[Lung pathology in post-covid syndrome]. / Patologiya legkikh pri postkovidnom sindrome.

The clinic and pathological anatomy of the infection caused by the SARS-CoV-2 virus (coronavirus infection - CI) with the development of Post-Covid syndrome (PS) have not been studied enough. This also applies to morphofunctional changes in the lungs, one of the most important components of PS. We conducted a histological and bacterioscopic study of lung biopsy specimens in 20 patients of both sexes aged 22-75 years. In many patients, PS developed relatively late - not earlier than 1 year - 1 year 4 months after the onset of acute clinical symptoms of CI. Structural changes in the lungs in PS appear as an inflammatory reaction such as interstitial pneumonia. Most patients had nonspecific interstitial pneumonia with elements of organizing interstitial pneumonia, in some cases complicated by the presence of a specific granulomatous reaction, characteristic of pulmonary tuberculosis. Despite this, according to the results of traditional bacterioscopic and bacteriological studies, the tuberculous etiology of pulmonary fibrosis has not yet been confirmed. Perhaps this is due to the fact that we are talking about an inapparent tuberculosis infection, the causative agent of which is the L-form of Mycobacterium tuberculosis. Patients with PS who have pulmonary fibrosis on x-ray should be under the special supervision of a phthisiatrician or pulmonologist.

[Pulmonary epithelioid hemangioendothelioma]. / Epitelioidnaya gemangioendotelioma legkikh.

The article describes the clinical, radiological and pathological features of epithelioid hemangioendothelioma (EHE) in 27 adult patients, mainly female. In all cases, with the exception of one, there was a benign course of the disease over many years with a tendency to stabilize growth, the morphological sign of which was the development of widespread sclerotic changes. With the help of immunohistochemical method, the endothelial nature of EHE cells and its relatively low proliferative potential were confirmed. Clinical and morphological features of EHE raise the question of the essence of proliferation of endothelial cells with the formation of tumor-like nodes. There is every reason to consider EHE as a pseudotumor of the type of nodose hyperplasia in the nosological group of dyshormonal hyperplasia, similar to benign leiomyoma of the uterus with lung damage, as we have previously proposed.

[Morphological characteristics of pulmonary tuberculosis concurrent with lung cancer]. / Morfologicheskie osobennosti sochetaniya tuberkuleza i raka legkikh.

The pathogenetic relationship between pulmonary tuberculosis and lung cancer in their concurrence is now still the subject of discussion. OBJECTIVE: To study the pathogenetic relationship between pulmonary tuberculosis and lung cancer. MATERIAL AND METHODS: The investigators examined surgical material from 51 patients (41 men) aged 41-73 years (mean age, 63.7 years) with pulmonary tuberculosis concurrent with lung cancer. They also studied tumors, tuberculous caverns, infiltrates, and foci with surrounding macroscopically intact lung tissue, as well as fibrotic changes by histological, histochemical and immunohistochemical examinations. RESULTS: Previous tuberculosis can be considered as a risk factor for lung cancer. Central cancer was more common in patients with inactive, chronic tuberculosis with a predominance of fibrotic processes in the root of the lung and in its hilar zones. Fibrous-cavernous tuberculosis and cavernous tuberculosis were more frequently concurrent with central cancer; peripheral tumors mainly occurred in infiltrative tuberculosis and tuberculomas. CONCLUSION: The findings suggest that in a number of cases, cancer and tuberculosis may be anatomically close, developing in the same anatomical unit - the lung. However, this does not indicate an unambiguous etiopathogenetic relationship between pulmonary tuberculosis and lung cancer. The relationships between pulmonary tuberculosis and lung cancer are much more complex and do not fit into the simple scheme of cause-and-effect relations.

[The morphological examination in the differential diagnosis of tuberculosis and sarcoidosis].

