A 28-year-old woman from rural Maharashtra presents with a 3-month history of firm, matted cervical lymphadenopathy and constitutional symptoms (fever, night sweats, weight loss). Excisional lymph node biopsy reveals the histopathological appearance marked as **B** in the diagram. Which of the following is the MOST COMMON EXTRAPULMONARY MANIFESTATION OF TUBERCULOSIS that this patient is presenting with?
A. Tuberculous meningitis, accounting for 5-10% of extrapulmonary TB cases
B. Tuberculous osteomyelitis of the spine (Pott disease), accounting for 10-15% of extrapulmonary TB cases
C. Tuberculous peritonitis with ascites, accounting for 20-25% of extrapulmonary TB cases
D. Tuberculous lymphadenitis (scrofula), accounting for 30-40% of extrapulmonary TB cases
Explanation
Why "Tuberculous lymphadenitis (scrofula), accounting for 30-40% of extrapulmonary TB cases" is right
The histopathological appearance marked B shows caseating granulomas with central amorphous eosinophilic necrosis, epithelioid macrophages, and Langhans giant cells — the pathognomonic hallmark of tuberculous lymphadenitis. According to Robbins & Cotran and WHO TB Guidelines, tuberculous lymphadenitis is the MOST COMMON FORM OF EXTRAPULMONARY TUBERCULOSIS, accounting for 30–40% of all extrapulmonary TB cases. When involving the cervical lymph nodes (as in this patient), it is classically termed "scrofula" or "king's evil." The clinical presentation of firm, matted, non-tender cervical lymphadenopathy with B symptoms is typical of this condition.
Why each distractor is wrong
Tuberculous peritonitis with ascites, accounting for 20-25% of extrapulmonary TB cases: While peritonitis is a significant extrapulmonary manifestation, it accounts for only 20–25% of cases — substantially less than lymphadenitis. The biopsy findings here are from a lymph node, not peritoneal tissue.
Tuberculous meningitis, accounting for 5-10% of extrapulmonary TB cases: Meningitis is a serious but less common extrapulmonary form, representing only 5–10% of cases. It would not present with lymphadenopathy on biopsy and carries much higher mortality.
Tuberculous osteomyelitis of the spine (Pott disease), accounting for 10-15% of extrapulmonary TB cases: Spinal TB is important but less common than lymphadenitis. The clinical and histological findings here point to nodal disease, not bone involvement.
High-YieldNEET PG
Tuberculous lymphadenitis is the most common extrapulmonary TB manifestation (30–40%); cervical involvement is called "scrofula"; caseating granulomas with Langhans giant cells are diagnostic.
Robbins & Cotran Pathologic Basis of Disease, 10th ed; WHO TB Guidelines
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