Postgrad Med J 76:457-465 doi:10.1136/pmj.76.898.457
  • Review

A clinicopathological classification of granulomatous disorders

  1. D Geraint James
  1. Royal Free Hospital School of Medicine, University of London, Rowland Hill Street, London NW3 2PF, UK
  1. Professor James
  • Received 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.