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Although chronic granulomatous inflammation (CGI) with concomitant caseous necrosis (CN) is a characteristic histological feature of tuberculosis (TB), few studies have investigated its frequency or various pathologic findings. The medical records of 227 human immunodeficiency virus (HIV) -negative, culture-positive TB patients who underwent biopsy were studied. After the frequency of characteristic pathological findings of TB was determined, a pathologist reanalyzed the pathological findings with particular focus on necrosis and reclassified CGI, CN, or possible CN into possible TB pathologic findings. The initial biopsy interpretation revealed that 63 (34.8%) of 181 patients with pulmonary TB had caseating granulomas, 36 (19.9%) patients had only CGI, and 6 (3.3%) patients had only CN. Among 46 patients with extrapulmonary TB, 16 (34.8%) patients had only caseating granulomas, and 14 (30.4%) patients had only CGI. More patients who underwent percutaneous lung biopsy had CGI or CN (76.3%) than patients who underwent transbronchial lung biopsy (53.6%). The reanalysis confirmed all CN cases identified by the first interpretation, and 20 (95.2%) of 21 non-CN cases were reclassified as possible CN. Ten cases (three pulmonary and seven extrapulmonary) were reclassified as possible TB pathologic findings from just necrosis. Caseating granuloma was present in only one-third of TB cases. Even in cases where only necrosis was identified, CN may be present.
Financial support: This work was supported by grants from the Clinical Medicine Research Institute at Chosun University Hospital (2010).
Authors' addresses: Kyung Min Bae, Hyung Ho Kim, Woo Jin Lee, Na Ra Yun, and Dong-Min Kim, Department of Internal Medicine, Chosun University College of Medicine, Gwangju, South Korea, E-mails: firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org. Sung-Chul Lim, Department of Pathology, Chosun University College of Medicine, Gwangju, South Korea, E-mail: email@example.com. Choon-Mee Kim, Division of Natural Medical Sciences, College of Health Science, Chosun University, Gwangju, South Korea, E-mail: firstname.lastname@example.org.