CORRELATION BETWEEN CLINICAL PRESENTATION AND HISTOLOGICAL PATTERNS IN GRANULOMATOUS INFLAMMATION

Abstract

Granulomatous inflammation represents a distinctive chronic inflammatory response encountered in a wide spectrum of infectious, autoimmune, and foreign-body-related disorders. Accurate correlation between clinical manifestations and histological patterns is essential for timely diagnosis and appropriate management. This prospective observational study aimed to evaluate the relationship between clinical presentation and histopathological patterns of granulomatous inflammation in tissue biopsy specimens. A total of 210 patients presenting with clinically suspected granulomatous lesions were enrolled between January 2024 and December 2025. Comprehensive clinical assessment, radiological investigations, laboratory evaluation, and tissue biopsy were performed. Histopathological examination was conducted using hematoxylin and eosin staining, while Ziehl–Neelsen stain, Periodic Acid-Schiff stain, and polymerase chain reaction (PCR) were utilized where indicated to identify infectious etiologies. Histological patterns were categorized as caseating granuloma, non-caseating granuloma, suppurative granuloma, foreign-body granuloma, and mixed granulomatous inflammation. Tuberculosis was identified as the most common etiology (48.6%), followed by sarcoidosis (16.2%), fungal infections (11.4%), foreign-body reactions (10.5%), and other causes (13.3%). Caseating granulomas demonstrated a significant association with constitutional symptoms, pulmonary involvement, elevated erythrocyte sedimentation rate, and positive PCR findings for Mycobacterium tuberculosis (p<0.001). Non-caseating granulomas were significantly associated with multisystem involvement and autoimmune manifestations (p<0.01). Histological patterns showed strong correlation with specific clinical presentations and underlying etiologies. The findings emphasize the diagnostic value of integrating clinical assessment with histopathological examination and molecular diagnostics to improve etiological identification and optimize patient management..