Other Manifestations of Tuberculosis

Tuberculous pneumonia in severely immunocompromised persons: In infants or severely immunocompromised patients, a diffuse pneumonia with PMNs and ordinary macrophages is the only response to the organism. Granulomas are absent. Acid fast organisms are plentiful.

This photo shows a high-power view of two alveolar spaces outlined by capillaries containing RBCs. Most of the cells filling the air spaces are PMNs. There is some fibrinous exudate in the air space to the left. The lack of RBCs in the exudate gives a pallor to the gross specimen, which is known as white pneumonia (pneumonia alba).

Necrosis as a major feature: In some persons, necrosis, seen here, rather than granuloma formation, is the major histologic feature.

Palisading histiocytes in tuberculosis: Occasionally, tuberculous granulomas will show palisading of histiocytes at the edge of the necrotic zone as shown here. The palisaded histiocytes have nuclei that are arranged perpendicular to the edge.

Granulomas and Neoplasia

Granulomas as a response to a neoplasm: Granulomas may be found around tumors as shown here. A granuloma (center) separates two nests of squamous carcinoma. The lower nest has a keratin pearl and the upper nest shows some keratinized cells in the center of the nest.

Although the needle aspirate of the lesion in our patient showed evidence of granulomas, the fact that a neoplasm could not be excluded led to the lobectomy.

Clinical summary Discussion

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