A pathologist examining a lymph node from a patient with cat-scratch disease observes stellate microabscesses surrounded by a rim of palisading histiocytes. Which term accurately describes this specific pattern of granulomatous inflammation?

• A Tuberculoid granuloma with caseation necrosis
• B Suppurative (necrotizing) granuloma with central microabscess — typical of Bartonella henselae, LGV, and Yersinia infections ✓
• C Sarcoid-type non-caseating granuloma with Schaumann bodies
• D Granuloma annulare pattern with mucin deposition in palisading histiocytes

Explanation

Stellate microabscesses (central suppuration with neutrophilic core) surrounded by a palisade of epithelioid histiocytes characterize the suppurative or necrotizing type of granulomatous lymphadenitis. This pattern is seen in cat-scratch disease (Bartonella henselae), lymphogranuloma venereum (Chlamydia trachomatis L1-L3), tularemia (Francisella tularensis), and Yersinia lymphadenitis. Differentiating this pattern from caseating (tuberculoid) granuloma — which has cheese-like dry necrosis rather than liquid pus — is diagnostically important. Sarcoid granulomas lack necrosis. Granuloma annulare is a dermal condition with mucin.

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

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