What pattern of granulomatous inflammation is typical in tuberculosis?

• A. Non-caseating granulomas with Langhans-type giant cells
• B. Caseating granulomas with Langhans-type giant cells
• C. Caseating granulomas without giant cells
• D. Suppurative granulomas

Answer: (B)

In tuberculosis, the inflammatory pattern is a granulomatous reaction that aims to contain the infection, driven by a Th1 cell–mediated response. The hallmark is a caseating granuloma: a center of cheese-like necrosis surrounded by epithelioid macrophages and Langhans-type giant cells. These giant cells arise from fused activated macrophages and have nuclei arranged peripherally in a horseshoe or ring. A lymphocytic mantle surrounds the structure. This combination—central caseation with Langhans-type giant cells—is characteristic of TB and helps distinguish it from granulomas that are non-caseating (seen in conditions like sarcoidosis) or granulomas with a predominantly neutrophilic, suppurative pattern.