Clinicopathological correlation in the diagnosis of granulomatous cutaneous disorders: a retrospective study (original) (raw)

Histopathological study of cutaneous granulomatous lesions

IP innovative publication pvt. ltd, 2019

Introduction: Cutaneous granulomatous lesions are very common encountered by pathologist and dermatologists. Granulomatous dermatoses can be seen in infectious as well as non-infectious conditions leading to chronic inflammation. Clinical features are overlapping, a confirmatory causative finding is essential for the management of patient as treatment varies greatly according to cause. Histopathology remains a gold standard for diagnosis as well as further subtyping of granulomatous inflammatory disorders of skin. Materials and Methods: A retrospective study of skin lesion biopsies performed for 2 years and 2 months, from November 2016 to January 2019. Clinical details were obtained from requisition forms and the cases of granulomatous lesions were diagnosed and subclassified with the help of H&E and special stains. Result: The study includes 70 cases. A predominance of male were found with M:F ratio of 1.3:1. 21 to 30 years of age group was the commonest for granulomatous lesions with 34.3% of cases. Infectious granulomatous dermatoses were far high than non-infectious ones. Leprosy remained the major etiology followed by tuberculosis of skin. Conclusion: Leprosy contribute the major cause of granulomatous dermatoses in this study. Histopathology is gold standard for diagnosis and subclassification of cutaneous granulomatous lesion with a proper history and clinical details.

Histopathological Spectrum of Cutaneous Granulomatous Lesions

2020

Background: Cutaneous granulomatous lesions often pose a diagnostic challenge to the pathologists because many of the lesions can clinically as well as morphologically mimick each other. This study was carried out in order to determine the morphology and relative frequency of these lesions and to compare the findings with previously done studies. Materials and methods: A retrospective study of the skin biopsies received in the Department of pathology, FMMC, Mangalore was carried out, and cases of cutaneous granulomatous lesions on histopathological examination and special stains were reviewed. Results: Out of the 84 cases included in the study, male preponderance was noted (71.43%), Maximum number of cases were observed in the patients of age group in the third and sixth decades. Tuberculoid granulomas were the most common type of granulomas (65.48%). Leprosy was the commonest cutaneous granulomatous lesion in the study. Conclusion: In our study, Leprosy was the most common granulom...

Histopathological Evaluation of Granulomatous Skin Lesions: A Study from North India

Medical Laboratory Journal , 2023

ABSTRACT Background and objectives: Granulomatous disorders of the skin are frequently encountered in clinical practice and require histopathological confirmation due to a considerable etiological and clinical overlap. A single histopathological pattern may be produced by many causative agents and at the same time, a single cause can present with varied histopathological patterns. The present study was performed to evaluate the histomorphological patterns of granulomas in various granulomatous skin lesions and to identify the causative agents. Methods: The study (both prospective and retrospective) was carried out in the department of pathology over 5 years. All skin biopsies were evaluated for the presence of granulomas. Detailed analysis of the histopathological pattern of granulomas was performed and categorization was made according to the type and etiology. Special stains were also used when required. A clinicopathological correlation was established with the Kappa statistic. Results: Of 1,150 skin biopsies, granulomatous skin lesions were observed in 325 cases. Histiocytic granuloma pattern was the most common subtype (55.7%). The predominant etiology of granulomatous inflammation was leprosy (93.5%), followed by cutaneous tuberculosis (2.7%). The cases of Hansen’s disease showed a maximum clinicopathological correlation (58.5%). Conclusion: Histopathological examination is the gold standard for the diagnosis and subtyping of granulomatous skin lesions. Varied morphologies of granuloma patterns were observed in our study, and infectious diseases were the causative agents in the majority of cutaneous granulomatous disorders. Keywords: Antibodies, Antinuclear, Lupus Erythematosus, Systemic, ELISA, Diagnosis.

A COMPARITIVE OVERVIEW OF HISTOPATHOLOGY OF GRANULOMATOUS LESIONS OF SKIN

Sarcoidosis. Histopathology remains a time tested tool for establishing a correct diagnosis. Clinical lesions often reveal surprising underlying pathology. Hence carrying out skin biopsies and microscopic study with routine haematoxylin and eosin (H&E) as well as special stains are must in these disorders so that the type and aetiological agent of the granuloma are properly identified. Besides, follow-up biopsies after the commencement of treatment help in evaluation of the response to therapy. Methods: 52 cases were studied over a period of 2 and a half years. Specimens were collected from the patients of skin, surgery and ENT department. A brief clinical history with age presenting symptoms and signs were recorded. Routine investigations like ESR were performed. Comparison of our study was done with others around the country. Results: Most common type of dermal granuloma was leprosy (59.6%) followed by cutaneous tuberculosis (21.1%), Foreign Body (5.7%), Granuloma Annulare (5.7%), Fungal (5.7%), Actinomycosis (1.9%) and Sarcoidosis (1.9%). Dermal granulomas were most common between the age group of 31 – 50 years. In leprosy and cutaneous tuberculosis, males were affected more as compared to females. Conclusion: Leprosywas most common than other dermal granuloma. Most common type of leprosy and tuberculosis were lepromatous leprosy and lupus vulgaris respectively.

