RESULTS OF HISTOLOGICAL EXAMINATION OF POST-OPERATIVE SPECIMENS WITH DETERMINATION OF DEGREE OF MORPHOLOGICAL ACTIVITY OF TUBERCULOSIS AND CLINICAL PRESENTATION OF TUBERCULOSIS PATIENTS AFTER VATS RESECTION AND VATS PLEUROECTOMY WITH DECORTICATION OF LUNG

Abstract

RESULTS OF HISTOLOGICAL EXAMINATION OF POST-OPERATIVE SPECIMENS WITH DETERMINATION OF DEGREE OF MORPHOLOGICAL ACTIVITY OF TUBERCULOSIS AND CLINICAL PRESENTATION OF TUBERCULOSIS PATIENTS AFTER VATS RESECTION AND VATS PLEUROECTOMY WITH DECORTICATION OF LUNG M. S. Opanasenko, I. V. Liskina, V. I. Lysenko, L. M. Zagaba, O. V. Tereshkovich, B. M. Konik, L. I. Levanda, S. M. Shalagai, M. I. Kalinichenko, M. U. Shamrai Abstract Patients with pulmonary tuberculomas of different histological structure, as well as pulmonary fibrous-cavernous tuberculosis (FCT) are subject to surgical treatment. These phase-forms require careful morphological examination, which provides an objective determination of the degree of activity of a specific inflammatory process. Materials and methods. 165 patients were examined: 130 (78,8 %) patients with different forms of tuberculosis and 35 (21,2 %) patients with tuberculosis of pleura. Morphological determination of the degree of activity of specific inflammation was performed according to the developed classification using hematoxylin and eosin staining. Specific lung lesions were detected in 130 (78.8 ± 3.2)% of cases, pleural TB was histologically detected in 35 (21.2%). Results and discussion. Most VATS resections were performed on tuberculosis - 98 (75.4%), 19 (14.6%) cases were operated on with FCT, 11 (8.5%) patients had post-tuberculosis changes. 2 (1.5%) patients underwent surgery for infiltrative tuberculosis. The following degree of morphological activity of tuberculous inflammation was established in the resection samples: high - 28 (21.5%), moderate - 42 (32.3%) and low - 60 (46.2%) cases. The degrees of morphological activity of the operative material and clinical symptoms were compared: low activity was found in 60 (46.2%) patients, 14 (10.8%) of them had typical symptoms of TB; measurable activity was found in 42 (32.4%), of which 21 (16.2%) patients had a clinical picture of TB; 28 (21.5%) patients had high activity, 22 (78.6%) of them showed symptoms, and in 8 (36.4%) patients of this subgroup the sputum was positive for Mycobacteria. These data do not demonstrate clear correlation, but suggest a a significant difference between groups. Chronic TB pleurisy was detected in 18 (51.4%) cases. It was characterized by the growth of coarse fibrous connective tissue with the presence of epithelioid-cell granulomas, and typical clinical and radiological symptoms. Conclusions. Determining the morphological degree of activity of specific inflammation allows to prescribe additional courses of anti-TB therapy. Low activity - 60 observations (46.2%), moderate degree - 42 cases (32.3%), high morphological degree - 28 (21.5%) cases. Different types of tuberculoma show different degrees of morphological activity. A significant difference was found between the presence of the clinical picture of TB in morphologically high and low levels of specific inflammatory activity. In tuberculosis of pleura patients with subacute or chronic course should receive surgery. Typical clinical presentation is usually observed in these patients. Key words: tuberculosis, morphological degree of activity, tuberculoma. Ukr. Pulmonol. J. 2022;30(4):28–33.