A 35-year-old man from a tuberculosis-endemic region presents with chronic right lower quadrant pain, weight loss, and intermittent diarrhoea for 4 months. He has low-grade fever and a positive Mantoux test. Colonoscopy shows ileocecal involvement with ulcerations. Biopsy reveals granulomatous inflammation. Which histological feature is MOST helpful in distinguishing intestinal tuberculosis from Crohn's disease?

• A Confluent caseating granulomas ✓
• B Non-caseating granulomas with Langhans giant cells
• C Lymphoid aggregates in the submucosa
• D Transmural inflammation with lymphoid hyperplasia

Explanation

Intestinal TB is distinguished from Crohn disease by the presence of caseating granulomas. Non-caseating granulomas with Langhans giant cells are typical of Crohn disease. In TB, granulomas tend to be confluent, larger, and contain central caseous necrosis. Crypt architectural distortion and transmural inflammation can occur in both conditions. Submucosal lymphoid aggregates are nonspecific findings present in chronic inflammation regardless of aetiology.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.