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Specimen 924B - Tuberculosis

Spiel: A 54 year old woman was admitted to hospital with fever, loss of appetite and weight, cough and weakness of six weeks duration. She had had contact with an uncle, who died of pulmonary tuberculosis 25 years earlier. Chest X-ray showed involvement of the apex (top) of both lungs, and tubercle bacilli, the bacteria responsible for tuberculosis, were recovered from her stomach. She died a few days after admission. The specimen is from the right lung and shows advanced tuberculosis in the upper lobe, with large areas of whitish, crumbly tissue in the upper portion, a cavity at the apex, and closely-set smaller areas of tuberculosis in the middle part. The lower half of the middle lobe is also extensively involved, but the lower lobe contains only occasional foci of caseation (cheese-like areas). Microscopy showed typical tuberculosis, with numerous areas showing central caseation (necrosis of tissue) and involvement by chronic inflammatory cells. At the edge of these lesions there are attempts at healing, with scarring and development of capillaries.

Anatomical Description

Specimen of the week - Tuberculosis

Name the organ present in this specimen.

  • Rt lung

Macroscopic Pathology

Describe the lesion(s) that you can see in the specimen. A 54 year old woman was admitted to hospital with fever, loss of appetite and weight, cough and weakness of six weeks' duration. She had had contact with an uncle, who died of pulmonary tuberculosis 25 years earlier. Chest X-ray showed involvement of the apex of both lungs, and tubercle bacilli, the bacteria responsible for tuberculosis, were recovered from her stomach. She died a few days after admission. The specimen is from the right lung and shows advanced tuberculosis in the upper lobe, with large areas of whitish, crumbly tissue in the upper portion, a cavity at the apex, and closely-set smaller areas of tuberculosis in the middle part. The lower half of the middle lobe is also extensively involved but the lower lobe contains only occasional foci of caseation (cheese-like areas). Microscopy showed typical tuberculosis, with numerous areas showing central caseation (necrosis of tissue) and involvement by chronic inflammatory cells. At the edge of these lesions there are attempts at healing, with scarring and development of capillaries.

Pathogenesis

What pathological process(es) is/are evident in this specimen? Describe the likely series of events that led to these appearances.

Clinical Manifestations

List the likely clinical manifestations in this case.

Complications

What complications might have arisen from the lesion shown in the specimen, and how might they manifest clinically?