Caseous necrosis with epithelioid granulomas was observed in 47 cases and granulomas without caseation
was observed in 27 cases.
Mycobacterium tuberculosis cultures assisted in definitive decision-making but granulomatous inflammation could not be anticipated when the specimens were initially processed except when visible caseation
Instead, a considerable number of ITB cases had biopsies with features of chronic inflammation or granulomas without caseation
, a finding consistent with other reports.
Microscopic examination showed numerous epithelioid cell granulomas with Langhans giant cells and large areas of caseation
necrosis in the pancreas.
Cases of caseating epithelioid granulomatous pattern can be wrongly labeled as necrotizing lymphadenitis pattern if material is aspirated from that part of the node that contains only caseation
Diagnosis of tuberculosis was confirmed on finding typical granulomas comprising of lymphocytes, Langhans type giant cells with or without caseation
Contrast enhanced CT scan (CECT) of neck showed multiple lymph nodes at level IV on the right side and in the right supraclavicular region showing peripheral rim enhancement with central caseation
necrosis (Figures 4, 5, and 6).
It has been suggested that this colonisation is followed by the destruction of the alveolar epithelium, granuloma formation and subsequent caseation
and liquefaction of the granulomatous tissue .
The histologic hallmark of hepatic tuberculosis is the epithelioid granuloma, often with caseation
and giant cells (Figure 2, A).
Upper dermis shows tuberculoid granulomas consisting of epithelioid cells and multinucle- ated giant cells mainly of Langhans type with sparse or no central caseation
within the tuber- cle9 along with abundant lymphocytic infiltra- tion.
22,23) TBRM is characterized by a gross granulomatous reaction with associated histiocytic proliferation, caseation
and tubercle formation that expands and fills the space between the spinal dura mater and the leptomeninges.
TB bacilli cause caseation
necrosis in the intestine followed by spread to the mesenteric lymph nodes that may rupture into the peritoneum causing TB peritonitis4.