HISTOMORPHOLOGICAL PATTERN OF LUNG IN PULMONARY TUBERCULOSIS IN AUTOPSY AND RESECTED SPECIMEN

Abstract

Tuberculosis (TB) continues to remain one of the most important health problems in India. India is the highest TB burden country in the world, accounting for one-fifth of the global incidence with an estimated 1.96 million cases per year. Without acid-fast bacteria (AFB) staining, smear-negative PTB is generally difficult to identify and may require mycobacterial culture and pathological or molecular diagnostics. Patient fails to take adequate treatment causing multidrug resistance to the anti-tubercular drugs. Some patients may require surgical intervention because of the associated complications. MATERIAL AND METHODS: Of the 15 surgically resected cases which include 8 lobectomy, 4 pneumonectomy, and 3 lung tissue for frozen section were taken. Patient demographic data and information was obtained from medical records and autopsy records. The specimens were stored in 10% formalin.

RESULTS: 24 cases from the autopsy and 15 cases from the surgically resected cases were diagnosed of tuberculosis which include 8 lobectomy, 4 pneumonectomy, and 3 lung tissue for frozen section. Age of the patients was ranging from 26 to 68 years with mean ± SD (standard deviation) was 34 ± 17.64. of the 39 cases 31 were male and 8 were female patients. In autopsy cases 21(87.50%) were male patients while 3(12.50%) were female. In surgical resection 10 (66.67%) were male cases and 5 (33.33%) were female. diagnosis of pulmonary tuberculosis was known in only 4 of 24 (16.67%) cases. All autopsies were done on patients who were suspected of tuberculosis and died within 24 hours of admission to hospital. On histopathology 7 cases were diagnosed as disseminated tuberculosis, 8 cases as fibrocavitary tuberculosis, and fibrocaseous tuberculosis (4 cases). A total of 19 cases were operated with suspicion of tuberculosis of which 2 were having associated malignancies hence were not included in the study and 2 were having Acquired immunodeficiency syndrome. So, finally 15 cases were included in this study. Histopathological evaluation of lung sections showed necrotizing granulomas in 32 (82.05%) patients, non-necrotizing granulomas in 3 (7.69%) of cases, caseous necrosis with Langhans giant cells in 2 cases (5.12%), and only caseous necrosis in 2 cases (5.12%). ZN stain for acid fast bacilli (AFB) was positive in 26 (66.67%) cases of which 12 (46.15%) were autopsy cases and 14(53.84%) surgically resected specimens. 

CONCLUSION: Timely diagnosis of tuberculosis can significantly reduce the morbidity and mortality. Tor tuberculosis diagnosis immunohistochemistry or molecular techniques such as polymerase chain reaction to paraffin sections can be done. Histopathology remains one of the important methods for diagnosis of smear negative and suspected cases.

Keywords: PTB, AFB, ZN, DST, TDL, TB and HAFB.