Epithelioid granulomas with central caseating necrosis, Langerhans giant cells, and peripheral lymphocytic cuffing are most characteristic of which type of granulomatous inflammation?

• A Foreign body granuloma
• B Type IV hypersensitivity (T-cell mediated) granuloma as seen in tuberculosis ✓
• C Sarcoidal (non-caseating) granuloma
• D Allergic (eosinophilic) granuloma

Explanation

Caseating granulomas with Langerhans giant cells (nuclei arranged at the periphery in a horseshoe pattern) and central necrosis are the hallmark of tuberculosis, resulting from Th1-mediated type IV delayed-type hypersensitivity to mycobacterial antigens, with activated macrophages fusing to form epithelioid granulomas. Foreign body granulomas contain foreign material and lack caseation; they result from mechanical irritation, not antigen-specific T-cell responses. Sarcoid granulomas are non-caseating. Eosinophilic granulomas are characteristic of Langerhans cell histiocytosis.

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

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