Lesions in Other Organs

Figure 1. Liver

The following 4 figures show extrapulmonary granulomas from the patient with miliary tuberculosis. Compare them to those in figures 5 and 6 below. Figures 1 to 4 show poorly-defined granulomas with absence of plump epithelioid cells and giant cells. There is diffuse necrosis.

Acid fast stains showed isolated organisms in a few of the granulomas.

No granulomas were found in the heart, pancreas, prostate, or brain.

Figure 2. Spleen

Figure 3. Kidney

Figure 4. Adrenal

Figure 5. A well-formed granuloma with plump epithelioid cells, a giant cell, and prominent lymphoid cells

Figure 6. The edge of a caseous granuloma with central necrosis and surrounding giant cells, lymphoid cells, and fibrosis

In contrast to the granulomas from the patient with miliary disease, figures 5 and 6 show lesions from a patient with localized disease. Small lesions (figure 5) show well-defined, cellular granulomas, and larger ones (figure 6) show granulomas with central, caseous necrosis and a granulomatous cellular margin. Both of these examples indicate a stronger host defense mechanism than that shown in figures 1 to 4 from the case with miliary tuberculosis.

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