- What is the inflammatory process seen in the images?
Granulomatous inflammation is present. Granulomas with caseation are seen in one section.
- Describe the giant cells seen in the lesions. What do you suspect as a
diagnosis?
These are Langhans giant cells (nuclei tend to pile up or line up on one side. You should suspect tuberculosis (or pathogenic fungi such as Histoplasma or Coccidioides).
- What would you do to confirm your diagnosis?
Sputum culture. If tissue is obtained, it can be cultured, and an acid fast stain can be done to detect mycobacteria in the tissue, and a GMS or PAS stain done to detect fungi in the tissue. In these cases, M. tuberculosis grew in culture.
- What determines the severity of this disease, and how can it spread in the body?
The virulence of the organisms as well as the immunocompetence of the patient determine the course of disease. In some parts of the world, there are strains of multiply drug-resistant tuberculosis. In most persons, infection with M. tuberculosis remains subclinical. In persons who are chronically ill or debilitated, there is a greater likelihood for development of significant pulmonary disease, and there can be spread of infection locally via lymphatics or there can be hematogenous spread to distant organs.
