Pathology report
Specimen:
Video-assisted thoracoscopic surgery (VATS) biopsy from hilar and mediastinal lymph nodes, composed of multiple well-encapsulated lymph nodes, the largest is 2 x 2 x 1 cm and lung biopsy composed of wedge-shaped soft tissue specimen measuring 1 x 0.5 x 0.3 cm.
Microscopy:
Examination of all nodes reveals nodal tissue showing complete effacement of nodal architecture. The nodal tissue is replaced by multiple granulomas of different sizes. Each granuloma is composed of epithelioid cells and multinucleated classic Langerhan giant cells. Areas of caseous necrosis are seen. The same granulomatous lesion is seen in lung specimen with wider necrotic changes.
Diagnosis:
Appearances are consistent with caseating tuberculosis in both hilar, mediastinal lymph nodes and lung specimen.