Granulomas without foreign body giant cells in perianal fistula tissue suggest Crohn's disease.

OBJECTIVES: Histopathological characteristics of granulomas in perianal fistula of patients with Crohn's disease (CD) remain unexplored. We aimed to assess the histopathological features of granulomas in perianal fistula in CD. METHODS: A retrospective analysis was conducted by reviewing the medical and pathological records of 4430 cases who underwent perianal fistulectomy at our hospital between June 2015 and June 2023. The patients were divided into the CD group, tuberculosis (TB), and non-CD group, respectively, based on their final diangosis. The detection rate of granulomas and differential histopathological features were investigated. RESULTS: Among the 4430 patients, granulomas were identified in 41 cases, including 25 had CD, 2 had pulmonary TB, and 14 only exhibiting perianal lesions with no other comorbidities. Additionally, there were altogether 93 CD cases, resulting in a detection rate of granuloma of 26.9%, which was considerably higher than that in the non-CD group (26.9% vs 0.3%, p < 0.001). The majority (85.7%) of the perianal fistula tissues in the non-CD group contained foreign body giant cells, while this was observed in only 1 (4.0%) out of the 25 cases with CD. We proposed that granulomas in the perianal fistula in the non-CD group were mostly foreign body granulomas. Moreover, granulomas in the non-CD group were larger than that of the CD group (1135 µm vs 519 µm, p < 0.001). CONCLUSION: Most CD cases have less granulomas (≤3) and no foreign body giant cells. Ribbon-like granulomas can be seen only in CD cases.

Pulmonary Hyalinizing Granuloma: Case Report and Discussion of Diagnostic Challenges and Terminology.

Pulmonary hyalinizing granuloma (PHG) is a rare, benign condition characterized by slow-growing pulmonary nodules, often mimicking malignant lesions radiologically. Its pathogenesis is unclear but is thought to result from an exaggerated immune response to persistent antigenic stimuli. This report presents a case of a 71-year-old male with PHG, incidentally detected during imaging for acute appendicitis. Diagnostic challenges arose due to the radiological resemblance to metastatic disease, and inadequate biopsy samples. Surgical resection revealed fibrocollagenous nodules with perivascular inflammatory infiltrates. Immunohistochemistry and special stains excluded malignancy and infection. The clinical course of PHG is typically benign, with surgery being the treatment of choice for solitary lesions. However, the current terminology may be misleading, as the lesions are not true granulomas but rather fibrosing lesions. Further research is needed to clarify the underlying pathophysiology and improve diagnostic accuracy.

Granulomas in Common Variable Immunodeficiency Display Different Histopathological Features Compared to Other Granulomatous Diseases.

Granulomatous disease affects up to 20% of patients with Common Variable Immunodeficiency (CVID). Granulomas are comprised of highly activated immune cells, and emerge in response to antigenic triggers. In CVID granulomas however, the underlying pathophysiology is unclear and the specific trigger remains unknown. Granuloma formation in CVID is often compared to sarcoidosis, although clinical context and prognosis differ, suggesting a different pathogenesis. The aim of this study was to investigate if the cellular organization and proteomics of granulomas in CVID is different from other granulomatous diseases. Therefore, tissue slides from formaldehyde fixed paraffin embedded biopsies obtained from patients with CVID, sarcoidosis, tuberculosis and foreign-material induced pseudo-sarcoidosis were stained with hematoxylin and eosin and assessed for histopathological characteristics. Targeted spatial protein analysis was performed, and immune fluorescent multiplex assays were used to analyze the cellular organization. Histological analysis revealed that CVID granulomas were smaller, less circumscribed, with fewer multinucleated giant cells and minimal fibrosis compared to the other granulomatous diseases. Spatial protein analysis showed that granulomas in all diseases expressed CD68, CD11c, CD44, CD127, and PD-L1. However in CVID, reduced expression of the fibrosis-related protein fibronectin, but enrichment of CD163, CD3 and FAPα inside CVID granulomas was observed. Immunofluorescence analysis conformed a different cellular organization in CVID granulomas with increased influx of neutrophils, macrophages, T and B lymphocytes. In conclusion, granulomas in CVID display a different histological and cellular organization with increased influx of myeloid and lymphoid cells, compared to sarcoidosis, tuberculosis and pseudo-sarcoidosis, indicating a distinct pathogenesis underlying granuloma formation.

Silicone granuloma with intact breast implants: A case report.

Silicone granuloma formation is a potential complication of silicone implant rupture. Breast magnetic resonance imaging (MRI) is a useful diagnostic tool to assess implant integrity and complications; however, there can be overlap in the enhancement pattern of silicone granuloma and malignancy. We present the case of an 85 year old with suspicious axillary masses on clinical exam for which MRI was recommended. MRI demonstrated enhancing masses in the right axilla that were suspicious for malignancy and biopsy was ultimately performed. This case discusses the use of inversion recovery sequences on MRI, as well as ultrasound, to differentiate malignancy from silicone granuloma formation to prevent unnecessary biopsies.

