炎症Inflammation · 脑 · 神经系统 · NTP ntp-0386

依据美国国家毒理学计划(NTP)Nonneoplastic Lesion Atlas 整理 · 中文译文与诊断建议 · 仅供科研使用,不用于临床诊断

一句话结论:在实验研究中偶尔可见急性细菌性或其他感染性疾病,此类感染所产生的炎症过程需要被识别和诊断,因为它们可能反映受试物对动物免疫状态的影响。
诊断要点:当诊断炎症时,叙述中应包含对存在细胞类型的描述。对罕见的神经化脓性或非化脓性浸润病例的识别,应附带严重程度分级及其解剖亚部位进行诊断。

病变描述

在实验研究中偶尔可见急性细菌性或其他感染性疾病,此类感染所产生的炎症过程需要被识别和诊断,因为它们可能反映受试物对动物免疫状态的影响。Figure 1在低倍镜下显示小脑软脑膜(leptomeninges)中急性炎症细胞(箭头)的聚集。Figure 2是Figure 1中软脑膜急性炎症细胞的放大图像。该渗出物中明显可见淋巴细胞与中性粒细胞的混合。Figure 3显示小鼠软脑膜中淋巴细胞的局灶性(focal)聚集。在本例中,该病变为偶然发现。然而,此类病变的出现可能提示对神经系统近期病毒感染的反应。偶尔,一个小的、外观上无活性的单核细胞簇,且周围无任何其他反应性改变,可被称为炎症细胞浸润(inflammatory infiltrate)。然而,中性粒细胞的存在应提醒病理学家对炎症的其他补充性征象进行仔细评估。在NTP研究中,炎症有五个标准类别:急性(急性(acute))、化脓性(化脓性(suppurative))、慢性(慢性(chronic))、慢性活动性(慢性活动性(chronic-active))和肉芽肿性(肉芽肿性(granulomatous))。在急性炎症中,主要的浸润细胞是中性粒细胞,尽管也可能存在较少的巨噬细胞和淋巴细胞。还可能有水肿或充血的表现。中性粒细胞也是化脓性炎症中的主要浸润细胞类型,但它们聚集在一起,其中许多已变性(化脓性渗出物)。渗出物中还可能存在来自 resident 细胞群和浸润白细胞的细胞碎片、含纤维蛋白的蛋白性液体、较少的巨噬细胞、偶见的淋巴细胞或浆细胞,以及可能的感染因子。肉眼上,这些病变将以脓液的存在为特征。在渗出物周围的组织中,可能存在成纤维细胞、纤维结缔组织和混合性炎症细胞,具体取决于病变的慢性程度。淋巴细胞在慢性炎症中占主导地位。淋巴细胞在慢性活动性炎症中也占主导地位,但也存在显著数量的中性粒细胞。两种病变均可能含有巨噬细胞。肉芽肿性炎症是慢性炎症的另一种形式,但该诊断要求存在显著数量的聚集性、大的活化巨噬细胞、上皮样巨噬细胞或多核巨细胞。

诊断与分级建议(NTP 共识)

当诊断炎症时,叙述中应包含对存在细胞类型的描述。对罕见的神经化脓性或非化脓性浸润病例的识别,应附带严重程度分级及其解剖亚部位进行诊断。若认为与受试物无关,则在最终研究评估中不予计入。若研究病理学家倾向于使用非标准炎症类别(如上所述),则叙述中应包含对存在的主要细胞类型以及炎症显著特征的描述。在存在并发病变时,通常诊断严重程度最高的病变。其他并发病变若严重程度足以支持,可单独诊断。

图谱

炎症(脑)组织学图谱 1
图 1 · 炎症 · 来源:NTP NNL Atlas
炎症(脑)组织学图谱 2
图 2 · 炎症 · 来源:NTP NNL Atlas

英文原文

展开 NTP 官方英文描述与建议

Comment:
Acute bacterial or other infectious disease is occasionally seen in experimental studies, and the inflammatory processes that such infections produce need to be recognized and diagnosed since they may reflect compound effects on the immune status of the animal. Figure 1 depicts the accumulation of acute inflammatory cells (arrows) in the leptomeninges of the cerebellum at low magnification. Figure 2 is the magnified appearance of acute inflammatory cells in the leptomeninges in Figure 1 . A mixture of lymphocytes and neutrophils is apparent in this exudate. Figure 3 shows the focal aggregation of lymphocytes in the leptomeninges of a mouse. In this case, it was an incidental finding. The occurrence of such a lesion may, however, indicate a response to a recent viral infection in the nervous system. Occasionally, a small, apparently inert cluster of mononuclear cells without any other reactive responses in the vicinity may be referred to as inflammatory infiltrate. However, the presence of neutrophils should alert the pathologist to conduct a diligent evaluation for other complementary signs of inflammation. In NTP studies, there are five standard categories of inflammation: acute, suppurative, chronic, chronic-active, and granulomatous. In acute inflammation , the predominant infiltrating cell is the neutrophil, though fewer macrophages and lymphocytes may also be present. There may also be evidence of edema or hyperemia. The neutrophil is also the predominant infiltrating cell type in suppurative inflammation , but they are aggregated, and many of them are degenerate (suppurative exudate). Cell debris from both the resident cell populations and infiltrating leukocytes, proteinaceous fluid containing fibrin, fewer macrophages, occasional lymphocytes or plasma cells, and, possibly, an infectious agent may also be present within the exudate. Grossly, these lesions would be characterized by the presence of pus. In the tissue surrounding the exudate, there may be fibroblasts, fibrous connective tissue, and mixed inflammatory cells, depending on the chronicity of the lesion. Lymphocytes predominate in chronic inflammation . Lymphocytes also predominate in chronic-active inflammation , but there are also a significant number of neutrophils. Both lesions may contain macrophages. Granulomatous inflammation is another form of chronic inflammation, but this diagnosis requires the presence of a significant number of aggregated, large, activated macrophages, epithelioid macrophages, or multinucleated giant cells.

Recommendation:
When inflammation is diagnosed, the narrative should include a description of the cell types present. The recognition of rare examples of neural suppurative or nonsuppurative infiltrates should be diagnosed with a severity grading and their anatomic subsite location. If not considered treatment related, they are discounted in the final study assessment. If the study pathologist prefers a nonstandard category of inflammation (as described above), then the narrative should include a description of the predominant cell types present along with prominent features of the inflammation. In the presence of concurrent lesions, lesions with the most severity are typically diagnosed. Other concurrent lesions may be diagnosed separately, if warranted by the severity.

来源与引用

原始条目:https://ntp.niehs.nih.gov/atlas/nnl/nervous-system/brain/Inflammation

图谱总目录:NTP Nonneoplastic Lesion Atlas。 内容属美国联邦政府作品(公有领域),可引用;引用时请标注来源。

建议引用格式:NTP Nonneoplastic Lesion Atlas. Inflammation (brain). LabSmart 中文版: https://www.labsmart.cn/ntp/brain-inflammation.html

中文图谱总页(可展开对照全部 595 条):https://www.labsmart.cn/ntp-atlas.html#brain-inflammation

出血发育不良坏死小胶质细胞增生矿化神经元变性