Ординатура / Офтальмология / Английские материалы / Eye Pathology An Atlas and Text_Eagle_2010

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Plasma Cell

Eccentric "cartwheel" nucleus

Basophilia of cytoplasm reflects RNA in RER Perinuclear "hof"- Golgi apparatus Activated "B" lymphocyte

Antibody synthesis and secretion, antibody "factory"

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Plasmacytoid cell

Plasma cell with granular eosinophilic cytoplasm (or lymphocyte with plasma celllike nucleus)

Russell body

Round immunoglobulin crystal formed in "constipated" plasma cells

Morula cell (of Mott)

Contains multiple grape-like Russell bodies

Mast Cell (tissue basophil)

Superficially resembles plasma cell, but stains + for MPS

Binds IgE to surface, contact with antigen causes degranulation and release of histamine and heparin

Cause of acute anaphylaxis, allergic conjunctivitis, etc.

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Chronic Nongranulomatous Inflammation:

Inflammatory infiltrate composed of lymphocytes and plasma cells;

Usually denotes activation of immune system, e.g., "endogenous iridocyclitis" (occasionally, lymphocytes and plasma cells may represent the acute response to certain viruses)

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Macrophage (histiocyte, monocyte)

Large mononuclear cell with eccentric reniform nucleus Second line of cellular defense

Body's primary phagocytic cell

Enormous phagocytic capacity with little tissue damage Regulate lymphocytic responses

Antigen presentation (process antigens, present to T helper cells in association with class II MHC molecules)

Monokine production

Transform into epithelioid cells, inflammatory giant cells

In eye, frequently contain phagocytized substances, e.g., lenmaterial, melanin, lipid, blood breakdown products

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Epithelioid Histiocyte (activated macrophage)

Activation caused by large quantities of relatively insoluble or indigestible antigen, or organisms that proliferate intracellularly

Abundant eosinophilic cytoplasm, large vesicular nucleus with nucleolus Groups of cells superficially resemble epithelium, hence name.

Necessary for diagnosis of Granulomatous inflammation!!!

Fuse to form inflammatory giant cells.

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Inflammatory giant cells

Langhan's giant cell

Peripheral rim of nuclei, homogenous cytoplasm

Foreign body giant cell

Contains or surrounds foreign material, nuclei random

If foreign body is too large, body "walls it off" with “insulation” of foreign body giant cells ( e.g.., precipitates on IOL's)

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Touton giant cell

Peripheral wreath of foamy lipid surrounds ring of nuclei Characteristic finding in JXG, also seen in other lipid

disorders such as necrobiotic xanthogranuloma, Erdheim-Chester disease (see appendix)

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Chronic Granulomatous Inflammation:

Infiltrate contains epithelioid cells and/or giant cells. Generally a response to large quantities of insoluble antigen or organisms that grow intracellularly. Eyes with granulomatous inflammation may harbor organisms (bacteria, fungi, acid fast bacteria) or foreign matter

May be a response to endogenous material acting as a "foreign body", e.g., lipid in chalazion, cholesterolosis; keratin in ruptured dermoid cyst.

Clinically, large, greasy "mutton fat" keratic precipitates denote granulomatous inflammation

Work-up!! Clinical work-up, special stains (Gram, AFB, GMS, polarization etc. may reveal causative organisms, foreign bodies, specific diagnosis, etc.

Patterns of Granulomatous Inflammation

Diffuse:

Borders ill-defined, epithelioid cells and giant cells randomly distributed against background of lymphocytes and plasma cells. "Salt and pepper" pattern. Examples: sympathetic uveitis, lepromatous leprosy

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Discrete (sarcoidal):

Discrete nodule or aggregate of epithelioid cells surrounded by rim of lymphocytes.

Examples: sarcoidosis, miliary tuberculosis, tuberculoid leprosy.

Sarcodosis

Discrete noncaseating granulomas

Retinal perivascualr candle wax drippings (tache de bougie) = potential for CNS Involvement

Uveitis; granulomas; Busacca and Koeppe nodules