Workshop

What we see:

• There is a marked inflammatory population present comprised of neutrophils, macrophages, and multinucleated giant cells.
• Small lymphocytes and plasma cells are scattered throughout. 
• Several fungal yeasts are noted. These yeasts are basophilic with a refractile, have a double-contoured cell wall. They sometimes are exhibiting broad-based budding. 
• Interpretation: Marked pyogranulomatous inflammation with Blastomyces dermatitidis yeasts
  
  

Let's talk about this case...

• The lymphoid population is reactive, and there is a marked inflammatory population present. The type of inflammation (pyogranulomatous) is not specific, though combined with his history, should warrant a search for fungal organisms (if you are in an endemic area). 
• Blastomyces is in the environment/soil in some geographical locations. When an animal inhales the mycelial form, it then transforms to yeast at body temperature and travels throughout the body. Essentially any body system/organ can be affected, including the lymphatics.