Inflammation Case Studies

Return to the Laboratory Menu.


CASE 1:

(Click here to go to the answers)

HISTORY:

A 19-year-old woman presented to the emergency room with severe left lower quadrant abdominal pain. She had vital signs with T 39.0 C (102.2 F), P 87, R 17, and BP 100/70 mm Hg. Physical examination revealed extreme tenderness in the left lower quadrant. Her WBC count showed a leukocytosis (19,200) with a "left shift" (75% segs and 10% bands). She was taken to surgery and a laparotomy revealed that the left fallopian tube and ovary were adherent and dilated and filled with yellow purulent material that was spilling into the peritoneal cavity from a site of rupture. Culture of this material grew Neisseria gonorrheae. (images 1.1 through 1.3 are the microscopic appearance of the tube, and image 1.4 is the gross appearance).

Image 1.1:

Image 1.2:

Image 1.3:

Image 1.4:

Questions

  1. Grossly the tube and ovary are adherent. What is demonstrated on sectioning?
  2. A microscopic cross section shows fallopian tube with a thickened wall and dilated lumen. What is the predominant inflammatory cell type seen in the wall and filling the lumen of the tube?
  3. What has happened to the vascular structures (blood vessels, lymphatics) in the tube?
  4. What is the process that is leading to the appearance of pink, homogenous material separating tissue structures and layered on the serosa?
  5. What is the diagnosis?


CASE 2:

(Click here to go to the answers)

HISTORY:

Over an 18 hour period, a 24-year-old man noticed increasing abdominal pain which was first centered in the periumbilical region, but later localized in the right lower abdominal quadrant. Physical examination demonstrated involuntary guarding and rebound tenderness in the right lower quadrant. A CBC revealed a WBC count of 18,550/microliter with a left shift. He was taken to surgery and an appendectomy was performed. The appendix examined in surgical pathology was swollen and covered with a purulent exudate. (image 2.1 is the peripheral blood smear; image 2.2 is the gross appearance of the appendix, and images 2.3 through 2.5 are the microscopic appearance).

Image 2.1:

Image 2.2:

Image 2.3:

Image 2.4:

Image 2.5:

Questions

  1. Sections of the appendix show what predominant inflammatory cell type in the wall?
  2. Through what series of steps are these inflammatory cells undergoing to reach the wall?
  3. In some places the wall shows disruption of the tissue. What is this process?
  4. How does the CBC relate to the findings in the appendix?


CASE 3:

(Click here to go to the answers)

HISTORY:

Following left anterior descending coronary artery thrombosis with an acute myocardial infarction involving most of the free wall of the left ventricle, a 73-year-old man experienced partial paralysis of his right side. He also developed acute renal failure and hematuria. He died a short time later. (image 3.1 is the gross appearance of the cardiac lesion; images 3.2 is the gross appearance of the renal lesion, and images 3.3 and 3.4 demonstrate the lesion's microscopic findings).

Image 3.1:

Image 3.2:

Image 3.3:

Image 3.4:

Questions

  1. Describe the lesion in the heart at autopsy.
  2. Diagnose and describe the lesion in the kidney removed at autopsy. What would be the typical gross appearance?
  3. How did the renal lesion result from the myocardial infarction?
  4. What was the probable cause of his paralysis?


CASE 4:

(Click here to go to the answers)

HISTORY:

An 83-year-old woman experienced cough, fever, and shaking chills for two days prior to admission. Physical examination revealed rales in the right lung base. She was coughing up a small amount of yellowish sputum. Chest x-ray initially showed a right lower lobe infiltrate, but several days later showed infiltrates throughout the right lung. Sputum culture grew Streptococcus pneumoniae. (image 4.1 demonstrates the gross appearance of the lung, and images 4.2 through 4.4 illustrate the microscopic findings).

Image 4.1:

Image 4.2:

Image 4.3:

Image 4.4:

Questions

  1. How would you describe the gross appearance of the lung?
  2. What do you see in the alveolar spaces in the lung?
  3. How would this differ from a causative agent such as influenza virus?
  4. What chemical mediators are responsible for fever?
  5. What is the diagnosis?


CASE 5:

(Click here to go to the answers)

HISTORY:

A 35-year-old man had a history of intravenous drug use. Over several days' time, he developed a high fever, then dyspnea. On physical examination, his temperature was 39.4 C (103 F), and a heart murmur was heard. Needle tracks and a red, tender, fluctuant area were noted near the left antecubital fossa. A blood culture grew Staphylococcus aureus. Despite antibiotic therapy, he died three days later. The aortic valve is shown in image 5.1. Sectioning of the myocardium revealed multiple small soft yellow foci (image 5.2). The epicardium showed a shaggy appearance (image 5.3).

