Journal Article

Causes of pulmonary granulomas: a retrospective study of 500 cases from seven countries

Narde, Ivy, Arava, Sudheer, Vaszar, Laszlo T, Zander, Dani S, Fukuoka, Junya, Capelozzi, Vera L, Tazelaar, Henry D, Farver, Carol F, Dempsey, Owen J, Iyer, Venkateswaran K, Tanaka, Tomonori, Nomikos, Angheliki, Kerr, Keith M, Mukhopadhyay, Sanjay, Gumurdulu, Derya, Mani, Haresh, Zeren, E Handan, Popper, Helmut H

2012

Overview

BackgroundThe 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.Methods500 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.ResultsA 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.ConclusionsAcross 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.

• Publisher: BMJ Publishing Group Ltd and Association of Clinical Pathologists,BMJ Publishing Group,BMJ Publishing Group LTD
• Subject: Adolescent / Adult / Aged / Aged, 80 and over / Asia - epidemiology / Biological and medical sciences / Biopsy / Brazil - epidemiology / Child / Child, Preschool / Europe - epidemiology / Female / Fungal / Granuloma - epidemiology / Granuloma - etiology / Granuloma - pathology / granulomatous / Humans / immunohistochemistry / Incidence / infection / Investigative techniques, diagnostic techniques (general aspects) / Lung - pathology / lung cancer / Lung Diseases - epidemiology / Lung Diseases - etiology / Lung Diseases - pathology / Male / Medical sciences / Middle Aged / mycobacterial / Mycobacterium / Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques / pulmonary pathology / Residence Characteristics / Respiratory Tract Infections - complications / Respiratory Tract Infections - epidemiology / Respiratory Tract Infections - pathology / Retrospective Studies / Risk Factors / sarcoidosis / Sarcoidosis, Pulmonary - complications / Sarcoidosis, Pulmonary - epidemiology / Sarcoidosis, Pulmonary - pathology / United States - epidemiology / Wegener granulomatosis / Young Adult