24320              APICAL TUBERCULOMA AND BRONCHIECTASIS

This patient was a 60 year old woman who was admitted severely breathless with central cyanosis, a raised JVP and a soft enlarged liver.  There was also orthopnoea and nocturnal breathlessness and the ankles were swollen.  She had had tuberculosis 24 years previously and the right lower lobe had been removed 12 years later.  She died of cardiac failure on the 2nd hospital day.

The specimen is of the left lung which shows an inspissated encapsulated caseous tuberculous focus in the posterior segment of the upper lobe, with marked fibrous thickening and adhesions of the overlying pleura.  The reverse of the specimen shows extension of the caseous focus, with quite marked surrounding fibrosis in which small bronchi are dilated.  Large bands of fibrous tissue extend anteriorly through the substance of the upper lobe.  Histology shows calcifying necrotic caseation walled off by fibrous tissue and lymphocytes.  There are a few Langhan's giant cells.