A histological section from a tuberculous lymph node shows granulomas with central amorphous, granular, eosinophilic debris in which all cellular outlines are lost. Which type of necrosis is this, and what does it grossly resemble?
- A Fat necrosis, resembling chalky white deposits
- B Coagulative necrosis, resembling infarcted kidney
- C Caseous necrosis, resembling crumbly cheese ✓
- D Liquefactive necrosis, resembling abscess pus
Correct answer: C. Caseous necrosis, resembling crumbly cheese
Explanation
Caseous necrosis is a distinctive form of necrosis encountered most often in foci of tuberculous infection. Microscopically it combines features of coagulative and liquefactive necrosis: amorphous granular eosinophilic debris with complete loss of cellular architecture, enclosed by granulomatous inflammation. Grossly the friable yellow-white appearance resembles clumped cheese, hence the name caseous. Coagulative necrosis preserves cell outlines, liquefactive necrosis yields liquid pus, and fat necrosis shows saponified chalky areas.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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