Which type of necrosis is characteristically seen in the center of a tuberculous granuloma, and what is its histological appearance?

• A Caseous necrosis — amorphous, granular, acellular eosinophilic material resembling cottage cheese ✓
• B Coagulative necrosis — ghost cell outlines preserved
• C Liquefactive necrosis — fluid-filled space with neutrophils
• D Fibrinoid necrosis — hyaline pink material with nuclear dust

Explanation

Caseous necrosis is the hallmark of tuberculosis and other mycobacterial/fungal granulomas. The necrotic center appears as amorphous, granular, acellular eosinophilic material (resembling cottage cheese or 'caseous' — cheese-like) with complete loss of cell architecture. This distinguishes it from coagulative necrosis where cell outlines are preserved. Fibrinoid necrosis is seen in vasculitis and immune complex deposition.

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

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