This 70-year-old patient presented with a transient left sided weakness. Their past medical history included hypertension, hypothyroidism, and coronary artery disease status-post placement of cardiac stents. Laboratory studies showed mild elevation of CPK (500). Brain MRI showed acute lacunar ischemic infarcts involving the left pons.
What do the cleft-like optically clear spaces within the foci of granulomata represent?
B. Foreign body
The optically clear spaces are characteristic of cholesterol crystals. Lipids (including cholesterol) are extracted during tissue processing for paraffin block embedding. The biconcave optically clear spaces correspond to the areas that were occupied by cholesterol from cellular breakdown and/or atheroemboli.
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