Cholesterol Granuloma of the Lower Lip: Report of a Rare Case.

Cholesterol granuloma is the result of foreign body type response to the deposition of cholesterol crystals in the tissues. It is usually associated with chronic middle ear diseases and the middle ear and mastoid antrum are the most common location for this lesion. Histopathological findings are accumulation of cholesterol clefts, ghost cells, chronic inflammatory cells, and giant cells in a fibrous granulation tissue. Cases of cholesterol granuloma have been recently reported in the jaws but still they are few in the literature of dentistry. This article presents a unique case of cholesterol granuloma occurring in the lower lip secondary to a history of trauma.

Combined endovascular therapy and surgery for central giant cell granuloma in the temporal bone: A case report.

Background: Central giant cell granuloma (CGCG) is an uncommon, benign intraosseous lesion that most frequently occurs in the mandible and maxilla. Case Description: A 31-year-old female with a medical history of Kawasaki disease presented to our hospital complaining of a clogged right ear. Head computed tomography revealed a mass in the squamous part of the right temporal bone, with osteolytic changes and invasion of the external auditory canal, middle ear, temporomandibular joint, and mastoid air cells. Enhanced magnetic resonance imaging (MRI) showed a strong signal in the intraosseous lesion. Digital subtraction angiography revealed tumor staining from multiple feeders, including the middle meningeal, posterior deep temporal, and posterior auricular arteries. Preoperative feeder embolization using a detachable coil and Embosphere Microspheres were performed for the middle meningeal artery under general anesthesia. After the endovascular treatment, we operated on the temporal bone lesion. Postoperative enhanced MRI showed subtotal resection and residual tumor near the external auditory canal, which was left in place to prevent opening the external auditory canal. The histopathological examination showed proliferation of mononuclear cells intermingled with osteoclast-like multinucleated giant cells. A diagnosis of CGCG was made. The postoperative course was uncomplicated, and the patient was discharged on day 10 of hospitalization. Conclusion: We reported a rare case of CGCG in the temporal bone, managed by endovascular therapy and surgical resection. This combination therapy resulted in subtotal resection, preserving surrounding normal structures, such as the external auditory canal and tympanic cavity.

Neuroendocrine tumor mimicking a recalcitrant vocal fold granuloma: Appearances can be deceiving.

Posterior glottic lesions resembling granulomas unresponsive to conservative treatment should raise suspicion of a neoplastic condition. Although surgery is rarely recommended for arytenoid granulomas due to their high recurrence rate, histological evaluation is mandatory in cases of uncertain diagnosis. Clinicians should be aware that, although very rare, a laryngeal neuroendocrine tumor occurring in the posterior glottis can mimic the appearance of an idiopathic granuloma, presenting a diagnostic challenge.

Routine Histopathology of Tonsillectomy Specimens, Is It Necessary? A Prospective Observational Study.

Routine histopathology of tonsillectomy specimens is not standard practice due to cost and resource constraints. This study aimed to evaluate the prevalence of abnormal histopathologies in tonsillectomy specimens to determine the necessity of routine histopathology. A prospective observational study was conducted from January 2014 to August 2016 at a general tertiary care center after approval of Institutional Ethics Committee (IEC). Patients scheduled for tonsillectomy surgery as per the AAOHNS 2011 criteria were included in the study. All tonsillectomy specimens were sent for histopathology, and abnormal findings were documented. Statistical analysis was performed. A total of 111 patients were enrolled in this study, and 222 tonsillectomy specimens were analyzed. The most common finding was chronic tonsillitis, which justified the selection criteria in 91.89% of patients. Two patients with chronic tonsillitis were also found to have actinomycosis present on the surface without parenchymal tissue reaction. Abnormal histopathological findings were observed in 9 (8.10%) of patients, leading to further investigations or treatment in 8 cases. These abnormalities included chronic granuloma, non-Hodgkin's lymphoma, early squamous cell carcinoma, and one choristoma. Tonsillar asymmetry, recent onset of symptoms and older age were found to be significantly correlated with abnormal histopathology and malignancy. Routine histopathology in tonsillectomy specimens helps to identify important findings that may require additional treatment. Based on the study we strongly recommend routine histopathology of tonsillectomy specimen. When significant cost constraints exist, risk-based approach can be adopted. Factors such as older age, asymmetry of tonsils, referred otalgia, duration of symptoms (recent onset) and a history of addiction should be considered for proceeding with histopathology. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04888-1.

Orbital Cholesterol Granuloma : A Rare Case Report.

