A surgical specimen from a patient with Crohn's disease shows transmural chronic inflammation with non-caseating granulomas, fissuring ulcers, and skip lesions. The granulomas in Crohn's disease are composed primarily of which cells and lack a central feature typical of tuberculosis?

• A Plasma cells and Russell bodies; lack fibrinoid necrosis
• B Foamy macrophages; lack multinucleated giant cells
• C Epithelioid histiocytes and Langhans giant cells; lack caseous necrosis ✓
• D Eosinophils and mast cells; lack eosinophilic crystalline granules

Explanation

Crohn's disease granulomas are non-caseating: they consist of epithelioid histiocytes often with Langhans-type multinucleated giant cells but conspicuously lack the central caseous (cheese-like) necrosis that defines tuberculosis granulomas. Caseation reflects the tissue-destructive delayed hypersensitivity response to Mycobacterium antigens and is not a feature of Crohn's or sarcoid granulomas.

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

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