MyMedR

Chronic granulomatous mastitis: diagnostic and therapeutic considerations

Azlina AF, Ariza Z, Arni T, Hisham AN

World J Surg, 2003 May;27(5):515-8.

PMID: 12715214 DOI: 10.1007/s00268-003-6806-1

To review the clinical presentation, histopathological features, and optimal treatment of chronic granulomatous mastitis, the authors conducted a retrospective study of 25 women admitted to a teaching hospital in Malaysia between January 1998 and December 2000 who met the required histologic criteria. The primary outcome measures were morbidity and recurrence of the disease. Thirteen patients presented with a breast mass clinically mimicking breast cancer, and 12 patients had breast induration and abscess formation. In addition, 8 of these patients had recurrent breast disease. Clinical and imaging diagnosis has often been difficult and inconclusive, so histopathology remains the optimal diagnostic tool. Of interest, 50% of patients experience recurrences, and long-term follow-up is therefore necessary. The authors concluded that, because chronic granulomatous mastitis is a rare benign breast condition that may be misdiagnosed as breast carcinoma, complete resection should be accomplished whenever possible. Steroid therapy may be an adjuvant for optimal treatment. Awareness among surgeons and pathologists should also be emphasized to avoid unnecessary misdiagnosis and treatment.

Matched MeSH terms: Granuloma/pathology

Actinomycosis of the vocal cord: a case report

Fernandez SH

Malays J Pathol, 1999 Dec;21(2):111-5.

PMID: 11068416

A 30-year-old Chinese lady was admitted for hoarseness of voice of one month's duration. Clinical examination revealed a granuloma of the left vocal cord while chest X-ray showed an opacity in the lower lobe of the right lung. The provisional clinical diagnosis was tuberculous laryngitis. A biopsy of the vocal cord lesion revealed inflamed tissue with actinomycotic colonies. Cultures and sputum smears did not reveal any tuberculous bacilli. The patient responded to a 6-week course of intravenous C-penicillin, regaining her voice on day 5 of commencement of antibiotics. A subsequent CT scan of the neck and thorax revealed multiple non-cavitating nodular lesions in both lung fields, felt to be indicative of resolving actinomycosis. She was discharged well after completion of treatment. It was felt that this is a case of primary actinomycosis of the vocal cord with probably secondary pulmonary actinomycosis.

Matched MeSH terms: Granuloma/pathology

Editorial Comment from Dr Goh to Usefulness of sonourethrography for penile abscess as a result of xanthogranulomatous granuloma in the corpus cavernosum of an adult: A case report

Goh EH

Int J Urol, 2015 Aug;22(8):792-3.

PMID: 26010227 DOI: 10.1111/iju.12825

Matched MeSH terms: Granuloma/pathology*

Oral Langerhans cell histiocytosis in Malaysian children: a 40-year experience

Jalil Ab, Hin-Lau S

Int J Paediatr Dent, 2009 Sep;19(5):349-53.

PMID: 19486369 DOI: 10.1111/j.1365-263X.2009.00985.x

BACKGROUND: Oral Langerhans cell histiocytosis is generally seen in children.
OBJECTIVE: To determine the clinicopathological features of oral LCH in Malaysian paediatric patients.
METHODS: A retrospective study was carried out to determine the clinicopathological features of Langerhans cell histiocytosis (LCH), Letterer-Siwe disease, Hand-Schuller-Christian disease, eosinophilic granuloma, and histiocytosis X occurring in the oral cavity in children, diagnosed histologically in the main oral histopathology laboratory in Malaysia from 1967 to 2007.
RESULT: There were 17 cases (eight girls and nine boys) with age ranging from 1 to 7 years. There were ten Malays, four Chinese, two Indians, and one of other ethnicity. Thirteen cases presented as gingival swellings with six of these cases accompanied with mobility of the teeth. Nine cases involved the mandible, two in the maxilla, and two cases in both the maxilla and mandible. The radiographic findings were mentioned only in nine cases with presence of bony erosion or destruction of the jaw bones. Four cases had punched-out radiolucencies of the skull. The patients also had other systemic signs and symptoms: skin lesions (n = 5), hepatosplenomegaly (n = 2), prolonged fever (n = 2), diabetes insipidus (n = 1), and exophthalmos (n = 1). Two cases were known cases of systemic LCH.
CONCLUSION: The histopathologic features of LCH are easily recognized; however, with the development of immunostaining, the use of CD1a helps in confirming the diagnosis.

