There are a bunch of different kinds of big, multinucleated cells in pathology. Here’s a question that you can use to test your knowledge of these cells. The answer is right below the question, so if you want to see if you can answer correctly, cover up everything below the question.

What is the name of this large, multinucleated cell found in a patient with tuberculosis?
A. Osteoblast
B. Langhans giant cell
C. Foreign body giant cell
D. Touton giant cell
E. Langerhans cell

The answer is: Langhans giant cell. This cell is named after Theodor Langhans, a German pathologist. It is a specific type of giant cell in which several epithelioid (meaning the cells are big and pink, like the cells of the skin) macrophages fuse together, the nuclei forming a cute horse-shoe shape around the periphery of the cell. In the past, Langhans cells were said to be specific for tuberculosis, but they are now known to occur in many types of granulomatous diseases.

By the way, Langhans cells should not be confused with Langerhans cells, which are skin dendritic cells derived (like Langhans cells) from monocytes. Why do they have to have such similar sounding names?

Another type of giant cell with multiple nuclei is the Touton giant cell, which is seen in lipid-laden lesions like fat necrosis. Touton giant cells also consist of fused epithelioid macrophages. However, in Touton giant cells, the nuclei form a ring and are surrounded by foamy cytoplasm.

You’ll undoubtedly see a few foreign body giant cells as you go through your pathology course. These occur when the body is exposed to – you guessed it – a foreign substance (like talc or sutures). Foreign body giant cells are formed by the same process (a bunch of epithelioid macrophages fuse together). However, the nuclei are arranged centrally and in an overlapping fashion (check out the image below).