The histopathological approach to granulomatous skin lesions

IP innovative publication pvt ltd, 2020

Introduction: Granulomatous inflammation of skin and subcutaneous tissue are common in India. An identical histological picture is produced by several causes. Present study aims at classifying infectious granulomas based on histomorphology and special staining and developing a proper approach for making a specific etiological diagnosis. Aims: To classify the granulomatous dermatitis and a simple diagnostic histological approach has been worked out based on morphology of granuloma, presence of caseous necrosis, palisading necrosis, location of the granuloma and use of special stains. Materials and Methods: A prospective study of skin biopsies with granulomatous inflammation over a period of 2 years is done. Histologically lesions were divided into six subtypes:-Tuberculoid, foreign body type, histoid, necrobiotic, suppurative and sarcoidal type. On basis of morphological features and special staining each type was further subclassified and a specific diagnosis was given. Results: Among 580 skin biopsies, 175 cases (30.17%) were of granulomatous skin lesions. On histopathological typing Tuberculoid type of granuloma was the most common type (62/175 cases, 35.43%) of which leprosy (40/62 cases, 64.52%) was the commonest etiology identified. Infections form an important etiology of granulomatous skin inflammation (120/175 cases, 68.57%) of which leprosy (82/120 cases, 68.33%) is the leading etiology in our study. Conclusion: Adequate clinical work-up in combination with pathological resources help in correctly approaching a granulomatous skin lesion and reaching a specific etiologic diagnosis.

Granulomatous dermatosis: histopathological study in a tertiary care hospital

International Journal of Research in Medical Sciences

Background: Granulomatous dermatosis shares the histological finding of granuloma formation; it is usually formed because of the persistence of a non-degradable product of active hypersensitivity. The identical histological picture may be produced by several causes, which pose a diagnostic challenge to dermatopathologist, Present study aims at classifying cutaneous granulomatous dermatosis based on the morphology and aetiology of granulomas, and to highlight its significance for specific clinical diagnosis.Methods: A retrospective analysis of skin biopsy was done and cases of cutaneous granulomatous lesions diagnosed on histopathological examination were retrieved for a period of 8 years. Clinical data and diagnosis were retrieved from hospital records. Hematoxylin and eosin stained paraffin sections were reviewed. The morphological pattern of granuloma was classified into sarcoidal, necrotizing, necrobiotic and suppurative granulomas and further aetiological evaluation for the gran...

A clinicopathological analysis of non-infectious granulomatous dermatoses

Indian Journal of Pathology and Oncology, 2021

Non-infectious granulomatous dermatoses involves a broad group of distinct reactive inflammatory conditions. They have overlapping morphological and clinical features and hence pose a diagnostic challenge to differentiate from other granulomatous dermatoses and affect the management of the patient. To study the histopathological patterns of non-infectious granulomatous dermatoses and to correlate with clinical features. It is a retrospective study for a period of 5 years at a tertiary care centre in central Karnataka.In the present study, out of 7273 skin biopsies there were 34 cases of non-infectious granulomatous dermatoses. Out of these 34 cases, granuloma annulare (50%) was the most common non-infectious granulomatous lesion followed by annular elastolytic giant cell granuloma (14%), foreign body granuloma (9%), tattoo granuloma (9%) perforating folliculitis (9%), xanthoma(6%) and xanthelasma (3%). Non-infectious granulomatous disorders of skin encompass a large group of disorde...

Non-infectious granulomatous dermatitis –a histomorphological study at a tertiary care centre

IP Archives of Cytology and Histopathology Research, 2020

Background: Non-infectious granulomatous dermatitis is a distinctive reactive inflammatory condition. They are relatively difficult to diagnosis and distinguish both clinically and histologically and most of them are associated with systemic diseases that impact on the overall prognosis. Present study aims at classifying the non-infectious granulomatous dermatitis based on morphology of granulomas, for making an accurate diagnosis. The definitive diagnosis of the granulomatous lesions of skin with identification of etiological agent is very essential for specific treatment and an appropriate desirable outcome. Aims and Objectives: To study the histomorphology of various non-infectious granulomatous dermatitis of skin and classify them, accordingly into different categories. Materials and Methods: A total of 2,690 skin biopsies received to the department of pathology over a period of five year (Jan 2011-Jan 2016) were objectively reviewed using different staining technique. Noninfectious granulomatous dermatitis were identified and classified into different types based on morphology, etiology and also compared among different age groups and genders. Results: Out of total 2,690 skin biopsies received, 314 cases exhibited granulomatous reaction pattern. Among the granulomatous lesions of skin, non-infectious granulomas were seen in 77 cases (2.8%). Among the non-infectious granulomas majority of the cases were mixed cell granuloma seen in 45 cases (58.44%), palisading granuloma in 19 cases (24.67 %), non-specific granulomas/miscellaneous in 10 cases (13 %) and epithelioid cell granuloma without necrosis granulomas in 3 cases (3.9 %). Conclusions: Knowledge of histomorphology of non-infectious granulomatous dermatitis is very important to understand and detect the early and old lesions of dermatitis. This helps in guiding and planning the therapeutic approaches of the dermatitis.

Spectrum of granulomatous lesions in a tertiary care hospital

2016

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.