vessels with phenomena of productive inflammation in the walls and proliferating endothelium (endovasculitis) are located in the inflammatory infiltrate.

78. Granulomatous inflammation in leprosy: etiology, pathogenesis, conditions of development. Morphological characteristics, outcomes, complications, clinical significance.

Leprosy granuloma is a nodule consisting mainly of macrophages, lymphocytes and plasma cells. Among macrophages, large cells with fatty vacuoles containing Mycobacterium leprosy packed in the form of balls are isolated — Virchow's leprosy cells. When they disintegrate, they release mycobacteria, freely located among the cells of the leprosy.

79. Granulomatous inflammation around animal parasites and foreign bodies: etiology, pathogenesis, conditions of development. Morphological characteristics, outcomes, complications, clinical significance.