Melnyk O. A., Liskina I. V., Zagaba L. M.

CLINICAL AND MORPHOLOGICAL CHARACTERISTICS OF POST-TUBERCULOSIS LUNG CHANGES BASED ON SURGICAL SPECIMENS

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About the author:

Melnyk O. A., Liskina I. V., Zagaba L. M.

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PATHOMORPHOLOGY

Type of article:

Scientific article

Annotation:

Tuberculosis (TB) remains a major medical and social challenge in Ukraine. But even with effective TB treatment, patients often retain pathological changes in their lungs. The aim of study – to determine the clinical and morphological characteristics of residual pulmonary changes following tuberculosis based on surgical material and to identify the most common pathomorphological patterns of post-tuberculosis lung lesions. This retrospective cohort study included 34 patients with residual pulmonary changes after treated pulmonary TB who underwent surgical intervention. Clinical, radiological, microbiological and data of histopathological examination of surgical material were analyzed. The study comprised 18 women and 16 men, with a mean age of 32,0±1,2 years. The most common clinical manifestations were exertional dyspnea, cough, general weakness, fatigue and chest pain, whereas eight patients were asymptomatic. The lesions were predominantly localized in the upper lobes, in 32 (94,1±4,0%) cases. At the time of surgery, microbiological examinations were negative for Mycobacterium tuberculosis in all patients. Histopathological examination identified four morphological patterns of post-tuberculosis pulmonary changes: 1) extensive residual post-tuberculosis changes – ERPTBC; 2) residual post-tuberculosis changes – RPTBC; 3) well formed tuberculomas-caseomas at least 2,0 sm in diameter; 4) ERPTBC associated with cirrhotic remodeling of the lung parenchyma. Patients initially diagnosed with infiltrative pulmonary TB constituted the largest group (17 cases), among whom RPTBC predominated, accounting for 10 (58,8±11,9%) cases. Similarly, among patients with an initial diagnosis of pulmonary tuberculoma (8 cases), RPTBC were the most frequent morphological pattern, being identified in 5 (62,5±17.1%) cases. Among 3 cases initially diagnosed with fibro-cavitary tuberculosis, 2 cases demonstrated ERPTBC with cirrhotic remodeling of the lung parenchyma at the time of surgical treatment. A spectrum of histopathological features, which revealed in different types of post-tuberculosis pulmonary lesions, was identified. The findings indicate that post-tuberculosis lung lesions are morphologically heterogeneous, which depending on the initial clinical form of TB, the extension of the specific inflammatory process and the features of reparative and regenerative responses during the prolonged course of the disease. Residual post-tuberculosis changes represented the most common morphological pattern, occurring in 21 cases. Regardless of the morphological subtype, fibrotic changes of the lung parenchyma was a constant finding and were observed in all cases. Tuberculous foci and granulomas are characteristic histopathological features of tuberculosis, however, their frequency varied among different types of residual post-tuberculosis pulmonary changes.

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Bibliography:

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Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 3, 182, 438-444 pages, index UDC 616.24-002.5-091:616-07

DOI:

10.29254/2077-4214-2026-3-182-438-444