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Granulomas – treatment and types

Granulomas – treatment and types

Granulomas are small nodular clusters of cells with typical dimensions of 1-2mm. Their formation is a long ongoing response to the slow destroying pathogens by the cells of monocyte-macrophage system. Granulomas may develop in any organ of the human body in a variety of diseases in which chronic inflammation develops. Granulomas appear as small whitish nodules on the surface and in the parenchyma of the organs, have a dense texture and larger sizes may mimic tumor process.

 

Tubercles

Tubercles

Factors that determine the formation of granulomas:

  • The agent, causing of inflammation- inorganic or organic substances, biological or immune nature.
  • Biology of the agent – as the transformation of bacteria from S forms in R reduces the number of formed granulomas, which do not reach the stage of epitellial cell.
  • Specific toxins and substances produced by a microorganism.
  • Difficulties in phagocytosis due to failure of enzyme systems of phagocytes to carry out intracellular digestion.
  • Reactivity of the organism, in particular – the state of immunity in relation to the secretion of mediators from T and B lymphocytes.
  • The presence of fibronectin in tissues that play a role in fibrosing granuloma.
  • Long – term persistence of harmful agents in the tissues.

 

Types of granulomas

Nonspecific are those granulomas whose construction does not allow to be made etiological diagnosis, i.e. to predict disease. For example, granulomas type “foreign body” always have the same structure, regardless of the nature of the foreign body. In the center of the node is located the foreign body, around it there are numerous macrophages,  multinucleated giant cells type “foreign body” and at the periphery – lymphocytes, fibroblasts and mature connective tissue that surrounds the capsule as a whole entity.

Specific granulomas are those in which by histology examination can be placed disease diagnosis, i.e. to predict disease. This is because each agent composition of the granulomas is highly specific and does not coincide with the construction of granulomas in other etiologic agents. Examples of such granulomas are tubercles in tuberculosis, gums in syphilis, granulomas in sarcoidosis, rinoskleroma, in rheumatism and many others.

Tubercles (in tuberculosis) contain in their center caseous necrosis around which a shaft of epiteloid cells, between them – multinucleated giant cells type “Langhans”, and at the outside – many T- lymphocytes, fibroblasts and connective tissue. Gums  (in syphilis) have almost the same construction as tubercles, but unlike them, the necrosis is gum- like, lymphocytes are B (plasma cells) and at the periphery there are many blood vessels with inflammatory changes in vascular walls – endarteriitis obliterans. Granulomas in sarcoidosis look also like in tuberculosis, but there is no central necrosis, and peripheral connective tissue forms clear outline of the node as print.

Treatment of granuloma consists of treating the underlying disease – tuberculosis, syphilis, sarcoidosis, rheumatic fever. In the healing process fibrosing granulomas and most of them that cause problems can be removed by surgical cutting.

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