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<ul><li class="ql-align-justify">Sections from the pleural biopsy show pleural tissue involved by multiple well-formed granulomas composed predominantly of epithelioid histiocytes, admixed with scattered Langhan's-type multinucleated giant cells. Several granulomas exhibit central amorphous eosinophilic necrosis consistent with caseation. A surrounding rim of lymphocytes is present, with focal fibroblastic response at the periphery. No evidence of malignancy.</li><li class="ql-align-justify">Preparations are hemorrhagic and show a moderate number of small lymphocytes with few reactive mesothelial cells. No evidence of atypical or malignant cells.</li></ul>
<p class="ql-align-justify">Pleural effusion. Pleural fluid sample and visceral pleural tissue biopsies were received.</p>
<p class="ql-align-justify">Three containers were received:</p><ol><li class="ql-align-justify">Soft tissue fragments collectively measured 11x9.5x1.7 cm, with the largest measuring 5.5x5x1.7 cm.</li><li class="ql-align-justify">One soft tissue fragment measured 4x3.5x0.5 cm.</li><li class="ql-align-justify">3 ml bloody fluid, from which 2 smears were prepared and stained.</li></ol>
<h3><strong><em><u>Pleura, biopsy:</u></em></strong></h3><ul><li class="ql-align-justify"><strong>Caseating granulomatous inflammation, consistent with tuberculous pleuritis.</strong></li><li class="ql-align-justify"><strong>Recommended for confirmatory further studies to establish the etiology.</strong></li></ul><p class="ql-align-justify"><br></p><h3 class="ql-align-justify"><strong><em><u>Pleural fluid cytology:</u></em></strong></h3><ul><li class="ql-align-justify"><strong> Hemorrhagic and moderate lymphocytic, negative for malignant cells. </strong></li></ul><h5 class="ql-align-justify"><strong><u>COMMENT:</u></strong></h5><h5 class="ql-align-justify">Confirmation of this etiology by microbiological studies, molecular studies and skin testing is recommended. </h5>
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