FORMATION OF TUBERCULOUS GRANULOMA IN THE LYMPHNODE AND ITS HEALING PROCESS

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Microscopic observations were made on tuberculous lesions in the lymphnodes obtained from 65 autopsy cases of tuberculosis and in the surgically removed ones of 36 patients, giving priority to the histological behavior of argyrophil fibers in the caseous lesion. Besides, there was an opportunity of reexamining the primarily infected lymphnodes of tuberculosis that had previously been studied by Dr. Tamura. The latter materials were obtained from a group of persons inoculated with typhoid vaccine which was incidentally contaminated with tuberculous bacilli of the human strain. Results obtained were as follows: 1) The formation of tuberculous lesion in the lymphnodes began with features of sinus catarrh and, occasionally, of a nodular form. Then, there was a slight infiltration of leucocytes, a micro-abscess being formed in the central part of the lesion. The central micro-abscess came to being surrounded by a zonal infiltration of epithelioid cells transformed from reticulum cells which manifested sinus catarrh. As epithelioid transformation was advanced, argyrophil fibers disappeared for the time being from granulation tissue of epithelioid cells. Soon, the abscess fell into necrosis and successively became homogenous. At the same time, argyrophil fibers began to extend again into the external layer of the epithelioid cell zone from its outside, especially from the circumference of the blood vessels, and an argyrophil network was then formed. In the central necrotic area, however, no argyrophil fiber was found. In case a living body was in good condition of the host-parasite relationship, collageniza tion of these argyrophil fibers took place from the site of stem-fibers, finally extending to their slender branches. At this moment, lymphoid cells containing microhistiocytes appeared and moved from the outside of the lesion into the central necrotic part through the epithelioid cell zone. These cells took part in scavengery of the central necrotic substances. Thus, the lesion as a whole looks like a doughnutshaped collagenous ring. When the lesion was still smaller, it was replaced by scar tissue. 2) While the processes above-mentioned were fundamental in the formation of the granuloma and in its healing in the lymphnode, findings might be modified according to an immunological status of an individual. The lesion in the lymphnode attached to the primary complex and of the early generali zation showed a severe infiltration of leucocytes, being accompanied by large mononuclear cells, and formed a large caseous tubercle which occupied a greater part of the lymphnode. Under the circumstances, argyrophil fibers disappeared extensively in the caseous lesion. On the contrary, caseous lesions in the lymphnodes of the late generalization and of tuber culosis of the third stage consisted of numerous tubercles which fell into caseation and were fused one another. On this occasion, no leucocytic infiltration was observed and, consequently, a plenty of nodular argyrophil network was found in the lesion. As such, the histological behavior of argyrophil fibers in the caseous lesion appeared to represent well the immunological status of the human subject against the tubercle bacillus.
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FORMATION OF TUBERCULOUS GRANULOMA IN THE LYMPHNODE AND ITS HEALING PROCESS

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