The paper considers the results of histological and bacterioscopic examinations of biopsy specimens from the lung and mediastinal lymph nodes of 120 patients with an unclear diagnosis of tuberculosis and sarcoidosis and with problem of their differential diagnosis. One hundred and five of these patients were microscopically diagnosed as having either tuberculosis or sarcoidosis. Additional examination of differently stained sections and that using immunohistochemical M. tuberculosis detection were conducted in 15 cases, which could diagnose tuberculosis and sarcoidosis in 7 and 8 patients, respectively. Bacterioscopic examination, in terms of extreme variability the phenotypic properties of mycobacteria, is of decisive importance in the differential diagnosis of tuberculosis and sarcoidosis.

[Reparative osteogenesis after incorporation of roncoleukin into therapy for experimental tuberculous gonitis].

The authors evaluated reparative osteogenesis after incorporation of roncoleukin into combination therapy for experimental drug-resistant tuberculous osteitis. Roncoleukin (12.5 pg/kg, 5 injections, once every 3 days) was used during antituberculosis therapy before and after combined plasty (autobone + OsteoSet-T) in repairing surgical defects. When used in the postoperative period of combined osteoplasty, roncoleukin was shown to contribute to a reduction in the spread of specific inflammatory foci in bone tissue, cessation of an alternative necrotic component, an increase in the rate of osteogenesis with newly formed bone trabeculae, and activation of hematopoietic processes in the bone marrow. In parallel with intensified bone reparative processes, there was immunomodifier-induced stimulation of the absorption and digestion of peritoneal macrophages suppressed in experimental tuberculous osteitis.

[The influence of immunotropic drugs on reparative processes in the lungs experimental chemotherapy drug resistant tuberculosis].

It is revealed that Roncoleukin (12.5 mg/kg, intraperitoneally, 5 injections a day), Betaleukin (0.1 mg/kg, intraperitoneally, 1 time in 3 days (5 weeks)), Bestim (0.1 mg/kg, intraperitoneally, 10 injections), cycloferon (3.6 mg/kg, intraperitoneally, 3 times a week for 6 weeks), Glutoxim (40 mg/kg subcutaneously (4 weeks)and the preparation of succinic acid remaxol (at a dose of 25 mg/kg intraperitoneally, daily 14 introduction), when you enter them in a comprehensive drug therapy pilot MDR tuberculosis in mice produce a positive effect on the regression of inflammation in the lung tissue, stimulate local immunity of the lungs, activate and digestive absorption capacity of peritoneal macrophages an average of 1.4 and 1.9, p < 0.05, inhibited the tuberculosis infection and chemotherapy.

[Pulmonary histiocytosis from Langerhans cells as the problem of clinical morphology].

There are discussed modern views on one of the most difficult diagnosed forms of pulmonary dissemination. They relate to the dynamics of granulomatous changes in the lung tissue at the cellular and subcellular level as well as a characteristic of the immunophenotype of Langerhans cells. At present the frequency of this disease increases, which improves the responsibility for the timely diagnosis based on performing explicit clinical and morphological studies.

[Airway granular cell tumor].

The paper describes the clinical, morphological, and immunohistochemical characteristics of 13 granular cell tumors of the upper airway. These tumors are shown to have virtually the same histological and immunohistochemical features as granular cell tumors at another site. The histogenesis of these tumors is discussed. There are currently a number of more or less solid grounds for considering them as neurogenic tumors to be close to schwannomas. At the same time one cannot ignore the fact that there is morphological and immunohistochemical evidence for that the granular cell tumors have rather cytotypical than histotypical properties, which cannot implicitly assign them to nerve tissue tumors. Most likely, the granular cell tumors belong to a histogenetically heterogeneous mixed group, in this connection their place in the classification of tumors needs further investigation, by applying the criteria developed by Russian histologists and oncomorphologists.

[Tuberculosis of the pharyngeal tonsil in a child].

