Question

Aschoff bodies in rheumatic heart disease show all of the following features EXCEPT:

• A. Anitschkow cells
• B. Epithelioid cells
• C. Giant cells
• D. Fibrinoid necrosis

Hint:

Aschoff bodies contain Anitschkow cells, Aschoff giant cells and central fibrinoid necrosis. Epithelioid cells belong to true granulomas, not Aschoff bodies.

Answer 1

The Correct Option is B

An Aschoff body is the tissue fingerprint of active rheumatic carditis. It sits in the heart muscle and has a set list of cells and changes that pathologists look for. The question wants the one item on the list that does not belong.

1. Anitschkow cells: these are the activated macrophages with the wavy caterpillar shaped nucleus that ring the Aschoff body. They are considered the single most specific marker of rheumatic carditis, so this feature belongs.
2. Epithelioid cells: these elongated, pink macrophages are the building block of granulomas seen in diseases like tuberculosis, not of Aschoff bodies. No standard description of rheumatic Aschoff bodies includes epithelioid cells or granuloma formation.
3. Giant cells: when several Anitschkow macrophages fuse, they form the multinucleated Aschoff giant cell, a recognised part of the lesion. This feature belongs.
4. Fibrinoid necrosis: the center of the nodule is made of degenerate, swollen collagen that stains like fibrin, called fibrinoid necrosis. This is the core the other cells surround, so it belongs.

Three of the four items, Anitschkow cells, giant cells and fibrinoid necrosis, are genuine building blocks of the Aschoff body. Epithelioid cells are not, because they belong to granulomatous disease, not to rheumatic carditis. So epithelioid cells is the correct exception.

Let's summarize:

• Aschoff body core: fibrinoid necrosis.
• Surrounding cells: Anitschkow cells and Aschoff giant cells.
• Epithelioid cells belong to granulomas (for example tuberculosis), not to Aschoff bodies.

The printed key for this paper lists giant cells as the exception, but Aschoff giant cells are a documented part of the lesion, so that option cannot be correct. The feature that does not belong is epithelioid cells.