Samsonova M V, Chernyaev A L
Pulmonology Research Institute, Federal Biomedical Agency of Russia, Moscow, Russia; A.S. Loginov Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow, Russia.
Pulmonology Research Institute, Federal Biomedical Agency of Russia, Moscow, Russia; A.S. Loginov Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow, Russia; Research Institute of Human Morphology, Moscow, Russia; N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia.
Arkh Patol. 2019;81(1):65-70. doi: 10.17116/patol20198101165.
Granulomatous diseases are a heterogeneous group of the diseases of different etiology, which are manifested by a variety of clinical syndromes and variants of tissue changes, by non-uniform sensitivity to therapy, and by the predominance of the common dominant histologic sign - the presence of granulomas that determine the clinical and morphological essence of each disease. Granuloma is a chronic inflammatory response, which involves macrophages and other inflammatory cells. After exposure to an antigen, T-lymphocytes, macrophages, epithelioid cells, and multinucleated giant cells are activated, resulting in the formation of granulomas. Granuloma also includes the extracellular matrix produced by fibroblasts, which can demarcate and isolate the antigen. According to etiology, granulomatous diseases are classified as infectious and non-infectious. However, recent investigations demonstrate that pathogenic microorganisms can cause granulomas in diseases previously considered non-infectious. In some cases, it is very difficult to classify a granulomatous process as infectious and non-infectious. The aim of this paper is to draw the attention of readers to the diversity of granulomatous diseases, to describe the key points of pathological and anatomical manifestations of various non-infectious diseases, as well as to determine an approach to the differential diagnosis of granulomatoses.
肉芽肿性疾病是一组病因各异的疾病，表现为多种临床综合征和组织变化的变体，对治疗的敏感性不一，且共同的主要组织学特征——肉芽肿的存在占主导地位，而肉芽肿决定了每种疾病的临床和形态学本质。肉芽肿是一种慢性炎症反应，涉及巨噬细胞和其他炎症细胞。接触抗原后，T淋巴细胞、巨噬细胞、上皮样细胞和多核巨细胞被激活，从而形成肉芽肿。肉芽肿还包括成纤维细胞产生的细胞外基质，其可界定和隔离抗原。根据病因，肉芽肿性疾病分为感染性和非感染性。然而，最近的研究表明，致病微生物可在以前被认为是非感染性的疾病中引起肉芽肿。在某些情况下，很难将肉芽肿性病变归类为感染性或非感染性。本文旨在引起读者对肉芽肿性疾病多样性的关注，描述各种非感染性疾病的病理和解剖表现要点，并确定肉芽肿病的鉴别诊断方法。
