General Pathology Healing and Regeneration 2024 -2025
Healing and Regeneration
Granulomatous Inflammation
֎ Definition: Forms of chronic inflammation in which there is accumulation of histocytes,
and giant cells surrounded by lymphocytes.
֎ Examples:
Caused by TB bacilli
A rare inflammatory disease of unknown etiology
affecting especially the lymph nodes and lungs,
but also many other organs.
:
Where particulate silicates introduced into the
tissues evoke an inflammatory reaction after a
latent period (usually years).
:
A chronic inflammatory disease affecting
the terminal ileum and colon
Draining ulcerated areas in which
breakdown of lipid is occurring.
o Giant cells: are popular in granulation tissue, they form by fusion of histocytes.
Their names differ according to different arrangement of nuclei inside the cell
o Types:
1) Langhan’s giant cell → in TB and Sarcoidosis
2) Foreign body giant cell → in foreign body granulomatous reaction
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General Pathology Healing and Regeneration 2024-2025
Complications of Inflammation
1. Ulceration:
o Definition: discontinuation of epithelium, formed when the surface covering of an
organ or tissue is lost due to necrosis and replaced by inflammatory tissue.
o Ulcers are divided into two groups:
1) Benign (Traumatic or Inflammatory)
2) Malignant
o Mechanism:
Tissue → necrosis
Necrotic tissue →
slough → forming
ulcer crater → filled
with fibrin and
inflammatory cells
2. Sinus:
o A sinus is a tract lined by granulation tissue leading from a chronically inflamed
cavity to a surface. In many cases the cause is the continuing presence of 'foreign' or
necrotic material.
o Examples include:
1) Sinuses associated with osteomyelitis, Where
necrosis of bone occurs, chronic sinuses form
over it.
2) Pilonidal sinus (pilonidal = nest of hairs).
Seen in the mid-line over the sacrum (natal
cleft) where hairs which have penetrated
deeply under the skin are associated with
chronic relapsing inflammation.
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General Pathology Healing and Regeneration 2024-2025
3. Fistula:
o A fistula is a track open at both ends, through which abnormal communication
between two surfaces is established.
o There are two main types:
1) Congenital: due to developmental abnormality: any inflammation is
superimposed, e.g. tracheoesophageal fistula which can lead to choking and
coughing during feeding in a newborn.
2) Acquired: due to:
a) Trauma → in biliary fistula, after operation
b) Inflammation → in Crohn’s disease
c) Tumors of cervix
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General Pathology Healing and Regeneration 2024-2025
Healing and Regeneration
֎ Definition: an active process by which the living tissue repairs the damaged area.
֎ Types of repair:
1. Regeneration
֎ Definition: replacement of the destroyed cells by new similar cells by division of nearby
living cells.
֎ Regeneration involves two processes:
1. Proliferation of surviving cells to replace lost tissue.
2. Migration of surviving cells into the vacant space.
֎ The factors which control healing and repair:
Include production of large variety of growth factors → each of them produces different
type of tissues
֎ The capacity of a tissue for regeneration depends on:
The type and Severity of the damage
Its proliferative ability of the cell.
Regeneration is not possible if the stem cells are destroyed.
o Three broad groups of cells are considered in the context of the cell cycle
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General Pathology Healing and Regeneration 2024-2025
Labile cells Stable cells Permanent cells
o Normally continuous o Characterized by low rate o Not capable of
turnover of division but remain proliferation
o Chance of regeneration is capable of rapid cell o Healing by scarring.
excellent division after injury
o Examples: o Examples: o Examples:
1. Covering epithelium 1. Parenchymal cells of the 1. Neurons of central and
2. Cells of bone marrow liver peripheral nervous
3. Endometrium. 2. Renal tubules system,
3. Osteoblasts & fibroblasts. 2. Cardiac muscle fibers
3. Renal glomeruli.
Wound Healing
o Healing of a wound shows both epithelial regeneration (healing of the epidermis) and
repair by scarring (healing of the dermis).
o Two patterns are described depending on the amount of tissue damage. These are the
same process varying only in amount as follows:
1) Healing by primary intention:
This occurs in clean, incised wounds with good apposition of the edges -
particularly planned surgical incisions.
Mechanism:
1- After wound, extravasated blood fills the cleft together
2- Appearance of polymorphs followed by macrophages.
3- New capillaries form → Granulation tissue formation which is formed of
(Newly formed capillaries + proliferating fibroblasts + collagen) in the
damaged area.
4- The surface epithelium grows from both sides and covers the wound.
5- After few weeks, more and more collagen is formed with gradual closure of
capillaries → white fibrous scares formed under the surface epithelium.
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General Pathology Healing and Regeneration 2024-2025
2) Healing by secondary intention
This occurs in open wounds, particularly when there has been significant loss of
tissue, necrosis or infection.
Mechanism:
1- After injury, the cavity is filled with extravasated blood
2- Blood clot and inflammation occurs, becomes surrounded by acute
inflammatory cells at the edges of the cavity
3- Few days later, Granulation tissue formation and fill the gap
4- At the same time, the surface epithelium at the edges undergoes mitotic activity
and there is gradual narrowing the gap until there is complete bridging by the
surface epithelium.
5- In the second week and later, there is gradual deposition of collagen & gradual
narrowing of the capillaries until thick collagenous avascular ugly scar is formed
under the surface epithelium. This process takes few months to be completed.
1ry intension 2ry intension
Gab Small Bigger
Infection Minimal or no Increased infection
Granulation Few Many
tissue
Time of healing Few much
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General Pathology Healing and Regeneration 2024-2025
o Complications of wound healing
1. Contracture:
May cause serious cosmetic and functional disability,
particularly in deep extensive skin bums and around
joints if muscles are badly damaged.
2. Keloid
The formation of excess collagen in the form of thick
interlacing bundles which causes marked swelling at the
site of the wound, is known as a Keloid. The essential
cause is unknown. It is common in black people.
o Factors Delaying Healing:
1. Local 2. General
a) Infection a) Deficiency of Vitamin C
b) Poor blood supply b) Deficiency of Amino Acids (in malnutrition)
c) Excessive movement c) Deficiency of Zinc
d) Presence of foreign material d) Excess of Adrenal Glucocorticoids
e) Debilitating Chronic Disease
Those factors lead to Failure of proper collagen
synthesis with delayed healing and weak scars.
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General Pathology Healing and Regeneration 2024-2025
Bone Fracture Healing
1) Formation of a hematoma at site of fracture due to laceration of blood vessels.
2) Newly formed capillaries from the periosteum invade the blood clot.
3) Osteoblasts (from the periosteum) proliferate and lay down osteomucin (non-calcified bone)
4) Formation of callus: which is composed of capillaries, osteoblasts and osteomucin. It is divided
into external, intermediate and internal soft callus.
5) Deposition of calcium salts. It is helped by alkaline phosphatase enzyme → by osteoblasts.
6) Reconstruction of bone by removal of the external and internal callus → by osteoclasts. Gradual
transformation of callus into lamellar bone.
o Complications of fracture healing:
1. Fat Embolism: may occur in fracture of long bones due to
entry of fat from the marrow cavity into the torn ends of
veins.
2. Pathological Fracture: When the break occurs to the
bone, due to bone disease, or tumor of the bone.
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General Pathology Healing and Regeneration 2024-2025
3. Infection: If the overlying skin is breached in any
way, i.e. the fracture is “compound”, the risk of
infection is greatly increased; this is an important
adverse factor in the healing process.
o Factors Influencing Healing of Fractures:
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