《Slide 40.》Intestinal tuberculosis, Intestine

A. Brief Descriptions：

1. Usually located in the ileocecal area.

B. Gross Findings：

1. Following the localization of lymphoid tissue in small bowel.

2. Annular ulcers lying transversely & raised above mucosa, sometimes with stricture.

3.  Local lymph nodes enlarged with florid caseating granuloma.

4.  Cut surface: white & friable.

C. Micro Findings：

1.  Large, closely packed granuloma, common in Payer’s patches.

2. Caseating foci, surrounded by epithelioid cells, Langhans` giant cells, lymphocytes & peripheral fibrosis.

3. Langhans` giant cells: nuclei ring surrounding in eosinophilic cytoplasm.

D. Others:

1. Mycobacterium tuberculum

• 0.2-0.5 by 2-5 um, straight or curved rod.

•  Proved by culture, acid fast stain, or hybridization.

1. Forms:

• Primary: infected the mesenteric lymph nodes & bowel walls.

• Secondary: swallowed sputum from an existing pulmonary lesion.

E. Reference：

1. Robbins Pathologic Basis of Disease, 6^th ed.  P.349-352.

　

 

 

【 Fig. 40-1 (LP)】Ulceration of the colonic mucosa with numerous transmural nodules infiltrate.

　

 

 

【 Fig. 40-2 (LP)】Presence of nodules in mucosa (top) and submucosa (top).

　

 

 

 

【 Fig. 40-3 (LP)】Numerous nodules infiltrate in muscularis propria (left) with extension to serosa (right).

　

 

 

【 Fig. 40-4 (HP)】The nodule (tubercle, caseous granuloma) is composed of caseous necrotic debris in the center, infiltrated by epithelioid histiocytes and surrounded by lymphocytes at peripheral. Note Langhans’ giant cells.