Granuloma in Sputum Cytology of Pulmonary Tuberculosis

BACKGROUND: Presence of epithelioid cell granuloma and Langhans' giant cells in sputum cytology in cases of pulmonary tuberculosis is of very uncommon occurrence. Only a few reports could be found in the English-language literature. CASE: A 73-year-old man, a chronic smoker for 50 years, reported to the medical out-patient department with complaints of cough and significant weight loss for the past 1 year. Routine sputum cytology revealed epithelioid cell granuloma along with Langhans' giant cells. Ziehl-Neelsen stain showed presence of multiple acid-fast bacilli (AFB). Chest radiography showed opacity of the airways and areas of cavitations in bilateral parahilar location and diffuse nodular opacity in bilateral lung fields. CONCLUSION: Albeit of very rare occurrence, presence of epithelioid cell granuloma and Langhans' giant cells, along with demonstration of AFB in routine sputum cytology, is capable of providing a conclusive diagnosis in appropriate clinical context, obviating the need of additional investigation.