Reactivation tuberculosis is characterized by chronic tissue lesions, the formation of tubercles, caseation
, and fibrosis.
Histopathological examination of sinus tract under the magnification of 20 showing the presence of granuloma with no central caseation
within the tubercles is seen in about half the cases and is rarely marked.
This diagnosis was presumed by the presence of necrotizing granulomatous necrosis with caseation
with a strongly positive Mantoux test of 25 mm (Figure 3), and later was supported by a marked response to antituberculous medication.
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
used the following laparoscopic criteria such as findings of tubercles, caseation
, granulomas, beaded tubes, tuboovarian masses, fimbrial agglutination, and hydrosalpinx to suggest TB.
However, histopathology was consistent with acute suppurative pericarditis on top of chronic granulomatous inflammation with Langhans-type giant cells and caseation
necrosis, indicative of tuberculous pericarditis with superimposed bacterial pericarditis.
Small discrete anechoic areas, representing zones of caseation
, may be seen within the nodes .
Instead, a considerable number of ITB cases had biopsies with features of chronic inflammation or granulomas without caseation
, a finding consistent with other reports.[sup],, In addition, multiple target biopsies, deep biopsy, and the culture of the biopsy material might increase the diagnostic yield.[sup], Biopsy specimens obtained surgically usually provide confirmative diagnosis, and surgery might be considered in some selected difficult cases.
Microscopic examination showed numerous epithelioid cell granulomas with Langhans giant cells and large areas of caseation
necrosis in the pancreas.
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).