IJCRR - 7(9), May, 2015
HISTOMORPHOLOGICAL ANALYSIS OF GRANULOMATOUS LESIONS IN A TEACHING HOSPITAL, PUDUCHERRY
Author: Sandhya Panjeta Gulia, M. Lavanya, Archana V., S. P. Arun Kumar, Kalaivani Selvi
Aims: The present study is done to study the frequency, morphology and to find out the etiology of granulomatous lesions by clinicopathologic correlation wherever possible.
Materials and methods: A retrospective analysis of 75 biopsy sections was done from August 2010 – July 2014. Diagnosis was confirmed by haematoxylin and eosine stained slides alongwith the special stains wherever required.
Results: A total of 75 cases of granulomatous lesions were identified of which 42(56.0%) were malesand 33(44.0%) were females. Granulomas due to tuberculosis accounted for the majority of the types of granulomas,i.e,46 cases(61.33%), followed
by 7 (9.33%)cases of foreign body granulomas, 5 (6.67%) fungal granulomas, 4 (5.33%) actinomycosis, granulomas of unknown etiology were - 4(5.33%) cases of granulomatous synovitis, 1(1.33%) cases of granulomatous cystitis and 5 (6.67%) cases of non infectious skin granulomas. The granulomatous skin lesions reported were mostly infectious –3(4.0%) leprosy, 2 (2.67%) lupus vulgaris, 3(4.0%)cases of actinomycosis, 1(1.33%) scrofuloderma, and fungal granulomas – 2(2.67%) subcutaneous phaeohyphomycosis 1(1.33%) maduramycosis, 1(1.33%) chromoblastomycosis, 1(1.33%)zygomycosis; 5(6.67%)non
infectious skin granulomas reported as granuloma annulare, erythema nodosum and acne agmeneta. Granulomatous lesions of the genitourinary tract constituted 8(10.67%) cases – 3 (4.0%) tuberculosis of cervix and fallopian tube, 4 (5.33%) tuberculousepididymoorchitis and scrotal abscess; 1 (1.33%) granulomatous cystitis. Tuberculous lesions affecting the gastrointestinal tract were – 3(4.0%)cases of fistula in ano, 1(1.33%) appendicular tuberculosis and 1(1.33%) case rectum.1(1.33%) case each of tuberculosis of spine and actinomycosis of tonsil was reported. AFB stain was positive in 14 (30.43%) cases of tuberculosis.
Conclusion: Tuberculosis was the commonest cause of granulomatous lesion and lymph nodes were the most common site affected. Epithelioid type of granuloma was the most common morphology.
Keywords: Epithelioid, Granuloma, Lymph nodes, Tuberculosis
Sandhya Panjeta Gulia, M. Lavanya, Archana V., S. P. Arun Kumar, Kalaivani Selvi. HISTOMORPHOLOGICAL ANALYSIS OF GRANULOMATOUS LESIONS IN A TEACHING HOSPITAL, PUDUCHERRY International Journal of Current Research and Review. 7(9), May, 78-84
1. Mariano M. Does macrophage deactivating factor play a role in the maintainence and fate of infectious granulomata? Mem. Inst. Oswaldo Cruz, 86:485-487,1991.
2. Weedon D. The granulomatous reaction pattern. In: Weedon D(ed). Skin Pathology, 2nded. Philadelphia: Churchill Livingstone;2002.pp193-220.
3. Jayashree Pawale, Rekha Purani, MH Kulkarni. A Histo- Jayashree Pawale, Rekha Purani, MH Kulkarni. A Histopathological study of Granulomatous Inflammations with an attempt to find the Aetiology. JCDR 2011;5(2):301-306.
4. Adhikari RC, Shrestha KB, Savami G. Granulomatous in- Adhikari RC, Shrestha KB, Savami G. Granulomatous inflammation: A histopathological study. Journal of Pathology of Nepal 2013;3:464-468.
5. Harish S. Permi, Jayaprakash Shetty K, Shetty K Padma, Teerthanath S, Michelle Mathias, Sunil Kumar Y, Kishan Prasad HL,Chandrika. A Histopathological Study of Granulomatous Inflammation. NUJHS 2012;2(1):15-19.
6. Vaidehi Patel, Jasmin Jasani, RajolI. Desai. The histo- Vaidehi Patel, Jasmin Jasani, RajolI. Desai. The histopathological study of granulomatous diseases in various organs to find the exact etiology of granulomas. IJBAR 2013;4(7):478-483.
7. BalA, Mohan H, Dhami GP. Infectious granulomatous dermatitis: aclinocopathologic study. Indian J Dermatol 2006;51:217-20.
8. Madeb R, Marshall J, Nativ O, Erturk E. Epididymal tuber- Madeb R, Marshall J, Nativ O, Erturk E. Epididymal tuberculosis: case report and review of the literature. Urology 2005;65(4):798.
9. Keyur N. Surati, Kaushal D. Suthar, Jainam K Shah. Isolat- Keyur N. Surati, Kaushal D. Suthar, Jainam K Shah. Isolated Tuberculous Epididymo-Orchitis: A Rare and Instructive Case Report. SEAJCRR 2012;1(3):46-50.
10. Vishnu Prasad Shenoy, Shashidhar Viswanath, Annet D Souza, Indira Bairy, Joseph Thomas. Isolated tuberculousepididymo-orchitis: an unusual presentation of tuberculosis. J Infect DevCtries 2012;6(1):92-94.
11. Krishnaswamy H, Job CK. The role of Ziehl Neelson and Flourescent stains in tissue sections in the diagnosis of tuberculosis. Indian Journal of Tuberculosis, 1974;21(10):18- 21.
12. Kunh, IIIC and Askin, F.B. Andersons Pathology, edited by J.M. Kissane, 8th Ed., Mosby Co, St. Louis, 1985, 852.
13. Ashish Kumar Chakrabarti, Krishna Kumar Halder, Shikha Das, Subrata Chakrabarti. Morphological Classification of Tuberuclous Lesions: Preliminary Observations. Ind. JTub 1994;41(139):139-142.
14. Gautam K, Pai RR, Bhat S. Granulomatous lesions of the skin. Journal of Pathology of Nepal 2011;1:81-86.
15. Billet A,Viseux V,Chaby G,Dascotte-Barbeau E,Gontier MF, Deneoux JP, Lok C. Perforating granuloma annulare with transfollicular perforation. Ann DermatolVenereol 2005;132(8-9):678-81.
16. Joana Alexandra Devesa Parente, Jose Alberto Machado Dores, Joao Manuel Pires Arhana. Generalized Perforating Granuloma Annulare: Case Report. Annal Dermatovenerol Croat 2012;20(4):260-262.
17. Sule RR, Athavale NV, Gharpuray MB. Lupus miliar- Sule RR, Athavale NV, Gharpuray MB. Lupus miliaris disseminates faciei. Ind J Dermatol Venereol Leprol 1992;58:102-4.
18. Nayak SV, Shivrudrappa AS, Mukamil AS. Role of fluorescent microscopy in detecting Mycobacterium leprae in tissue sections. Annals of diagnostic pathology 2003;7(2):78-81.
19. Chavan SS. A clinicopathlogical study of fungal lesions encountered in tissue sections (dissertation unpublished), Hubli, Karnataka university, 1998.
20. Mirza M, Sarwar M. Recurrent cutaneous actinomycosis. Pakistan Journal of Medical Sciences 2003;19:230-31.