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FEEDBACK EXERCISE 1b FOR MLS 222 EXERCISE 1b: ELABORATE PATHOLOGY A. ACUTE NEPHRITIS as seen in rapidly progressive glomerulonephritis NORMAL HISTOLOGY PATHOLOGIC Crescent-shaped Crescentic glomerulonephritis (PAS stain). Note the collapsed glomerular tufts and the crescent-shaped mass of proliferating parietal epithelial cells and leukocytes internal to Bowman capsule. The hypercellularity is caused by (1) infiltration by leukocytes, both neutrophils and monocytes; (2) proliferation of endothelial and mesangial cells; and (3) in severe cases by crescent formation. The proliferation and leukocyte infiltration are typically global and diffuse, that is, involving all lobules of all glomeruli. There is also swelling of endothelial cells, and the combination of proliferation, swelling, and leukocyte infiltration obliterates the capillary lumens. Crescents are formed by proliferation of parietal cells and by migration of monocytes and macrophages into the urinary space. Neutrophils and lymphocytes may be present. The crescents may obliterate the urinary space and compress the glomerular tuft. Fibrin strands are frequently prominent between the cellular layers in the crescents; the escape of procoagulant factors, fibrin and cytokines into Bowman space may contribute to crescent formation. Page 1 of 5 Prepared by: A.Walsi-en FEEDBACK EXERCISE 1b FOR MLS 222 B. FOREIGN BODY granuloma (tophi) Tophi are the pathognomonic hallmark of gout. They are formed by large aggregations of urate crystals surrounded by an intense inflammatory reaction of foreign body giant cell. Tophi may appear in the articular cartilage, ligaments, tendons, and bursae. Less frequently they may occur in soft tissues (earlobes, fingertips) or kidneys. Superficial tophi can ulcerate through the overlying skin. Amputated great toe with white tophi involving the joint and soft tissues. Page 2 of 5 Prepared by: A.Walsi-en FEEDBACK EXERCISE 1b FOR MLS 222 Gouty tophus—an aggregate of dissolved urate crystals is surrounded by reactive fibroblasts, mononuclear inflammatory cells, and giant cells. C. MILIARY TUBERCULOSIS of the lung Miliary pulmonary disease occurs when organisms draining through lymphatics enter the venous blood and circulate back to the lung. Individual lesions are either microscopic or small, visible (2-mm) foci of yellow white consolidation scattered through the lung parenchyma (the adjective “miliary” is derived from the resemblance of these foci to millet seeds). Miliary lesions may expand and coalesce, resulting in consolidation of large regions or even whole lobes of the lung. With progressive pulmonary tuberculosis, the pleural cavity is invariably involved, and serous pleural effusions, tuberculous empyema, or obliterative fibrous pleuritis may develop. Page 3 of 5 Prepared by: A.Walsi-en FEEDBACK EXERCISE 1b FOR MLS 222 D. CHRONIC GLOMERULONEPHRITIS as seen in end-stage renal disease “thyroidization” The microscopic changes involve predominantly tubules and interstitium. The tubules show atrophy in some areas and hypertrophy or dilation in others. Dilated tubules with flattened epithelium may be filled with casts resembling thyroid colloid (thyroidization). Page 4 of 5 Prepared by: A.Walsi-en FEEDBACK EXERCISE 1b FOR MLS 222 MORPHOLOGY: The kidneys are symmetrically contracted and have diffusely granular cortical surfaces. On section, the cortex is thinned, and there is an increase in peripelvic fat. The glomerular histology depends on the stage of the disease. In early cases, the glomeruli may still show evidence of the primary disease (e.g., membranous nephropathy or MPGN). However, there eventually ensues obliteration of glomeruli, transforming them into acellular eosinophilic masses, representing a combination of trapped plasma proteins, increased mesangial matrix, basement membrane-like material, and collagen. Marked atrophy of associated tubules, irregular interstitial fibrosis, and mononuclear leukocytic infiltration of the interstitium also occur. REFERENCE: Robbins SL, Cotran RS, Kumar V, Abbas AK, Aster JC. Pathologic basis of disease. 9TH ed. Philadelphia, PA: Saunders Elsevier; 2015. Page 5 of 5 Prepared by: A.Walsi-en