Cholesterol Granuloma is a rare lesion which occurs at locations like ear, peritoneum, lungs, breast etc. and formed due to interaction of Cholesterol and living tissue. But Cholesterol Granuloma occurring in the orbit is a very rare entity and so we authors present a case of Cholesterol Granuloma of the orbit.

A Novel Case of Paediatric Petrous Apex Cholesterol Granuloma.

The petrous apex is medial most part of temporal bone, which is surrounded by vital structures. Cholesterol granuloma is the most common benign lesion of the petrous apex. Symptoms are related to mass effect and/or direct involvement of closely adjacent vital structures. The lesions can be manged either by open surgery via craniotomy or through the newer endoscopic approach. Case report and review of the literature concerning cholesterol granulomas of the petrous apex and their management. The lesion was approached endoscopically trans nasal and trans sphenoid and cholesterol granuloma was excised and marsupialised. Post operative patient recovery was uneventful. Endonasal Endoscopic approach has significantly lower complication rate when compared to open approaches. Petrous apex lesions are rare and need a multidisciplinary team approach for optimal management. By endoscopic approach one can remove lesion or marsupialize the sac with natural drainage into sinus and result in better prognosis and minimal chance of recurrence. Endonasal procedure has also lower complication rates and shorter median follow-up than open approaches.

BAFF-associated granulomatous lung disease in a patient with GATA2 deficiency.

A patient with GATA2 deficiency developed corticosteroid-responsive sterile granulomatous lung disease despite monocytopenia. The presence of B-lymphopenia, autoimmunity, an elevated level of serum B-cell-activating factor, and pulmonary plasma cell infiltration, which together suggested an underlying mechanism similar to that of combined variable immunodeficiency lung disease.

Peripheral Giant Cell Granuloma - A Case Report of a 9-Year-Old Male Child.

"Giant cell epulis" nowadays known as "peripheral giant cell granuloma" (PGCG) is a soft tissue benign overgrowth seen in the oral cavity. It is a type of reactive exophytic lesion of gingiva whose etiology is still not specific. Peripheral giant cell lesion may not be a life-threatening condition but when the size of the lesion exceeds a certain limit it hampers day-to-day activity of the oral cavity. It may also have a psychological effect on the person. We report a case of a 9-year-old boy with a large peripheral giant cell lesion, which interfered with his chewing habits. The purpose of reporting this case is to create awareness about peripheral giant cell lesions and its treatment modality. Under general anesthesia, the soft tissue growth was excised using an electrocautery that was approximately 5.3 cm in length and 2 cm in width. The patient was reviewed on the 7th day (postoperative), followed by 10, 20, and 30 days. After this, the patient was reviewed monthly for 6 months. Healing was successful without any events. Proper history taking is mandatory before coming to a final diagnosis. Various diagnostic aids help in coming to a confirmatory diagnosis. Complete surgical excision and elimination of any irritant factor along with clearing of the base of the lesion is mandatory to avoid recurrence rate and have a complete uneventful healing.

An Isolated Cutaneous Nodule: Dupilumab-Induced Sarcoid-Like Reaction.

Dupilumab has recently been recognized as a potential trigger for drug-induced sarcoid-like reactions (DISR). This phenomenon may become more prevalent with increased utilization of this drug for a multitude of skin and atopic conditions. We present a unique case of a patient developing a solitary cutaneous nodule on her left forearm following dupilumab initiation. Histopathology and MRI studies confirmed that this nodule had features of a sarcoid granuloma. Six months following dupilumab discontinuation, the patient's granuloma resolved. This case demonstrates that dupilumab can induce cutaneous-limited autoimmune disease and stresses the importance of prompt recognition of dupilumab-induced sarcoid-like reactions for appropriate diagnosis and treatment.

Sublingual Traumatic Ulceration in a Nine-Year-Old Child: A Case Report.

Sublingual traumatic ulceration is a rare inflammatory disorder characterized by benign, ulcerative, and granulomatous processes and caused by repetitive trauma from mandibular anterior incisors to the mucosa of the ventral surface of the tongue. Historically known as the Riga-Fede disease, sublingual ulceration is associated with natal and neonatal teeth in newborns and infants. Even cases have been reported of Riga-Fede disease associated with the eruption of mandibular primary incisors. Commonly, the treatment for Riga-Fede disease is the smoothening of incisal edges or the extraction of offending teeth. If this disorder is not diagnosed early and proper treatment is not provided, it may result in dehydration, nutritional deficiency, and deformity of the tongue. Here, we present a case of sublingual traumatic ulceration in a nine-year-old child, which is a rare occurrence. As the associated teeth in our case were permanent mandibular incisors, we opted for useful instructions to avoid repetitive trauma and medicinal treatment to resolve the lesion rather than extraction of teeth. We opted for topical corticosteroids with multivitamin supplements, which proved effective, and we achieved a positive outcome with complete resolution of the lesion following treatment.