Tuberculosis of the adenoids is a rare form of extrapulmonary tuberculosis, which is unassociated with pulmonary tuberculosis. In adults, this form occurs much more frequently than in children. The authors observed tuberculosis of the adenoids in a 14-year-old adolescent operated on in a planned way for second-third-degree adenoids. Intraoperative specimens exhibited epithelioid-cell tubercles with Langhans cells. Ziehl-Nielsn staining showed granular forms of acid-resistant mycobacteria. The latter were identified by an immunohistochemical assay. The specific feature of this case is the absence of tuberculous involvement of cervical lymph nodes, which is characteristic of the similar pathology in adults.

[The Saint Petersburg Society of Pathologists is 100 years old].

The paper describes the history of the Saint Petersburg Society of pathologists since it was founded in 1909. It shows what great role is played by outstanding Russian medical scientists who have established their own schools of pathomorphologists and are respected in our and foreign countries. The activities of the society's members in research developments in cardiovascular and infectious diseases, cancer morphology, etc., as well as their practical participation in the work of the health care facilities of the city and its region are characterized. This work is characterized by the permanent conformance to the world standards of human pathology as a basic science of the present day, by steadily maintaining the established traditions of the Saint Petersburg school. The authors follow the evolution of a pathologist and his/her becoming to a clinical pathologist as the problems facing pathomorphology are extended and its methodic and methodological capacities are improved.

[Ex juvantibus diagnosis in suspected skin tuberculosis].

The paper deals with the diagnosis of cutaneous tuberculous lesions, by performing expectancy antituberculous treatment (ex juvantibus and ex nocentibus). The urgency of this problem is confirmed by the analysis of 205 cases of cutaneous tuberculosis of different clinical forms, which demonstrates that the efficiency of antituberculous therapy proved to be significant in 18.5% of cases to make a definitive diagnosis. The optimum procedure for this therapy is discussed.

[Specific and nonspecific bronchial and regional lymph nodal lesions as a manifestation of synergism in the lymph epithelial system in pulmonary tuberculosis].

The lung and lymph nodes were examined in 130 patients aged 19-70 years, who had been operated on at the Department of Surgery, Saint Petersburg Research Institute of Phthisiology, for pulmonary tuberculosis. The immunopathological changes have close correlations in the bronchi and pulmonary respiratory parenchyma. This gives grounds to regard the lung and lymph nodes jointly as the organ of local immunity (sui generis) and to suggest that there is a synergism of immune reactions. Every gross organism prefers this or that line of development of an inflammatory process in the lung. This choice is predetermined genetically, on the one hand, and caused by other factors, on the other. The latter include the duration of disease, its inclination for the undulating course, and a rather steady-state high activity of inflammation along with concomitant bronchopulmonary pathology that in turn varying in manifestations, depending on the morphofunctional status of BALT. The development of specific bronchial damage in the presence of nonspecific bronchitis argues for the key impact of BALT.

[Some regularities of an immune response in patients with pulmonary tuberculosis and drug-resistant Mycobacterium strains].

Clinical and immunological studies were conducted in 62 patients with infiltrative pulmonary tuberculosis and 53 with disseminated one. As drug resistance and viability of mycobacteria increased, an immune response was found to develop as the humoral type and cellular immunity was suppressed. A more marked reduction in the activity of T helper cells type 1 of an immune response and the neutrophilic granulocytic system was revealed in patients with disseminated pulmonary tuberculosis. The maximum suppression of cell immunity was found in patients with multidrug-resistant mycobacterial strains. The observed changes in an immune response and in the production of cytokines (IL-2, IL-8) are informative signs correlating with deterioration of a specific process. Mycobacterial drug resistance and its suppressed cell immunity make chemotherapy policy difficult. The findings identify patients with mycobacterial drug resistance and high viability as a group of priority in the context of immunomodulator therapy.

[Immunohistochemical study in the diagnosis of tuberculosis].

The comparative analysis of the immunohistochemical method and Ziehl-Neelsen staining was used to search for a new highly sensitivity procedure for diagnosing tuberculosis. With both methods, mycobacteria tuberculosis were detected in 10 cases of fibrocavernous pulmonary tuberculosis, 1 case of general tuberculosis, and 10 cases of disseminated lung lesion (sarcoidosis?). The improved immunohistochemical option using Mycobacterium tuberculosis antibodies (clone 1.1/3/1) have shown AEC and appeared to be the most sensitive than the Ziehl-Neelsen staining and may be therefore recommended for the diagnosis of tuberculosis.

