Productive (los yog proliferative) o yog lub cev teb. Ntawm qhov tsos ntawm uas ib theem twg prevails. Ntawd yog, qhov no, kev loj hlob ntawm cov hlwb ntawm histiogenic thiab hematogenous keeb kwm predominates. Lub hauv paus tseem ceeb hauv thaj tsam ntawm cov kab mob tshwm sim yog suav tias yog monocyte uas nkag mus rau cov ntaub so ntswg ncaj qha los ntawm cov hlab ntsha; hauv cov ntaub so ntswg, cov monocyte hloov mus rau hauv macrophage.
YMacrophage
Lub luag haujlwm tseem ceeb ntawm macrophage yog phagocytosis. Ntawm nws qhov chaw muaj ntau yam receptors uas tsim nyog los ntes cov kab mob, fungi, kab mob, immunoglobulins. Phagocytosis thaum lub sij hawm proliferative o yuav tsis tas yuav ua tiav, uas yog, nws tsis xaus nrog kev zom zaub mov ntawm tus neeg sawv cev txawv teb chaws. Cov kab mob thiab cov kab mob microbial hauv macrophages muaj sia nyob, sib npaug, uas yog vim li cas cov txheej txheem dhau los ua ntev. Ntxiv rau macrophages thaum lub sij hawm proliferative o, feem ntaupom lwm cov hlwb. Cov no suav nrog lymphocytes, eosinophils, plasma cells, mast cells, ib leeg neutrophils.
Thaum lub sijhawm ntawm cov cell proliferation, cellular diffuse lossis focal infiltrates raug tsim.
Ntau yam
Qhov teeb meem tuaj yeem tshwm sim hauv txhua lub cev ntawm lub cev thiab ntawm txhua cov ntaub so ntswg. Muaj cov nram qab no hom kab mob proliferative:
- interstitial (interstitial);
- tsim tawm nrog kev tsim ntawm polyps, qhov chaw mos warts;
- granulomatous.
Cia peb txiav txim siab nyias.
Interstitial
Interstitial (los yog interstitial) yog ib hom kab mob proliferative nyob rau hauv uas ib tug diffuse los yog focal cellular inflammatory infiltrate yog tsim nyob rau hauv lub stroma ntawm lub plawv, daim siab, ob lub raum, thiab lub ntsws. Cov infiltrate yog sawv cev los ntawm lymphocytes, plasma hlwb, macrophages, eosinophils, ib leeg mast hlwb, puas parenchyma ntsiab, tsawg neutrophils.
Hauv cov ntsiab lus parenchymal, hais dystrophic, qee qhov kev hloov pauv necrobiotic raug txiav txim. Qhov tshwm sim ntawm interstitial o yuav yog interstitial fibrosis, uas yog proliferation ntawm connective cov ntaub so ntswg.
Nrog polyps thiab qhov chaw mos warts
Lub sijhawm loj hlob ntawm qhov mob nrog kev tsim ntawm polyps, nrog rau qhov chaw mos pob, yog tus cwj pwm los ntawm kev mob ntev. Nws yog localized ntawm lub mucous daim nyias nyias. Sib cais thaj chaw ntawm hyperplasia yog tsim nyob rau hauv lub mucous daim nyias nyias ntawm ntau yam kabmob, nrog rau cov epithelial loj hlob nyob rau hauv daim ntawv ntawm polyps, nyob rau hauv uas lub connective cov ntaub so ntswg puag.infiltrated nrog macrophages, lymphocytes, plasma hlwb thiab lwm yam.
Localized feem ntau ntawm cov mucous ntawm lub qhov ntswg, plab, uterus, hnyuv, bronchi. Nyob rau hauv cov ntaub ntawv ntawm localization ntawm o ntawm kev sib tshuam ntawm ib txheej cylindrical thiab stratified squamous epithelium, lub thiaj li hu ua condylomas yog tsim. Cov kev tsim no feem ntau tshwm sim hauv qhov quav, nrog rau ntawm qhov chaw mos. Nyob rau hauv cov kab mob proliferative mob, nquag warts yog qhov chaw mos warts, uas yog tshwm sim los ntawm papillomavirus. Nws suav hais tias yog ib qho kev pheej hmoo rau kev loj hlob ntawm squamous cell carcinoma.
