Granuloma with langhans giant cells: An overview
A 55-year-old male patient reported with a complaint of swelling in the left side of his face for the past 3 months. The patient noted a gradual increase of the swelling to the present size over a period of 3 months. The swelling was painless with no discharge. There was no history of fever or associated symptoms like cough and expectoration. He had no dental infection or history of trauma. He had no history of oral habits involving tobacco or other products. Radiograph of the chest did not reveal any significant findings.\nOn extraoral inspection, there was a single swelling of size 2 × 2 cm in the left submandibular region extending posteriorly from the angle of the mouth. Borders of the swelling were well-defined, and the overlying skin appeared normal. On palpation, the swelling was firm, non-tender, and not indurated. The overlying skin was pinchable, with no appreciable warmth. The patient was advised hematological and histopathologic investigations. He reported after 2 weeks when the swelling become fluctuant with development of a pointing abscess.\nHematologic investigations revealed a negative HIV status and normal hemogram values except for an elevated erythrocyte sedimentation rate (ESR) level. On aspiration, a purulent fluid was collected with the swelling remaining firm. A biopsy for histopathological examination was suggested. On surgical exploration, the swelling revealed lesional tissue with yellowish areas suggestive of degeneration. The specimen was sent for histopathological evaluation.\nHistologically, the lesional tissue was encapsulated and exhibited lymph node architecture with germinal centers []. The lesional tissue exhibited multiple granuloma formation and numerous giant cells. The granuloma was composed of central epitheloid and foamy macrophages bounded by lymphocytes and plasma cells []. Multinucleated giant cells were seen in different foci []. A few granulomas exhibited eosinophilic areas suggestive of central necrosis []. The giant cells were Langhans type displaying numerous nuclei arranged in horseshoe pattern and an eosinophilic cytoplasm [Figure and ]. Some of the giant cells exhibited arrangement of the nuclei at both poles []. Nuclei were uniform and appeared normal and vesicular. The giant cells were not associated with hemorrhagic foci, which were fairly observed. The histopathology was suggestive of a chronic granulomatous disease.\nBased on the histopathology, the differential diagnoses considered were:\nMycobacterial diseases Tuberculosis Leprosy Bacterial infections\nSyphilis Actinomycosis Cat scratch disease Fungal infections\nHistoplasmosis Blastomycosis Paracoccidioidomycosis Protozoal infections\nToxoplasmosis Miscellaneous diseases\nSarcoidosis Orofacial granulomatosis Crohn's disease Melkersson-Rosenthal syndrome Wegener's granulomatosis.\nThe patient was advised for further investigations to confirm the diagnosis but could not be followed-up as he was transferred. A list of hematological, microbiologic, and immunologic investigations was advised to be done at his work place.