Tuberculosis with Caseating Granuloma

Tuberculosis, or TB, is characterized by the formation of granulomas that often have central necrosis, called caseous necrosis due to its cottage-cheese appearance on gross evaluation.  Caseating granulomas characteristically have central necrosis surrounded by an immediate layer of macrophages and inflammatory cells, which, in turn, are surrounded by proliferating fibroblasts.  This effort to contain the mycobacterium (which is the organism that causes TB) can generate intense gliosis and edema in the adjacent brain tissue, leading to symptoms that bring a person to medical attention.