Granulomatous
Granulomatous - lwm qhov sib txawv ntawm kev tsim khoom (proliferative) o. Thaum lub sij hawm uas lub ntsiab morphological substrate yog suav hais tias yog ib tug granuloma, qhov twg hlwb predominate: macrophages, raws li zoo raws li lawv derivatives (cov hlwb loj, epithelioid).
Morphogenesis ntawm granulomas muaj plaub theem ua tiav. Cov no suav nrog cov hauv qab no:
- sib sau ntawm cov tub ntxhais hluas monocytes hauv qhov txhab;
- maturation ntawm cov hlwb hauv macrophage nrog tsim ntawm macrophage granuloma;
- ntxiv kev loj hlob ntxiv thiab hloov pauv ntawm monocytes thiab macrophages mus rau hauv ib qho epithelioid cell thiab tsim cov epithelioid cell granuloma;
- hloov pauv ntawm cov cell epithelioid rau hauv Pirogov-Langhans giant cell (tshwj xeeb lub cev cell) thiab tsim cov cell loj heev granulomas.
Nws yuav tsum tau muab sau tseg tias phagocytic kev ua haujlwm ntawm granuloma cell thaum nws loj hlob zuj zuspoob.
Qhov txoj kab uas hla ntawm granulomas yog li 1-2 hli, feem ntau lawv pom tsuas yog nrog lub tshuab tsom. Hauv thaj tsam nruab nrab ntawm granuloma, ib tus tuaj yeem pom cov ntaub so ntswg detritus, uas yog tsim los ntawm cov ntaub so ntswg necrosis thiab nyob rau hauv uas tus neeg sawv cev ntawm tus kab mob hauv qab tuaj yeem kuaj pom, yog tias qhov no muaj cov txheej txheem sib kis. Macrophages yog nyob rau ntawm lub periphery ntawm necrosis. Kuj tseem muaj cov hlwb loj heev, cov hlwb epithelioid, ntawm lawv kuj tseem yuav muaj cov plasma hlwb, neutrophils, lymphocytes, eosinophils.
Granulomatous disease
Ntawm cov kab mob no nyob rau hauv daim ntawv ntawm cov kab mob proliferative o, 4 pawg yog txawv. Cov no suav nrog:
- kis mob etiology, uas yuav tsum muaj xws li mob rheumatism, typhus thiab typhoid fever, rabies, brucellosis, tularemia, viral encephalitis, yersineosis, actinomycosis, syphilis, mob ruas, schistosomiasis, tuberculosis, scleroma,
- tsis kis kab mob etiology, uas yuav tsum muaj xws li gout, silicosis, anthracosis, talcosis, asbestosis, berylliosis, aluminosis;
- tshuaj mob, xws li tshuaj tiv thaiv kab mob siab, kab mob oleogranulomatous;
- kab mob uas tsis paub txog etiology: Crohn's kab mob, sarcoidosis, Horton's kab mob, Wegener's granulomatosis, rheumatoid mob caj dab, xanthogranulomatous pyelonephritis.
Txhua yam granulomas muaj qhov sib kis etiology, txawm tias qhov sib txawv uas twb muaj lawm, lawv zoo ib yam hauv morphology. Nws tseem tsim nyog sau cia tias nyob rau txhua qhov xwm txheej, cov kab mob granulomas tshwm sim ua pawg.cov cell muaj monocyte-macrophage xwm. Hauv qee cov granulomas, lymphocytes, neutrophils, plasma hlwb raug tsim, nrog helminthiasis ntau eosinophils tshwm.