Matched MeSH terms: Eosinophilic Granuloma/pathology*

Histopathology of lymph nodal tuberculosis--university hospital experience

Jayalakshmi P, Malik AK, Soo-Hoo HS

Malays J Pathol, 1994 Jun;16(1):43-7.

PMID: 16329575

Fifty-nine cases of tuberculous cervical lymphadenitis were analysed histologically. Characteristic epithelioid cell granulomas were seen in all the cases with central areas of caseation necrosis in 96.6% (57/59) of these cases. The diagnosis of tuberculosis was further established by the demonstration of acid-fast bacilli (AFB) in the tissue sections in 29 cases. These AFB, although occasional, were found more frequently within the epithelioid cells as compared with other zones of the granuloma. There was no significant association between necrosis and bacillary content. We conclude that light microscopical assessment is still a useful screening method to diagnose tuberculosis in cases of cervical lymphadenopathy.

Matched MeSH terms: Granuloma/pathology

Fulltext Erythema nodosum leprosum in Malaysians

Jayalakshmi P, Ganesapillai T, Ganesan J

Int. J. Lepr. Other Mycobact. Dis., 1995 Mar;63(1):109-11.

PMID: 7730709

Matched MeSH terms: Granuloma/pathology

Fulltext Xanthogranulomatous pyelonephritis in a Malaysian population

Koh KB

Singapore Med J, 1993 Aug;34(4):341-2.

PMID: 8266209

Xanthogranulomatous pyelonephritis is a clinico-pathological entity that is gaining awareness amongst urologists worldwide. It is an unusual chronic inflammatory lesion involving the kidney that destroys renal parenchyma and may mimic renal carcinoma. It is usually seen in middle-aged women and is associated with urinary tract infections and urinary calculi. Most reports and reviews of this condition come from the West; this study reviews the incidence and presentation of the condition in a Malaysian population.

Matched MeSH terms: Granuloma/pathology

Isolated cervical lymph node sarcoidosis: a diagnostic challenge of a case report

Lim CC, Ghauth S, Liew YT, Bakar MZBA, Narayanan PAL

Eur Arch Otorhinolaryngol, 2023 Feb;280(2):925-927.

PMID: 36592173 DOI: 10.1007/s00405-022-07808-7

BACKGROUND: Sarcoidosis is a granulomatous disorder involving multi-systemic organs. Patients invariably have lung involvement but some may have extrapulmonary disease. Rarely, cervical lymphadenopathy is the only sign without mediastinal or pulmonary abnormalities.

CASE PRESENTATION: We report a Malay male who complained of neck swelling exclusively. On imaging, multiple enlarged cervical lymph nodes deep to the sternocleidomastoid muscle were seen. An excision biopsy revealed non-caseating granulomas with epithelioid macrophages. Extensive investigations led to the diagnosis of isolated cervical lymph node sarcoidosis.

CONCLUSIONS: Sarcoidosis can present as cervical lymphadenopathy alone, without mediastinal or lung disease. The presence of epithelioid granulomas on histopathology warrants the exclusion of other granulomatous diseases. Isolated cervical lymph node sarcoidosis is only diagnosed in the presence of consistent clinical and radiological findings. In this case, close monitoring for systemic sarcoidosis is important as it can manifest later in life.

Matched MeSH terms: Granuloma/pathology

MRI findings of penile paraffinoma

Majedah S, Hanafiah M, Awang MK

BMJ Case Rep, 2014;2014.

PMID: 25406214 DOI: 10.1136/bcr-2014-205448

Matched MeSH terms: Granuloma/pathology*

Granulomatous pulmonary zygomycosis in a patient without underlying illness. Computed tomographic appearances and treatment by pneumonectomy

Majid AA, Yii NW

Chest, 1991 Aug;100(2):560-1.

PMID: 1864139

Pulmonary zygomycosis rarely occurs in the absence of underlying disease. We report a patient with granulomatous pulmonary zygomycosis without underlying disease who presented with a pulmonary mass. We present the computed tomographic findings that we believe have not been described previously. We also report the successful treatment by pneumonectomy.

