the tissues invaded by the lepra bacilli show two types of chronic inflammatory

infiltrates; the simple inflammatory and the granulomatous. the simple inflammatory
infiltrate consists of lymphocytes with occasional histiocytes and fibrocytes localized
around blood vessels, nerves, and glands of the skin. it is banal in character and it can be
observed in many other disorders. in the indeterminanate group it can be only
histopathologic finding for many years. this simple infiltrate is found in the skin.mucous
membranes, nerves, and lymph glands.

in lepromatous lesions the granulomatous infiltrate is histiocytic, with acid-fast

bacilliand, as azulay showed, lipids, while in tuberculoid lesions it contains epithelioid-
cell tubercles with no bacilli and no lipid.

tuberculoid type. the histopathology reflects the degree of resistance on the part the
host. there is a tuberculoid granuloma consisting of groups of epithelioid cell among
which some giant cell are seen. the granuloma extends up to the epidermis, with no
clear zone in between. lympocytes are found about the periphery. acid-fast bacilli are
rarely seen. the most important specific diagnostic feature, next to finding a bacillus, is
selective destruction of nerve trunks. bacilli are frequently found with comparative ease
in sections of nerves, however, no fat is found in the epithelioid cells or elsewhere. the
infiltrate contains predominantly T helper cells.

Borderline tuberculoid(BT) the histopathology of this type is similar to that seen in the
tuberculoid variety, but there are some vacuolated cells and a few bacilli. The most
distinctive is the narrow clear subepidermal zone serating the granuloma from the
eoidermis. Some lipid may be found.

Borderline leprosy(bb) most characteristic is the diffuse spread of epithelioid cells

throughout the granuloma. In addition, lymphocytes are not aggregated in zones.
Langhans giants cell are absent, but acid-fast bacilli are typically numerous.lipid is always
present in fat-stained sections.

Borderline lepromatous(bl). Histiocytes compose most of the granuloma, although there

is a tendency for epithelioid cell to form.the histiocytes form foam cell. There is a dense
lymphocytes infiltration. Perineural involvement with lymphocyte infiltration may be
present.lipid is abundant

Lepromatous type(LL). The granulomatous lesions in this type are composed chiefly of
bacillus laden histiocytes. These are the so calledlepra cell or foamcells of Virchow. The
vacuolescontain lipids,fatty acids.and bacilli, which are either isolated or aggregated in
globi.between these foam cells are seen fibroblast and a fewlymphocutes, which be
comemore abundant as the nodules or lessionbe come older. In the skin the infiltrateis
localized in the dermis and is always separatedfrom the epidermis by a well-defined
clear grez zone.acid-fast bacilli are typically abundant. In the lepromatous type,
degenerative changes with amyloid deposits may be seen in the liver, kidney, and
spleen. The infiltrate contains predominantly suppressor cell