Tsuas yog qhov tshwj xeeb yuav yog granulomas nyob rau hauv cov ntaub ntawv ntawm tuberculosis, syphilis, scleroma, glanders, mob ruas. Hauv cov kab mob no nrog cov kab mob proliferative, cov granulomas muaj cov yam ntxwv tshwj xeeb uas yog cov yam ntxwv ntawm qee yam kab mob. Thiab qhov no tso cai rau peb los muab cov pab pawg ntawm cov kab mob no rau cov pab pawg tshwj xeeb granulomatosis. Los yog kev mob tshwj xeeb.
Nyob rau hauv lub tswv yim morphological rau ib qho mob tshwj xeeb, tsim ntawm ntau yam granulomas yuav yog tus yam ntxwv. uas muaj tus yam ntxwv qauv. Nws yuav txawv nyob ntawm seb cov kab mob tseem ceeb - qhov ua rau muaj mob loj heev. Yog li, cov cellular muaj pes tsawg leeg, nrog rau qhov chaw ntawm cov hlwb ncaj qha rau hauv granuloma, yog qhov tshwj xeeb rau txhua tus kab mob.
tuberculosis
txheej txheem mob ntsws hauv tuberculosis, uas yog, Mycobacterium tuberculosis tuaj yeem ua rau peb hom tshuaj tiv thaiv kab mob: exudative, alterative, thiab proliferative.
Raws li lwm txoj kev mob, nws feem ntau tshwm sim los ntawm hypoergy, nyob rau hauv rooj plaub ntawm kev txo qis hauv kev tiv thaiv ntawm tib neeg lub cev. Qhov o no yog morphologically manifested los ntawm caseous necrosis.
Exudative hom o tshwm sim los ntawm qhov uas twb muaj lawm hyperergy (xws lihypersensitivity rau mycobacterium co toxins, antigens). Morphologically, tsub zuj zuj ntawm manifests nws tus kheej nyob rau hauv qhov mob ntawm fibrinous, serous los yog tov exudate, uas tom qab kuj undergoes caseous necrosis.
Kev mob o, kab mob hais tias, txhim kho nyob rau hauv cov xwm txheej ntawm cov kab mob tshwj xeeb tuberculous. Lub morphological manifestation nyob rau hauv cov ntaub ntawv no yuav tsim ib tug thiaj li hu ua tuberculous granulomas, nthuav tawm nyob rau hauv daim ntawv ntawm millet nplej.
tuberculosis granuloma
Yog li, peb tau txheeb xyuas dab tsi ua rau tus kab mob proliferative. Tam sim no nws tsim nyog xav txog qee qhov xwm txheej uas nws tshwm sim nws tus kheej.
Tuberculosis granuloma muaj tus yam ntxwv qauv: nyob rau hauv nws cheeb tsam hauv nruab nrab muaj qhov ua kom pom tseeb ntawm qhov hu ua caseous necrosis, tom qab uas yog lub hauv paus ntawm radially localized (uas yog, elongated raws qhov ntev mus rau qhov chaw ntawm qhov chaw.) cov kab mob epithelium. Tom qab cov hlwb no, cov hlwb loj heev Pirogov-Langhans pom.
Nws tseem yuav tsum tau muab sau tseg tias nyob rau ntawm qhov chaw ntawm cov granuloma no muaj cov qog ntshav lymphocytes. Nyob rau hauv ib tug loj tus naj npawb ntawm cov kab mob no, plasma hlwb, raws li zoo raws li macrophages, tseem tuaj yeem pom nyob rau hauv me me. Tsis tas li ntawd, ib lub network nyias uas muaj argyrophilic fibers kuj tau tshwm sim ntawm no. Raws li cov hlab ntsha, lawv tsis pom ntawm no. Mycobacterium tuberculosis tuaj yeem kuaj pom hauv cov hlwb loj heev hauv cov ntaub ntawv ntawm Ziehl-Neelsen staining.
txheej txheem mob syphilis
Cov txheej txheem mob syphilis ntawm lub sijhawm sib txawv yuav cuam tshuam cov ntaub so ntswg sib txawv rau daj ntseg treponema: raws li txoj cai, thawj zaug, theem nrab, thiab lub sijhawm tertiary yog qhov txawv thaum muaj tus mob syphilis.
