Spectrum of Granulomatous Lesion of Skin Among Skin Punch Biopsies

Abstract

The granulomatous reaction pattern is defined as a distinctive inflammatory pattern characterized by the presence of granulomas. Granulomas are relatively discrete collections of histiocytes or epithelioid histiocytes with variable numbers of admixed multinucleated giant cells and inflammatory cells

Material & methods -This prospective observational study was conducted in dept of pathology  at a tertiary level health care centre in rajasthan . 500 consecutive skin punch from 1^ST Aug 2019 onwards reviewd .  Clinical information and clinical diagnosis were noted .Sections stained with hematoxylin and eosin along with other necessary special stains were studied. The granulomas were subclassified into sarcoidal, tuberculoid, necrobiotic, suppurative, foreign body and miscellaneous granulomas.

Results- In consecutive 500 skin punch biopsies, 60 cases (12.00%) were diagnosed as granulomatous lesion.Granulomatous lesion was more common in male , 3^rd decade of life and Upper extremities was commonly involved  site  in granulomatous lesions.Tuberculoid was most common type of granuloma . Infectious etiology was coomonest in this spectrum , leprosy followed by tuberculosis. In leprosy  tuberculoid leprosy  was commonest followed by borderline leprosy .Among cutaneous lupus vulgaris was commonest . In  suppurative type , mycetoma was predominant.

Conclusion - Increased incidence of granulomatous lesions needs a good clinical history, a close histological examination and a clinico-pathological correlation in making a final diagnosis. Optimum communication between pathologists and clinician is utmost important with strict adherence to clinical criteria while deciding site and depth of biopsy.