Initial impression: Necrotizing granulomatosis. The differential diagnosis is very extensive, including infections, connective tissue diseases, neoplasms, among others.

From the above photos, it is difficult to determine the nature of the multinucleated giant cells: histocytes? Langerhans' cells? or others?

Recommend submit three blocks from each mass, and submit the cystic wall too.

If possible, submit sterile tissue for microbiology tissue culture.