Matched MeSH terms: Granuloma/pathology

Fulltext Bilateral maxillary sinus cholesterol granuloma: a rare entity

Marina MB, Gendeh BS

Med J Malaysia, 2006 Jun;61(2):226-8.

PMID: 16898317

Cholesterol granuloma in the paranasal sinuses is rare. It is more common in the mastoid antrum and temporal bone air cells in chronic middle ear disease. A case of bilateral maxillary sinus cholesterol granuloma that mimics chronic maxillary sinusitis is reported. This is the first reported case of cholesterol granuloma of the maxillary sinus in the Malaysian Literature.

Matched MeSH terms: Granuloma/pathology

Giant cell myocarditis with cardiac tamponade: a rare combination

Murty OP

Am J Forensic Med Pathol, 2008 Sep;29(3):245-8.

PMID: 18725781 DOI: 10.1097/PAF.0b013e318183d55f

Giant cell myocarditis (GCM) is a rare but fatal disease of idiopathic origin. It results in focal necrosis of myocardium. This is a case report of middle aged Malaysian Indian female who died due to cardiac tamponade due to rupture myocardium and tear in the root of aorta. On naked eye examination, it simply resembled as recent as well as old fibrotic areas of myocardial infarction. She was clinically diagnosed as a case of obstructive cardiomyopathy with atrioventricular block, and was on pace maker. There was subendocardial fibrosis and left ventricular transmural infarction in the left ventricle. On histopathology, this was diagnosed as GCM, there were widespread areas of inflammatory cellular infiltration within the myocardium with multinucleated giant cells and granulomas interspersed with lymphocytes. Microscopic field showed up to 10 multinucleated giant cells. In this case, there were focal areas at multiple locations and caused uneven thickness in the left ventricle wall. Idiopathic GCM is very rare and causation of hemopericardium is the unique feature of this case. In this case the direct link of GCM with aortitis and rupture of left ventricle wall resulting in hemopericardium is shown. This case is documented through macroscopic as well as microscopic photographs in H&E, Ziel-Nelson, and GMS staining.

Matched MeSH terms: Granuloma/pathology

Microfilarial granulomas in the spleens of wild-caught cynomolgus monkeys (Macaca fascicularis)

Narama I, Miura K, Tsuruta M, Tsuchitani M

Vet Pathol, 1985 Jul;22(4):355-62.

PMID: 4035940

Splenic nodules from 38 cynomolgus monkeys (Macaca fascicularis) which were captured in Malaysia and Indonesia were studied histologically. The lesions were characterized by well-circumscribed focal fibrosis, accumulation of eosinophils and histiocytes, hemorrhage or hemosiderosis, and loss of normal splenic architecture. Small arteries in the lesion frequently had intimal thickening and narrowing of the lumen in addition to the presence of microfilariae. Microfilariae were also seen in the extravascular area of the lesion, and were occasionally engulfed by multinucleated giant cells. The splenic lesion was thought to have been initiated by incomplete infarction caused by intimal thickening and microfilarial occupation of the small arteries.

Matched MeSH terms: Granuloma/pathology

Fasciolosis (liver fluke) of the breast in a male patient: a case report

Naresh G, Gomez PA, Salmah B, Suryati MY

Breast, 2006 Feb;15(1):103-5.

PMID: 16024249

Fasciolosis is an uncommon disease in this region, as are parasitic infections of the breast. This report describes a 56-year-old man with a previous history of liver abscess presenting with a painful breast mass. He underwent a mastectomy and is well. The pathological findings revealed chronic granulomatous mastitis with Fasciola spp. ova. The literature on this very rare condition is reviewed.

Matched MeSH terms: Granuloma/pathology

[A case of chronic schistosomiasis four years after infestation]

Pedalino M, Vercesi E, Manini C, Piras D, Di Primio OG, Vella R, et al.

Urologia, 2010 Oct-Dec;77 Suppl 17:38-41.

PMID: 21308673

Authors present a case of bilharziosis incidentally diagnosed in a patient undergoing TURB for suspected bladder cancer. The patient, who in 2005 had gone to Malaysia, had been suffering from recurrent hemorrhagic cystitis since 2007, which were treated with antibiotic therapy. In November 2009 he presented to our observation for persistent hematuria, underwent ultrasound examination, fibroscopy and TURB diagnostics for suspicious lesions. The histopathology diagnosis found granulomatous lesions with typical parasites eggs due to schistosomiasis eggs. As a consequence of that, the patient underwent medical therapy. The pathologist's role becomes nullifying not only for the diagnosis of parasitic infections but also for the exclusion or evidence of urothelial squamous neoplasia. The low incidence of this rare parasitic disease in European tourists and the presence of immigrants in our country require to spread the knowledge of these parasites and the most simple tests for early detection.