Thaum tus mob syphilis thawj zaug, cov tshuaj hu ua productive-infiltrative tshwm sim hauv thaj tsam ntawm treponema nkag mus.
Thaum lub sijhawm thib ob, pom muaj cov tshuaj tiv thaiv exudative tau pom zoo, ua rau muaj kev cuam tshuam ntawm cov kab mob, Thaum lub sij hawm tertiary ntawm tus mob syphilis, cov tshuaj tiv thaiv-necrotic yuav raug nthuav tawm nyob rau hauv daim ntawv ntawm syphilitic granuloma, nrog rau gummous infiltrates.
Ntau txog Syphilitic Granuloma
Syphilitic granuloma hauv cov tshuaj kuj muaj lub npe luv "gumma". Nyob rau hauv no granuloma, zoo li nyob rau hauv cov ntaub ntawv ntawm tuberculosis, caseous necrosis yog pom nyob rau hauv qhov chaw, tab sis nyob rau hauv no qhov teeb meem nws yuav loj loj.
Los ntawm necrosis ntawm qhov chaw ib puag ncig yog ntau cov lymphocytes, fibroblasts, thiab cov ntshav plasma. Hauv ib qho me me, macrophages, cov hlwb loj, thiab cov hlwb epithelioid tej zaum yuav muaj nyob ntawm no. Hauv qhov no, kev loj hlob ntawm cov ntaub so ntswg yog suav tias yog tus yam ntxwv (qhov no yog vim kev loj hlob sai ntawm fibroblasts), uas tsim ib hom tshuaj ntsiav, nrog rau ntau cov hlab ntsha.
Tsis tshua muaj, ntawm cov hlwb no, cov kws tshaj lij tswj xyuas qhov hu ua daj ntseg treponemanyiaj plating raws li Levaditi. Gumma yog ib qho zoo rau lub sijhawm tertiary ntawm tus mob syphilis, uas pib tshwm sim tom qab ob peb xyoos (5 lossis ntau dua) txij li lub sijhawm kis tus kabmob.
Hauv ntau lub cev: tawv nqaij, siab, pob txha, hlwb, pob qhov 0.3-1.0 cm inch yog tsim nyob rau hauv ib xyoo caum. Nyob rau hauv cov ntsiab lus ntawm cov nodes, ib tug tej yam jelly-zoo li loj ntawm ib tug yellowish xim yog txawv, uas nyob rau hauv nws cov tsos zoo li cov pos hniav arabic kua nplaum, uas lub npe "gum" los ntawm.
Gumous infiltration
Ntxiv rau cov pos hniav no, gummous infiltration kuj tuaj yeem txhim kho nyob rau hauv lub sij hawm tertiary ntawm syphilis. Lub infiltrate yog sawv cev los ntawm tib lub hlwb, uas yog, sclerosis, vascular proliferation. Cov infiltrate feem ntau nyob hauv lub plawv ascending, nrog rau lub aortic arch, thiab hu ua "syphilitic mesoaortitis".
Nws, nyob hauv nruab nrab thiab sab nraud ntawm lub plawv aorta, maj mam rhuav tshem nws txoj haujlwm elastic, thiab cov ntaub so ntswg pib loj hlob nyob rau hauv qhov chaw ntawm elastic fibers. Vim tag nrho cov no, lub plhaub sab hauv ntawm lub aorta ua tsis sib xws thiab wrinkled nrog ntau cov cicatricial retractions, bulges, outwardly zoo li daim tawv nqaij shagreen.
Zoo kawg
Raws li peb tau sau ua ntej, kev loj hlob (lossis tsim khoom) o yog tus cwj pwm los ntawm kev loj hlob ntawm tes. Exudative thiab lwm yam kev hloov pauv tsuas yog rov qab rau hauv keeb kwm yav dhau. Tag nrho cov chav kawm ntawm no inflammatory txheej txheem tuaj yeemmob hnyav, tab sis feem ntau mob ntev.
