Granulomas co-occurring in malignancies – tale of etiological relationship

Objectives To determine the possible aetiopathogenesis of co-occurrence of granulomas with different malignancies in different body sites. Material and methods All cases with granuloma formation observed in draining lymph nodes or in the primary site of malignant tumors were included in the present study. After routine histopathology examination, modified Ziehl-Neelsen (ZN) staining for Mycobacteria was carried out in all the cases. Detailed history, especially of Tuberculosis, sarcoidosis, neoadjuvant chemotherapy, radiation, or previous procedure, was recorded. Results 11 out of 35 cases (31.4%) had granulomas within the primary tumor, while 24 cases out of 35 (68.6%) showed nodal granulomas. Of the 24 cases, 5 cases had nodal metastatic tumor deposits. Also, necrotizing granulomas with AFB were significantly more as compared to AFB in non-necrotizing granulomas (p value of 0.05). Of the total cases, 20% had an attributed risk factor. Three cases received neoadjuvant chemotherapy, and three had a history of systemic tuberculosis, while one case had associated Crohn’s disease. Conclusion We recommend to characterize granulomas as necrotizing/nonnecrotizing, confluent/discrete, tumor deposit present/absent; prior history of systemic/local illnesses (like SS, TB, fungal infections, IBD, etc.); prior history of CT/RT; and to follow routine ZN staining in all cases of granulomas with malignancy.