A histopathological analysis of granulomatous dermatoses – a single centre experience from Sri Lanka

M P G N S Jayawardhana,R T A W Gunewardhana,M Dissanayake,N V I Ratnatunga

doi:10.4038/jdp.v11i1.7691

M P G N S Jayawardhana, R T A W Gunewardhana + Show 2 more

Open Access

https://doi.org/10.4038/jdp.v11i1.7691

Copy DOI

Abstract

Granulomatous inflammation is a common histological pattern encountered in skin biopsies which pose a diagnostic challenge to pathologists because of overlapping histological features produced by various aetiological agents. We conducted the following study to analyze the aetiological factors and morphological patterns of granulomatous dermatoses in a cohort of Sri Lankan patients from the Central Province. This is a retrospective analysis of skin biopsies dectected to have granulomatous inflammation over a 12 year period at the Department of Pathology, Faculty of Medicine, University of Peradeniya. All biopsies had been assessed using haematoxylin and eosin stain and special stains when necessary. Of the 1547 skin biopsies received, 128 (8.3%) were recognized to have granulomatous inflammation. An infectious aetiology was present in 86.7% (111/128).The most prevalent infectious cause was leprosy, accounting for 39.8% (51/128) followed by the category differential diagnoses in 22 (17.1%) of which had an infectious differential. Cutaneous tuberculosis was the cause in 17 (13.3%) cases. In 102 cases (79.7%) necrosis was absent in the granulomata and when present most were (58%) of suppurative type; typical caseous type necrosis was present in only a few cases. In conclusion, a large majority of granulomatous inflammation is due to infectious causes and leprosy is the leading cause in this study cohort.

Highlights

IntroductionGranulomatous inflammation in skin biopsies often poses a diagnostic challenge to pathologists because many aetiological agents can produce similar histological changes
Granulomatous inflammation is a special type of chronic inflammation, which is often a result of a tissue reaction to an offending agent that is resistant to be eliminated.Granulomatous inflammation in skin biopsies often poses a diagnostic challenge to pathologists because many aetiological agents can produce similar histological changes
Granulomatous inflammation is a common histological pattern encountered in skin biopsies which pose a diagnostic challenge to pathologists because of overlapping histological features produced by various aetiological agents

Summary

Introduction

Granulomatous inflammation in skin biopsies often poses a diagnostic challenge to pathologists because many aetiological agents can produce similar histological changes. Granulomatous inflammation in the skin could be due to infectious or noninfectious causes. Common infectious causes of granulomatous skin lesions include leprosy, tuberculosis, leishmaniasis and fungal infections. Use of special stains such as Ziehl Neelsen stain for tuberculosis, Fite’s stain for leprosy, Giemsa stain for leishmaniasis and Grocott methanamine silver stain for fungal infections are often helpful in making a definitive diagnosis. In some situations, even if the organism is not visualized histochemically, a definitive diagnosis may be given based on the overall histological pattern and the clinical picture. Use of ancillary techniques such as, culture and polymerase chain reaction (PCR) may be helpful in some situations such as tuberculosis

Methods

Results

Discussion

Conclusion