[Experimental morphological analysis of perichondrial chondrogenesis].

Microscopic structure of perichondrium of rabbits of different age groups was studied under normal conditions and after its ortho- and heterotopic transplantation in several variants. The results obtained showed that after isolation from its normal environment and placement into unusual conditions of survival, perichondrium maintained its capacity for growth; its cells were found to divide and differentiate actively eventually forming regular hyaline cartilage in a manner similar to that taking place during normal ontogenesis. Perichondrial chondrogenesis occured in all cases of free perichondrial transplantation, provided the experimental conditions assured the optimal vascularization of transplant bed and there were no inerference with the realization of perichondrial histoblastic potential. The most intensive and full-scale chondrogenesis was obtained in the experiments that provided the expansive growth of transplant due to availability of a free space above it. Under these conditions, the proliferation of chondroblasts occured similar to that taking place in normal articular cartilage, outer surface of which faces the free space of articular cavity. These experimental data were supported by the clinical practice, where perichondrial transplantation is successfully used for the treatment of osteoarticular pathology.

[Pathological characteristics of drug-resistant fibrocavernous pulmonary tuberculosis].

A histological examination of the pulmonary and bronchopulmonary lymph nodes was made in 47 patients treated surgically for fibrocavernous pulmonary tuberculosis. The speed of immunopathological reactions development is the main reason of differences between drug-resistant and drug-sensitive primary tuberculosis. Formation of cellular immunity in drug-resistant tuberculosis has all necessary morphological prerequisites both in the lungs and lymph nodes but their realization is delayed. Immunogenesis concentrates on the early stages when initial paraspecific reactions prevail. Morphologically, they are most demonstrative in the bronchial walls where in different patients or even in one patient but in various bronchi all reactions of delayed type (contact, tuberculine type and granulematous) can be simultaneously observed.

[Historical reference: giant multinuclear cells in tubercular granuloma].

By studying the background materials, the authors have analyzed N. I. Pirogov's works on the pathological anatomy of tuberculosis. They show the fallacy of the widespread statement on N. I. Pirogov's priority in describing one of the characteristic cell elements of tuberculous granulation tissue, namely multinuclear giant cells referred in the Russian literature to as Pirogov-Langhans cells.

[Immunological parameters and mycobacterial biological properties in infiltrative pulmonary tuberculosis].

Thirty-one patients with infiltrative pulmonary tuberculosis were clinically and immunologically examined. A relationship was found between the definite immunological parameters and the biological properties of mycobacteria. The higher viability of mycobacteria and the increase in the drug resistance have been shown to be associated with the decreased activity of lymphocytes and the suppressed production of interleukin-2, which suggests a decrease in the activity of type 1 T helper cells and a significant increase in the synthesis of tuberculosis antibodies with the lower serum concentrations of circulating immune complexes. This is an informative indicator of a severe specific process, as previously established. Moreover, the authors show certain differences in the changes of immunological parameters in patients with infiltrative pulmonary tuberculosis with varying mycobacterial properties. Thus, the results of the performed study make investigators pay a particular attention to the immunopathogenetic value of the biological properties of Mycobacterium tuberculosis.

[Clinical classification of extrapulmonary tuberculosis].

The authors propose a clinical classification of extrapulmonary tuberculosis, which is based on the standard reporting signs. They give the definitions of classification criteria established in any locations of tuberculous infection: etiology (tuberculosis, BCG infection, tuberculoallergic lesions), the extent and activity of a process with regard to clinical and morphological stages; bacterial isolation with consideration of the drug resistance of Mycobacteria; the nature of complications and sequels, etc. The characterization of local lesion includes the determination of organ-dependent clinical forms of tuberculosis; the type and form of complication; residual and sequels.