A surgical pathology specimen shows a foreign body reaction around retained suture material containing multinucleated giant cells in which the nuclei are randomly scattered throughout the cytoplasm. How does this giant cell differ morphologically from a Langhans giant cell?

• A Its nuclei are arranged in a peripheral horseshoe pattern
• B It contains no nuclei, unlike the Langhans giant cell
• C Its nuclei are clustered at one pole of the cell
• D Its nuclei are dispersed haphazardly across the cytoplasm ✓

Explanation

Foreign body giant cells, formed around inert material such as sutures, talc or urate crystals, have nuclei scattered randomly throughout the cytoplasm. Langhans giant cells, typical of tuberculosis and sarcoidosis, show nuclei arranged in a peripheral rim shaped like a horseshoe. Both arise by fusion of macrophages under IFN-gamma driven Th1 signaling, so the distinction is purely morphological.

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

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