Abstract
Background: Cutaneous granulomas comprise a wide spectrum of diseases that are frequently encountered. Since clinical assessment alone is insufficient in most of the cases, skin biopsies are a basic requisite in evaluating these lesions. Histopathological examination, although helpful in deciding the nature of granulomas and etiology in most of the cases, maybe noncontributory in some cases, thus requiring further ancillary tests such as microbial culture, polymerase chain reaction.
 Materials and Methods: This prospective cross sectional study enrolled 109 cases of skin biopsies after histopathological confirmation of granulomatous lesions. The specimens were received at the Department of Pathology from 14th April 2017 to 13th April 2018.
 Results: Out of 650 skin biopsies, 109 cases (16.8%) were diagnosed as granulomatous lesions on histology. Male predilection was noted and age group of 31 to 40 years was the commonest affected. Upper extremities were more commonly involved. Leprosy was the commonest etiological agent and tuberculoid granulomas were the commonest type based on their histology.
 Conclusions: Leprosy was the most common cause of cutaneous granuloma followed by Tuberculosis, fungal infection and foreign body reaction. Among the cases of leprosy, borderline tuberculoid leprosy and tuberculoid leprosy were the commonest subtype.
Highlights
Granulomas are focal chronic inflammatory response characterized by a collection of activated histiocytes and multinucleate giant cells that may or may not have a cuff of surrounding lymphocytes or show necrosis
Developed granulomas with sheets of epithelioid histiocytes and giant cells are recognized, but more subtle lesions containing a few epithelioid histiocytes still qualify as granulomatous lesions
Skin biopsies comprised of 650 cases, out of which 109 cases were histologically diagnosed as granulomatous lesions
Summary
Granulomas are focal chronic inflammatory response characterized by a collection of activated histiocytes and multinucleate giant cells that may or may not have a cuff of surrounding lymphocytes or show necrosis. Granulomas occurring in the skin have numerous etiologies and variable clinico-pathological presentations. The etiologies range from infections like tuberculosis, leprosy, fungal infections to other causes like foreign body, sarcoidosis, necrobiosis and drug reactions. Granulomas can be classified into seven types, namely Sarcoidal, Tuberculoid, Suppurative, Necrobiotic (Palisaded), Foreign body, Xanthogranuloma and Miscellaneous.[1] Many conditions described within this group may show only non-specific changes in the early or late resolving stage.[1] The histological appearances will depend on the stage of the disease process and treatment status. Histopathological examination, helpful in deciding the nature of granulomas and etiology in most of the cases, maybe noncontributory in some cases, requiring further ancillary tests such as microbial culture, polymerase chain reaction
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