CWM Hospital Fiji School of Medicine Depts' of Medicine

1
CWM Hospital / Fiji School of Medicine Depts. of
Medicine Pathology
CPC Meeting 6/6/2002

• Pleural Effusion
• Tuberculosis

2
History

• 62 Year Fiji Indian Female
• Presented two years before with large mass per
  abdomen, treated at private hospital with
  aspiration of over 1 litre of pus.
• Presented 6 months before with recurrent mass
  suprapubic and left ileac mass. Liver and spleen
  moderately enlarged.
• Soft mass felt in rectum.
• Possible malignancy with multiple secondaries.

3
History Cont..

• Presented last week again with cough, dyspnoea
• Chest X-ray opacity - ? Pleural effusion
• Pleural fluid aspiration done turbid yellow,
• Glucose 6.7(Blood 5.8), WBC- 250
• Lymphocytes 92, No organisms grown
• LDH 160
• ? Malignancy ? Sarcoidosis

4
Pleural Biopsy

• Multiple bits of fibrous tissue
• blood clots.

5
Pleural Biopsy

• Fibrous tissue
• With many irregular capillaries and bleeding.
  (Grannulation tissue)

6
Pleural Biopsy

• Fibrous tissue
• Collection of linear Macrophages granuloma
• Areas of caseous necrosis.

7
Pleural Biopsy

• Fibrous tissue
• Plenty of Inflammatory cells (black dots-nuclei)
• Areas of caseous necrosis. (no dots-dead cells)

8
Pleural Biopsy

• Granuloma
• Linear macrophages
• Around areas of caseous necrosis. (no dots-dead
  cells)
• No giant cells were seen.

9
Discussion

• Multiple bits of fibrous tissue with blood clots
• Showed areas of chronic inflammatory cells and
  granulation tissue (chronic inflammtion
  healing)
• Some area showed granuloma with central caseous
  necrosis.
• Features suggest Tuberculous pathology.
• AFB stains done did not show TB bacilli.