RCPA Examinations in Anatomical pathology - Questions ... - Rcpa.tv

Case 12: Male 52 – burns on
hands, tissue from thickened ulnar
nerve
• MICROSCOPIC
• The submitted slide shows soft tissue containing an area of granulomatous
inflammation. The inflammation is well circumscribed but not encapsulated, shows
central necrosis and a peripheral rim of mononuclear cells including macrophages and
lymphocytes. Residual peripheral nerve is unable to be identified. ed. Adjacent to this
there is a small linear structure which appears to represent a small s
nerve. This
shows perineural and intraneural infiltration by lymphocytes.
• Comment: Correlation of the histological findings of granulomatous inflammation
and perineural inflammation with the clinical history of burns on hands and a
thickened ulnar nerve is consistent with a diagnosis of leprosy involving the ulnar
nerve.
• Investigations
• Immunoperoxidase stain for EMA and S100 may demonstrate residual perineurium
and Schwann cells. A Wade-Fite
stain or PCR for Mycobacterium leprae would be
undertaken to confirm the presence of organisms.
• SUMMARY
• Ulnar nerve: Granulomatous inflammation consistent with leprosy.