RT Journal Article
SR Electronic
T1 Causes of pulmonary granulomas: a retrospective study of 500 cases from seven countries
JF Journal of Clinical Pathology
JO J Clin Pathol
FD BMJ Publishing Group Ltd and Association of Clinical Pathologists
SP 51
OP 57
DO 10.1136/jclinpath-2011-200336
VO 65
IS 1
A1 Sanjay Mukhopadhyay
A1 Carol F Farver
A1 Laszlo T Vaszar
A1 Owen J Dempsey
A1 Helmut H Popper
A1 Haresh Mani
A1 Vera L Capelozzi
A1 Junya Fukuoka
A1 Keith M Kerr
A1 E Handan Zeren
A1 Venkateswaran K Iyer
A1 Tomonori Tanaka
A1 Ivy Narde
A1 Angheliki Nomikos
A1 Derya Gumurdulu
A1 Sudheer Arava
A1 Dani S Zander
A1 Henry D Tazelaar
YR 2012
UL http://jcp.bmj.com/content/65/1/51.abstract
AB Background The frequencies of various causes of pulmonary granulomas in pathological material are unknown, as is the influence of geographical location on aetiology. The aim of this study was to identify the causes of pulmonary granulomas in pathological specimens, to define their frequencies, and to determine whether these causes vary by geographical location.Methods 500 lung biopsies and resections containing granulomas were reviewed retrospectively by expert pulmonary pathologists from 10 institutions in seven countries. Fifty consecutive cases from each location were assigned a diagnosis based on histological features and available clinical/microbiological data.Results A specific cause was identified in 58% of cases (290/500), most commonly sarcoidosis (136, 27%) and mycobacterial or fungal infections (125, 25%). Mycobacteria were identified in 19% of cases outside the USA versus 8% within the USA. In contrast, fungi accounted for 19% cases in the USA versus 4% in other locations. Fungi were mostly detected by histology, whereas most mycobacteria were identified in cultures. In 42% of cases (210/500) an aetiology could not be determined.Conclusions Across several geographical settings, sarcoidosis and infections are the most common causes of pulmonary granulomas diagnosed in pathological specimens. Fungi are more commonly identified than mycobacteria in the USA, whereas the reverse is true in other countries. A definite aetiology cannot be demonstrated in more than a third of all cases of pulmonary granulomas, even after histological examination. These findings highlight the need to submit material for histology as well as cultures in all cases in which granulomatous disease enters the differential diagnosis.