FNA Smear showing Caseation Necrosis
in Caseating Lymphadenitis
Biopsy of a representative lesion was performed and the histological examination revealed the presence of tuberculoid granulomas accompanied by caseation necrosis
. The tuberculin skin test was found positive.
Secondary GM involves caseation necrosis
and emerges with a variety of infectious conditions such as vasculitis, sarcoidosis, tuberculosis, actinomycosis, and blastomycosis filariasis [2, 3].
Features such as granulomatous inflammation, with epithelioid macrophages, Langhans' giant cells, and lymphocytes, accompanied by characteristic caseation necrosis
typify TB infection .
The classical picture of histopathology of the lymph nodes is a granulomatous lesion with caseous necrosis and numerous epitheloid cells, lymphocytes, plasma cells, and fibroblasts and Langerhans type of multinucleated giant cells.16 The two histological features which specifically point towards the diagnosis of tuberculosis are variation in the size of the granulomata and the presence of caseation necrosis
. The histological differential diagnosis is granulomatous lymphadenitis due to sarcoidosis, foreign body granuloma or fungal infection which should be ruled out via appropriate diagnostic techniques.
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).
An ultrasound guided biopsy of liver mass showed chronic lymhoplasmacytic inflammation with caseation necrosis
and giant cells surrounded by epithelioid histiocytes (Figure-3).
(4) Hip infection is similar to progression in lungs with chronic granulomatous inflammation and caseation necrosis
. Radiographs may initially show soft-tissue swelling with progressive osteopenia, periosteal thickening, and periarticular bony and cartilaginous destruction.
Cytopathological analysis showed n=30 (41.10 %) diagnosed as Tuberculous lymphadenitis while n=23 (31.51 %) were labeled as cold abscess, n=17 (23.29%) were reported tuberculosis with extensive Caseation necrosis
and n=3 (4.10%) were reported as Tuberculous Mastitis.
They consist of accumulations of epithelioid histiocytes with Langhans giant cells and varying amount of caseation necrosis
in the center.9 In our case, incisional biopsy specimen showed normal epidermis with caseating tuberculoid granulomas consisting of epithelioid histiocytes and Langhans giant cells in the papillary dermis.
A synovial biopsy taken from the knee detected granulomatous inflammation with caseation necrosis
. Antibiotic treatment with isoniazid, rifampicin, ethambutol and pyrazinamide were prescribed for two months followed by rifampicin and isoniazid for seven months.
Non-suppurative necrosis, including caseation necrosis
, was present.