On histopathological examination, epitheloid granulomas with caseating necrosis
were seen which was suggestive of tuberculosis (figure 2).
Histopathological study of the sections revealed epitheloid granuloma with multinucleate giant cells with large areas of caseating necrosis
suggestive of tuberculosis.
Histopathology from gallbladder shows granuloma comprising of caseating necrosis
, epitheloid cells, giant cells, lymphocytes and fibroblast.
Sections from the growth showed granuloma formation along with areas of caseating necrosis
and Langhans type giant cells, suggestive of tuberculosis (Fig.
Pathologic examination of excised lymph nodes of the bilateral inguinal area showed reactive lymphoid proliferation and granulomatous inflammation with multinucleate giant cell formation, suggestive of mycobacterial disease; however, there was no evidence of caseating necrosis
or acid-fast bacilli.
The histopathology showed features of epitheloid granuloma, caseating necrosis
surrounded by Langhans giant cells, (Fig.
These tubercles show characteristic amorphous caseating necrosis which may rupture into surrounding structures, such as the airway and blood stream, causing endobronchial or hematogenous dissemination.
In nodes undergoing necrosis, contrast-enhanced MR imaging shows rim enhancement with a central area of no enhancement representing caseating necrosis.
Findings on analysis of the primary ulcer--which contained caseating necrosis
with florid granulomas, Langerhans' giant cells, and abundant epithelioid cells--were strongly suggestive of tuberculosis (figure 3).
Investigations leading to the diagnosis are histologic analysis showing a granuloma with or without caseating necrosis
, and the microbiologic identification of Mycobacterium tuberculosis.