S12C14bP4b-Atypical AFB Infection

S12C14bP4b-1:The epidermis is thin. It shows effacement of the rete ridges. The epidermis has separated from the dermis; the defect is empty. The papillary dermis is widened and fibrotic. The subcutaneous fat and a portion of the dermis has been replaced by inflamed granulation tissue. At its interface with the compressed dermis, the granulation tissue is expansile and circumscribed. There is a cystic defect in the granulation tissue (AFB infection - M. fortuitum).

S12C14bP4b-2: There is an angulated defect in the inflamed granulation tissue. The infiltrates of the granulation tissue are lymphohistiocytic. They contain a high component of activated histiocytes, but tight clusters of histiocytes, in granulomatous patterns, are not a feature of this field.

S12C14bP4b-3: In this field, a granuloma is represented; it has the features of a lipogranuloma. Neutrophils are loosely sprinkled among the histiocytes.

S12C14bP4b-4: In the center of the field, neutrophils have collected in a defect to produce the pattern of a small abscess. Histiocytes are loosely clustered about the area of suppuration; the features, in combination, qualify as those of a suppurative granuloma. The granulomas are individually isolated in the neighboring granulation tissue.

S12C14bP4b-5: At the margin of the large defect seen in S12C14bP4b-1, histiocytes form ill-defined granulomatous patterns. Neutrophils and histiocytes are present along the surface of the defect. The lesion is suppurative and granulomatous.

S12C14bP4b-6: Blue arrows point to acid fast organisms.

 

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