title: The relevance of biopsy in tuberculosis patients without human immunodeficiency virus infection.
abstract: Although chronic granulomatous inflammation (CGI) with concomitant caseous necrosis (CN) is a characteristic histological feature of tuberculosis (TB), few studies have investigated its frequency or various pathologic findings. The medical records of 227 human immunodeficiency virus (HIV) -negative, culture-positive TB patients who underwent biopsy were studied. After the frequency of characteristic pathological findings of TB was determined, a pathologist reanalyzed the pathological findings with particular focus on necrosis and reclassified CGI, CN, or possible CN into possible TB pathologic findings. The initial biopsy interpretation revealed that 63 (34.8%) of 181 patients with pulmonary TB had caseating granulomas, 36 (19.9%) patients had only CGI, and 6 (3.3%) patients had only CN. Among 46 patients with extrapulmonary TB, 16 (34.8%) patients had only caseating granulomas, and 14 (30.4%) patients had only CGI. More patients who underwent percutaneous lung biopsy had CGI or CN (76.3%) than patients who underwent transbronchial lung biopsy (53.6%). The reanalysis confirmed all CN cases identified by the first interpretation, and 20 (95.2%) of 21 non-CN cases were reclassified as possible CN. Ten cases (three pulmonary and seven extrapulmonary) were reclassified as possible TB pathologic findings from just necrosis. Caseating granuloma was present in only one-third of TB cases. Even in cases where only necrosis was identified, CN may be present.
authors.affiliation: Departments of Internal Medicine and Pathology, Chosun University College of Medicine, Gwangju, South Korea; Division of Natural Medical Sciences, College of Health Science, Chosun University, Gwangju, South Korea.
authors.forename: Kyung Min
authors.initials: KM
authors.lastname: Bae
authors.affiliation: Departments of Internal Medicine and Pathology, Chosun University College of Medicine, Gwangju, South Korea; Division of Natural Medical Sciences, College of Health Science, Chosun University, Gwangju, South Korea.
authors.forename: Sung-Chul
authors.initials: SC
authors.lastname: Lim
authors.affiliation: Departments of Internal Medicine and Pathology, Chosun University College of Medicine, Gwangju, South Korea; Division of Natural Medical Sciences, College of Health Science, Chosun University, Gwangju, South Korea.
authors.forename: Hyung Ho
authors.initials: HH
authors.lastname: Kim
authors.affiliation: Departments of Internal Medicine and Pathology, Chosun University College of Medicine, Gwangju, South Korea; Division of Natural Medical Sciences, College of Health Science, Chosun University, Gwangju, South Korea.
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: Departments of Internal Medicine and Pathology, Chosun University College of Medicine, Gwangju, South Korea; Division of Natural Medical Sciences, College of Health Science, Chosun University, Gwangju, South Korea.
authors.forename: Na Ra
authors.initials: NR
authors.lastname: Yun
authors.affiliation: Departments of Internal Medicine and Pathology, Chosun University College of Medicine, Gwangju, South Korea; Division of Natural Medical Sciences, College of Health Science, Chosun University, Gwangju, South Korea.
authors.forename: Choon-Mee
authors.initials: CM
authors.lastname: Kim
authors.affiliation: Departments of Internal Medicine and Pathology, Chosun University College of Medicine, Gwangju, South Korea; Division of Natural Medical Sciences, College of Health Science, Chosun University, Gwangju, South Korea drongkim@chosun.ac.kr.
authors.forename: Dong-Min
authors.initials: DM
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014376:Tuberculosis / Q000473:pathology*; D055815:Young Adult