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Giant Cell Lesions of Lungs: A Histopathological and Morphometric Study of Seven Autopsy Cases
B N Kumarguru1, M Natarajan2, Dayananda S Biligi2
1Assistant Professor, Department of Pathology, PES Institute of Medical sciences and Research , Kuppam, Andhra Pradesh, India .
Introduction:
Macrophages undergo fusion to form multinucleated giant cells (MGC) in several pathologic conditions. The exact mechanism of their generation is still unclear. MGC are a common feature of granulomas that develop during various inflammatory reactions.
Aim:
To study the histopathological features of giant cell lesions in lungs and correlate the characteristics of giant cells with other histopathological findings. Also, to determine the utility of morphometry to differentiate foreign body and Langhans MGC.
Materials And Methods:
Seven cases were analysed. Specimen of lungs was grossed, sectioned and processed. Routinely, tissue sections were stained by Haematoxylin and Eosin (H&E) stain. Polarizing microscopy and special stains were employed in selected cases. Granulomas and MGC were counted and measured. Several other parameters like location, distribution, type and number of MGC, associated predominant inflammatory component and nature of granulomas were analysed.
Results:
Five patterns of lesions were observed in seven cases. Aspiration pneumonia was seen in three cases (42.85%) and constituted the most common pattern. However, aspiration pneumonia as the only cause of MGC was seen in only one case (14.28%). Pulmonary tuberculosis and asteroid bodies constituted two cases (28.57%) each. Cryptococcal pneumonia and cholesterol clefts constituted one case (14.28%) each. Crypococci were demonstrated to be positively birefringent by polarized microscopy on Ziehl-Neelsen stained sections. Based on statistical analysis of morphometric data, a new index (NP index) was proposed to statistically categorize MGC into foreign body type and Langhans type. NP index value of ≤0.016 was found to be statistically significant (p<0.005) in foreign body MGC. It had high sensitivity and efficacy.
Conclusion:
MGC may not be always associated with granulomas. The mechanisms that lead to the occurrence of MGC, independent of granuloma needs to be elucidated. Morphometry may serve as a useful aid. But a pathologist has to rely on the morphological details to categorize MGC.
Insights
Multinucleated giant cells (MGC) can form independently of granulomas. Morphometry, using a novel NP index, aids in differentiating foreign body and Langhans MGC types in lung pathology.
Area of Science:
- Pulmonary pathology
- Cell biology
- Histopathology
Background:
- Macrophages fuse to form multinucleated giant cells (MGC) in various pathological conditions.
- MGC are characteristic features of granulomas in inflammatory reactions.
- The precise mechanisms of MGC formation remain incompletely understood.
Purpose of the Study:
- To investigate the histopathological characteristics of giant cell lesions in lung tissue.
- To correlate MGC features with other histopathological findings.
- To assess the utility of morphometry in distinguishing between foreign body and Langhans MGC.
Main Methods:
- Analysis of seven lung tissue cases.
- Routine Hematoxylin and Eosin (H&E) staining.
- Polarizing microscopy and special stains were utilized.
- Morphometric analysis of granulomas and MGC, including counting and measurement.
- Evaluation of parameters such as MGC location, distribution, type, number, inflammation, and granuloma nature.
Main Results:
- Observed five distinct lesion patterns across seven cases.
- Aspiration pneumonia was the most frequent pattern (42.85%), but not always the sole cause of MGC.
- Pulmonary tuberculosis, asteroid bodies, cryptococcal pneumonia, and cholesterol clefts were also identified.
- A novel NP index, derived from morphometric data, demonstrated statistical significance (p<0.005) in categorizing MGC into foreign body and Langhans types with high sensitivity and efficacy.
Conclusions:
- MGC formation is not invariably linked to granulomas, necessitating further research into granuloma-independent mechanisms.
- Morphometry, particularly the NP index, shows promise as an adjunct tool for MGC classification.
- Pathologists must still rely on detailed morphological assessment for accurate MGC categorization.
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