Granuloma

What is a granuloma:
A granuloma is a tiny cluster of white blood cells and other tissue that
can be found in the lungs, head, skin or other parts of the body in some
people. Granulomas are not cancerous. They form as a reaction to
infections, inflammation, irritants or foreign objects.

types of granulomas:
Foreign body granulomas
This type of granuloma develops when the body's immune system
reacts to an object or irritant that penetrates the skin, eye or body.
They can form in reaction to:

 foreign objects such as splinters

 bee stings and spider bites where parts of the insect's body are
left behind
 substances that irritate the person, including red tattoo ink and
the silica in talcum powder
 injections, including corticosteroids and dermal fillers, such as
collagen
 surgical stitches

Skin granulomas
Several types of granuloma can affect the skin.

The most common is granuloma annulare, a

harmless skin condition that causes raised pink or
flesh-colored bumps under the skin.
The bumps are usually found over bony areas, like the elbow, and may
have a distinctive ring shape. They often affect hands and arms, but can
also affect legs, feet, trunk or face.

What causes granulomas?

Granulomas form in response to chronic inflammation.

Accordingly, the most common cause of granulomas are infections. Caseating

granulomas are formed by infections, such as tuberculosis and fungal infections.

Noncaseating granulomas may be formed by an inflammatory condition

(e.g., sarcoidosis and Crohn disease), vasculitis, and exposure to foreign objects.

Formation of granulomas is characteristic of certain diseases. Most commonly,

1) chronic granulomatous disease (CGD),
2) inherited genetic mutation reduces the ability of white blood cells to kill certain
bacteria and fungi, like Staphylococcus aureus and Aspergillus.
Granulomas form when immune cells clump together and create tiny
nodules at the site of the infection or inflammation.

A granuloma is the body's way:

 to contain an area of bacterial, viral or fungal infection so it can try

to keep it from spreading; or
 to isolate irritants or foreign objects

Granulomas most frequently form in the lungs, but can also be found in
the liver, the eye or under the skin.

They can be felt as a lump or can show up on x-rays and during other
investigations.

Granulomatous inflammation formation :

 o Pathogenesis of granuloma formation.
o Resident cells initiate an immune response after exposure to
antigen.
o These include mast cells, resident histiocytes,
and γδT cells, which produce tumor necrosis
factor (TNF) and interferon (IFN)-γ to recruit
circulating monocytes and neutrophils.
o Activated antigen-loaded dendritic cells
migrate to peripheral lymph nodes via
lymphatic channels (not shown) and produce
interleukin (IL)-12.
o Under the influence of IL-12, naïve CD4 + cells differentiate into T
helper (Th1) cells and expand with IL-2, which promotes T-cell
survival and proliferation.
o The activated Th1 CD4 + cells preferentially traffic to sites where
the microcirculation has been altered by TNF and other
chemokines produced by resident cells.
o If the source of antigen is not eradicated, chronic inflammation
persists.
o The Th1 CD4 + T cells and activated macrophages lead to the
production of IFN-γ and TNF, which results in further maturation
of macrophages and ultimately the formation of granulomas.
o Hypothetically in WG, chronic T-cell activation by antigen-matured
dendritic cells may finally promote the development of B cells that
secrete antigen specific antineutrophil cytoplasmic antibodies
(ANCA).  

How are granulomas diagnosed?

Diagnosing granulomas begins with a medical examination, including a history of
the individual’s present illness, the individual’s medical history, and
the conduction of a thorough physical examination.
Afterwards, imaging may be conducted, such as X-rays or CT scans.
Scans may show numerous minute granulomas in an organ such as the
lungs. These can help diagnose the underlying cause .

If a mass is present in the initial imaging, biopsy of the suspected tissue will
typically be conducted to confirm a diagnosis and determine if the granuloma is
non-caseating or caseating.
If caseating granulomas are discovered in the lungs, the individual may be tested
for tuberculosis (TB) by either a blood or a skin test.
With skin granulomas, your doctor may only need to do a physical
examination to confirm a diagnosis.

Other types of blood tests may also be performed to diagnose the underlying cause
of the granulomas, such as an antineutrophil cytoplasmic antibody (ANCA) test for
diagnosing Granulomatosis with Polyangiitis.

How are granulomas treated?

Some people with a granuloma need treatment, buts others may not. It
depends on the type of granuloma.

For example, people with chronic granulomatous disease may be given

antibiotics and other treatments to try to prevent further infections.

More than half of all people affected by sarcoidosis recover without

treatment within 3 years.

Most forms of granuloma annulare get better without treatment.