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granuloma
Classification:
There are two types of granulomas:
1) foreign body granulomas
2) immune granulomas
a) presence of indigestible particles from organisms
b) T-cell mediated immunity
Etiology:
diseases associated with the formation of granulomas:
1) sarcoidosis
2) tuberculosis: granulomas may have a central area of necrosis (caseous necrosis) rare in other granulomatous diseases
3) fungal infections
4) brucellosis
5) tularemia
6) syphilis
7) leprosy
8) Hodgkin's disease
9) drug reactions (hypersensitivity pneumonitis)
10) vasculitis - granulomatous arteritis
11) cat scratch disease
12) lymphogranuloma inguinale
13) infectious mononucleosis (Epstein Barr virus)
14) carcinomas
15) occupational exposure
a) berylliosis
b) silicosis
c) zirconium exposure
d) talcosis
e) Bakelite exposure
16) pharmaceutical agents
a) methotrexate
b) cromolyn
17) foreign body granulomas
a) cotton fibers (IV drug use)
b) talc
c) mineral oil
18) hypogammaglobulinemia
Pathology:
- microscopic aggregation of macrophages transformed into epithelium-like cells (epithelioid histiocytes) surrounded by lymphocytes & occasional plasma cells
- a focal area of granulomatous inflammation
- epithelioid histiocytes may fuse to form giant cells
- older granulomas develop an enclosing rim of fibroblasts
- most diseases that produce granulomas also produce hilar lymphadenopathy
Related
granulomatous disease
Specific
actinic granuloma
giant cell epulis
gumma
melasma (chloasma, mask of pregnancy)
xanthogranuloma
General
abnormal morphologic structure (malformation)
References
- Internal Medicine, J Stein (ed), Little, Brown & Co, Boston, 1983,
pg 1091
- Cotran et al Robbins Pathologic Basis of Disease,
5th ed. W.B. Saunders Co, Philadelphia, PA 1994 pg 82
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 761