Spectrum of granulomatous lesions in a tertiary care hospital

Introduction: Granulomatous lesions comprise a large family of disorders sharing a common histological denominator of formation of granulomas, either immune or non-immune category with tuberculosis being the most common cause in our country. Aims and Objectives: To study the spectrum of granulomatous lesions in a tertiary care hospital, to categorise tuberculous versus non-tuberculous causes and to study the incidence of acid-fast bacilli (AFB) positivity in granulomatous lesions. Material and Methods: This is a retrospective descriptive study of all granulomatous lesions reported over a period of two years from November 2013 to November 2015. All cytology and histopathology cases reported as granulomatous inflammation during this period were taken for this study and, while granulomatous lesions of the skin (Hansens disease) were excluded. Histological findings and acid-fast bacilli staining were then analyzed. Result: In this study, majority of the patients were of 51-60 year age group (30%) followed by 41-50 years (21.42%). The majority of the patients were male (64.28%) followed by females (35.72%). Out of a total of 70 patients, 42.86% (30 cases) showed features of tuberculosis, out of which 7 were positive for Acid-fast bacilli by Ziehl Neelsen stain, and 22 were negative. Out of the 30 cases, 22 showed extensive caseation necrosis. One case of tuberculous lymphadenitis was associated with metastatic ductal carcinomatous deposits in axillary lymph node. 41.42 % showed chronic granulomatous inflammation, 4.29% showed foreign body granulomatous reaction (2 cases of fungal infection and 1 case of gossypiboma). 2.86% showed xanthogranuloma, 1.42% showed Lipogranuloma (chalazion). Conclusion: Tuberculosis is considered first in differential diagnosis of granulomatous diseases, especially in the countries with a high incidence of tuberculosis, but detailed analysis of clinical and ancillary studies are essential to rule out other granulomatous lesions. Exact diagnosis is important for treatment purpose as a lot of granulomatous lesions are treated as tuberculosis on an empirical basis.