Melnik O. Morphological changes in human lungs subject to progression of pulmonary tuberculomas

Dissertation is devoted to the solution of an important task namely elucidation and establishment of a new cytological and histological signs of progression of a tuberculous inflammatory process in pulmonary tuberculomas (T). It was defined that pulmonary T are the most frequent in surgery of pulmonary tuberculosis in humans, with progression - 19,7%. The morphological examination allows to determine the degree of inflammatory activity based on the following features: bionecrosis and destruction of the inner content, a two-layer structure of T capsules; outside of the T - significant accumulations of foamy macrophages (FM), focuses of tuberculosis inflammation, a large number of granulomas with central necrosis and clusters of small lymphocytes. The research of the existence and character of the distribution in the tissue of non-dissolved fibrin with different "age" is an additional criterion for determine of the degree of inflammatory activity. Immunohistochemical study revealed that in the progression phase the high level of expression of CD68+ cells was observed in a granulation layer of T, in the alveoli and near small bronchus. The progression of the inflammatory process at T is accompanied by disorders of lipid metabolism in the lung tissue: considerable accumulation of free lipids in necrotic masses of T, granulomas and in the alveolar spaces, and formation of a substantial amount of FM. The largest number of acid-fast bacilli (AFB) in progression of inflammation was localized in the necrotic core of T and in distant perifocal areas of lung tissue. Maximal efficiency of AFB detection by using fluorescence method - 80% was proven.