Matched MeSH terms: Granuloma/pathology

Pentastomiasis: a common finding at autopsy among Malaysian aborigines

Prathap K, Lau KS, Bolton JM

Am J Trop Med Hyg, 1969 Jan;18(1):20-7.

PMID: 5812657

Matched MeSH terms: Granuloma/pathology

Fulltext Extrapulmonary sarcoidosis: unusual cause of epiphora

Ramlee N, Ramli N, Liza-Sharmini AT

Singapore Med J, 2007 Jun;48(6):e168-70.

PMID: 17538739

Sarcoidosis is a multisystemic granulomatous disease of unknown aetiology mainly affecting African-Americans, Scandinavians, and the Irish. However, individuals of other races and ethnicities are still not immune. The clinical presentations vary widely with most patients having some respiratory problems. Though extrapulmonary sarcoidosis is no longer rare, sarcoidosis involving the lacrimal sac is an infrequently-reported problem. We present a case of sarcoidosis involving the lacrimal sac in a 42-year-old Malay woman who presented with epiphora. She was successfully treated with steroids and dacryocystorhinostomy. There was no evidence of systemic involvement. It is suggested that in an unusual presentation of sarcoidosis, a thorough search should be made for localisation of other sites, lungs in particular, even in the absence of respiratory complaints.

Matched MeSH terms: Granuloma/pathology

Calcifying fibroblastic granuloma. A case report

Taiyeb Ali TB, Siar CH

J N Z Soc Periodontol, 1997.

PMID: 9522721

Matched MeSH terms: Periapical Granuloma/pathology*

Cardiac sarcoidosis: two cases with autopsy findings

Wan Muhaizan WM, Swaminathan M, Daud MS

Malays J Pathol, 2004 Jun;26(1):59-63.

PMID: 16196153

Cardiac sarcoidosis is a disease of young adults. In most cases it presents with sudden death, arrhythmias, conduction disorders, heart failure or cardiomyopathy. The authors describe two cases of myocardial involvement by sarcoidosis that lead to death of the patients. Case one was a 26-year-old Indian man who was previously well and presented with sudden death. Autopsy showed nodules of sarcoid granuloma involving the heart, lungs and lymph nodes. Case two was a 47-year-old Indian lady who complained of reduced effort tolerance. Echocardiography showed that she had restrictive hypertrophic cardiomyopathy with heart failure. Seven months after initial presentation, she developed worsening of heart failure and died. Autopsy revealed involvement of the heart, lungs and liver by sarcoidosis.

Matched MeSH terms: Granuloma/pathology

The histopathology of human melioidosis

Wong KT, Puthucheary SD, Vadivelu J

Histopathology, 1995 Jan;26(1):51-5.

PMID: 7713483

We examined human tissues infected by Burkholderia (Pseudomonas) pseudomallei which is endemic in Malaysia to study the types of inflammation invoked, and to look for histopathological clues to its diagnosis. The lesions which varied from acute to chronic granulomatous inflammation were not tissue-specific. In five autopsy cases, the inflammation was usually a focal or diffuse, acute necrotising inflammation with varying numbers of neutrophils, macrophages, lymphocytes and 'giant cells'. The 'giant cells' probably represent giant macrophages with phagocytosed leukocytes. There were numerous gram-negative, non-acid-fast, intra- and extracellular bacilli, occurring either singly or in chains. Intracellular bacteria within macrophages and 'giant cells' were so numerous as to resemble globi. This feature has not been previously reported and may be a useful diagnostic clue in melioidosis. In 14 surgical cases biopsies showed acute inflammatory lesions that appeared no different from acute inflammation due to other causes. In many biopsies, however, the inflammation was either an acute-on-chronic inflammation with a focal granulomatous component, or was purely granulomatous in character. Bacilli were difficult to demonstrate in surgical biopsies even with the gram strain.

Matched MeSH terms: Granuloma/pathology

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