Qap (Anatomical Pathology) 

QAP Peer Review

AP157
Case History: F/30, had cervical lymhadenopathy and sudden deterioration of vision. There were multiple enhancing nodules in the suprasellar and Sylvian areas.
Intended diagnosis: Tuberculosis (culture positive). Contributed by:PKH
Code Diagnosis Comment Score
anonymous Caseating granulomatous inflammation (100%) Mycobacterial infection has to be considered. Please perform special stain and culture study for Mycobacterial and fungal infection.  100
anonymous Necrotizing granulomatous inflammation (100%). Possible causes include histoplasmosis, toxoplasmosis, other fungal infections and mycobacterial infections. Need to perform special stains for fungi, parasites and mycobacterial organisms.  100
anonymous Necrotizing granulomatous inflammation, infection to be excluded. 100% Special stains for infective miro-organisms to be performed, particularly fungus and acid fast bacilli. Also correlate with microbiology laboratory results.  100
anonymous Necrotizing granulomatous inflammation Speical studies to look for infective organisms: 1) Toxoplasmosis : Giemsa stain, immunostaining; 2) Mycobacteria : ZN stain, Wade Fite stain, PCR for M. tuberculosis 3) Fungus : PASD, Grocott  100
anonymous NECROTIZING GRANULOMATOUS INFLAMMATION. 100% Special stains eg. Grocott, PAS+D, ZN, and more sampling to look for infective organisms such as fungi, parasites, and Mycobacteria.  100
anonymous Histiocytic proliferation favor necrotizing granulomatous inflammation.(100%) Do fungal stains, including Grocott stain, to look for fungal infection. Ziehl Neelsen and Wade Fite stains to look for mycobacterial infection. Also do S100 protein stain to exclude Rosai-Dorfman disease.  100
anonymous Brain - necrotizing granulomatous encephalitis 100% Special stains required: Ziehl-Neelsen stain, PAS, Grocott - to look for causative organisms. The history of cervical lymphadenopathy is suggesting TB, which then spread intracranially.  100
anonymous Necrotizing granulomatous inflammation (100%) Need to perform Gram, Grocott, Ziehl Neelsen, Warthin Starry stains to look for bacteria, fungi, acid fast bacilli and spirochetes. Also need to correlate with microbiological culture result.  100
anonymous Necrotizing granulomatous inflammation (100%). Infective causes including toxoplamosis and tuberculosis have to be considered. Suggest Gimesa and PAS stains to look for tachyzoites and bradyzoites of Toxoplasma, Ziehl Neelsen stain for mycobacteria.  100
anonymous NECROTIZING GRANULOMATOUS INFLAMMATION. Suggest specific stains (PAS and Ziehl-Neelsen) for acid fast bacilli and fungus. (100%) nil  100
anonymous Necrotizing granulomatous inflammation 100% Likely infective cause: special stains for AFB (ZN) and fungus (Grocott, PAS)  100
anonymous Necrotizing granulomatous inflammation, of infectious etiology Neurosarcoidosis (if organisms are excluded by special stains, etc) nil  90
anonymous Necrotizing granulomatous lesion, favor infective. 100% Probability Perform ZN, PASD, mucicarmine, grocott, Giemsa and toludine blue for organism.  100
anonymous Necrotising granulomatous inflammation 100% Infective causes have to be considered; in particular, mycobacterial infection, fungal infection and toxoplasmosis have to be considered. Special stains including Gram, Grocott, PAS, Giemsa and Ziehl-Neelsen stains should be performed to look for microorganisms. Immunohistochemical stain for toxoplasma antigens can be performed. Correlation with microbiological studies may be helpful.  100
anonymous brain - granulomatous inflammation 100% Special stains for infective organisms including ZN and PAS.  100