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

Step 1: Recall what an Aschoff body is.
An Aschoff body (or Aschoff nodule) is the classic microscopic marker of active rheumatic carditis. It forms in the myocardium, most often around small blood vessels, during acute rheumatic fever.

Step 2: List the parts that make up an Aschoff body.
Each nodule has a core of swollen, degenerate collagen showing fibrinoid necrosis. Around this core sit plump activated macrophages called Anitschkow cells, which have a wavy, caterpillar shaped chromatin strand and are considered pathognomonic for rheumatic fever. Some of these macrophages fuse together to form multinucleated Aschoff giant cells. Lymphocytes and a few plasma cells surround the whole nodule.

Step 3: Check option 1, Anitschkow cells.
These are a core, defining component of the Aschoff body, so this feature IS seen. It is not the exception.

Step 4: Check option 3, Giant cells.
The multinucleated Aschoff giant cells form from fused Anitschkow macrophages and are a standard, well documented part of the lesion. This feature IS seen, so it is not the exception either.

Step 5: Check option 4, Fibrinoid necrosis.
The central zone of degenerate, eosinophilic collagen is fibrinoid necrosis, and it forms the core the other cells gather around. This feature IS seen.

Step 6: Check option 2, Epithelioid cells.
Epithelioid cells are macrophages that have taken on an elongated, pink, epithelium like shape, and they are the hallmark of true granulomas such as those in tuberculosis or sarcoidosis. Standard descriptions of the Aschoff body do not list epithelioid cells or granuloma formation as one of its components; the macrophages here are Anitschkow cells and Aschoff giant cells, not epithelioid cells. So this is the feature that is NOT seen.

Step 7: Final answer.
Since Anitschkow cells, giant cells and fibrinoid necrosis are all genuine parts of the Aschoff body, and epithelioid cells are not, the correct exception is epithelioid cells.
\[ \boxed{\text{Epithelioid cells}} \]

Note on the source answer key:
The original printed key for this paper marks "Giant cells" as the answer. Aschoff giant cells are a textbook-confirmed component of the Aschoff body, so that option cannot be the exception. This entry has been corrected to Epithelioid cells, which is the option with no place in the standard description of an Aschoff body.