Review
A clinicopathological classification of granulomatous disorders
D Geraint James
Royal Free
Hospital School of Medicine, University of London, Rowland Hill Street,
London NW3 2PF, UK
Correspondence to: Professor James
Submitted 7 July 1999;
Accepted 22 November 1999
Granulomatous disorders comprise a large family sharing the
histological denominator of granuloma formation. A granuloma is a focal
compact collection of inflammatory cells, mononuclear cells
predominating, usually as a result of the persistence of a
non-degradable product and of active cell mediated hypersensitivity. There is a complex interplay between invading organism or prolonged antigenaemia, macrophage activity, a Th1 cell response, B cell overactivity and a vast array of biological mediators. Differential diagnosis and management demand a skilful interpretation of clinical findings and pathological evidence. They are classified into
infections, vasculitis, immunological aberration, leucocyte oxidase
deficiency, hypersensitivity, chemicals, and neoplasia.
Keywords: granuloma; Th1 cell; cytokines; neoplasia
© 2000 by The Fellowship of Postgraduate Medicine
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