Granulomatous diseases

Histologically, granulomas are focal, rounded collections of histiocytes, often with giant cells as in tuberculosis. Clinically, however, 'granuloma' includes many chronic inflammatory' conditions (e.g. apical granuloma, Wegener's granuloma, etc.) which lack granulomas histologically.

Tuberculosis

Aetiology Tuberculous oral ulceration, secondary to chest infection, occasionally seen in AIDS patients, otherwise very rare. Mycobacteria arc rarely found in oral lesions but arc present in sputum.

Microscopy Deep ulcer with overhanging edges (usually on dorsum of tongue) with tuberculous granulomas and Langhans' giant cells (Figs 248 & 249).

Fungal infections (deep mycoses)

Immunosuppressed and AIDS patients are susceptible to many fungal infections such as histoplasmosis or aspergillosis. Other such infections are common in South America. Many produce oral lesions at some stage.

Microscopy Several of the mycoses (not candidosis) produce granulomatous reactions more or less resembling tuberculosis (Fig. 250). Tissue forms of the fungus, usually spore forms or hyphac, may sometimes be detectable, but usually only with special stains. Histoplasma capsulatum is unusual in that the spores, with characteristic halo-like capsule, may be seen in H & E stained sections (Fig. 251).

Fig. 248 Tuberculous ulcer of lip edge.

Fig. 249 Tuberculous granuloma beneath ulcer.

Fig. 248 Tuberculous ulcer of lip edge.

Fig. 249 Tuberculous granuloma beneath ulcer.

fig 250 Histoplasmosis of the tongue: Langhans' giant cell and granuloma.

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