Image 5.1:

Image 5.2:

Image 5.3:

Questions

  1. What is the appearance of the aortic valve (image 5.1)?
  2. Note the dark purple focus in this section of myocardium. Describe what you see in these foci (image 5.2).
  3. How do these foci in the myocardium relate to the lesions on the aortic valve?
  4. Bacteria are being phagocytozed because what agents are acting as opsonins?
  5. What is the diagnosis? What is the pathogenesis of this process?
  6. What is the process involving the epicardium (image 5.3)?


CASE 6:

(Click here to go to the answers)

HISTORY:

A 53-year-old man was the driver of a car involved in a head-on collision with another vehicle at 45 mph. He was not wearing a seat belt and his vehicle did not have an airbag. He sustained blunt trauma to the upper abdomen. On admission to hospital, he complained of severe abdominal and mid-back pain. He appeared gravely ill. A peritoneal lavage revealed bloody abdominal fluid. Serum lipase was 7500 U/L. At surgery, multiple liver lacerations were noted, and there were flecks of white, chalky material in adipose tissue adjacent to a slightly swollen pancreas.

Image 6.1:

Image 6.2:

Questions

  1. Diagnose and describe what you see grossly (image 6.1) and microscopically (image 6.2).
  2. How does this lesion occur?
  3. Name another site at which trauma can produce this lesion.


CASE 7:

(Click here to go to the answers)

HISTORY:

A 42-year-old woman underwent hysterectomy because of pelvic pain and irregular menstrual cycles associated with heavy menstrual bleeding. She also complained of an intermittent, whitish mucoid vaginal discharge between menstrual periods for several months.

Image 7.1:

Image 7.2:

Image 7.3:

Image 7.4:

Questions

  1. What is the gross appearance of the cervix (image 7.1)?
  2. Microscopically, the uterine cervix at the squamocolumnar junction has ectocervix lined by glycogen rich, non-keratinizing stratified squamous epithelium. The endocervical canal is lined by a layer of columnar mucinous epithelial cells. At the squamocolumnar junction, the mucinous epithelium exhibits focal squamous metaplasia. What do you see adjacent to this area in the fibromuscular stroma (images 7.2 and 7.3)?
  3. Why is there metaplasia (image 7.4)?
  4. What is the diagnosis?


CASE 8:

(Click here to go to the answers)

HISTORY:

A 45-year-old man had a 30 year history of alcohol abuse. He died from head trauma in a motor vehicle accident. At autopsy, the liver showed a diffusely nodular, firm surface. (image 8.1 demonstrates a normal liver in situ for comparison; image 8.2 shows the gross appearance of the liver in this case, and images 8.3 and 8.4 show the microscopic findings).

Image 8.1:

Image 8.2:

Image 8.3:

Image 8.4:

Questions

  1. Diagnose and describe the liver lesions seen grossly and microscopically.
  2. Which process is reversible (in weeks)?


CASE 9:

(Click here to go to the answers)

HISTORY:

A 30-year-old African-American man complained of fever, night sweats, fatigue, weight loss, and shortness of breath for several months. A chest x-ray revealed prominent bilateral hilar lymphadenopathy. Physical examination revealed cervical lymphadenopathy. A cervical node biopsy was performed (images 9.1 through 9.3 demonstrate the histopathologic findings). Microbiologic culture of the node showed no growth of bacteria, fungi, or mycobacteria.

Image 9.1:

Image 9.2:

Image 9.3:

Questions

  1. What general type of inflammatory process is seen in the section of lymph node?
  2. What inflammatory cell types are present?
  3. What is the diagnosis?


CASE 10:

(Click here to go to the answers)

HISTORY:

A 53-year-old woman comes to you because of pain and swelling on the right lower side of her face for several weeks. Your physical examination reveals a tender submandibular mass. At surgery, a calcified concretion (salivary duct stone) is noted in the duct draining this gland and the stone is removed. The submandibular gland is then biopsied.

Image 10.1:

Image 10.2:

Image 10.3:

Questions

  1. Describe what you see in the salivary gland.
  2. What was the role of the salivary duct lithiasis?
  3. What is the diagnosis?


CASE 11:

(Click here to go to the answers)

HISTORY:

A 49-year-old woman had a chronic cough for over a year. Recently, she noted that the sputum was streaked with blood. She also had fever, and had lost 20 lbs in the last 4 months. Chest x-ray revealed bilateral upper lobe nodular infiltrates along with a left upper lobe cavitation. (image 11.1 shows the gross appearance of the lung, and images 11.2 through 11.5 show the microscopic findings).

Image 11.1:

Image 11.2:

Image 11.3:

Image 11.4:

Image 11.5:

Questions

  1. What is the inflammatory process seen in images?
  2. Describe the giant cells seen in the lesions. What do you suspect as a diagnosis?
  3. What would you do to confirm your diagnosis?
  4. What determines the severity of this disease, and how can it spread in the body?

Return to the Laboratory Menu.