Indian Journal of Pathology and Microbiology
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Year : 2022  |  Volume : 65  |  Issue : 5  |  Page : 125-134

Granulomatous diseases of the central nervous system: Approach to diagnosis

Department of Pathology and Lab Medicine, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India

Correspondence Address:
Sundaram Challa
Sr Consultant and Advisor, DNB Pathology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, 500 034 Telangana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpm.ijpm_1067_21

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Diagnosis of central nervous system (CNS) granulomas is challenging. The etiology may be infectious or non-infectious. The infectious causes are due to mycobacteria, fungi, parasites and rarely bacteria. The non-infectious causes include autoimmune diseases, diseases of uncertain etiology like sarcoidosis, those associated with neoplasms and reparative processes. Histologic evaluation of type of granuloma as necrotizing, non-necrotizing, fibrotic/calcific or foreign-body type, site of CNS involvement (leptomeninges/dura, brain/spinal cord) and identification of etiologic agent on histochemistry/culture/molecular methods resolves the diagnosis in a many a patient. Correlation with clinical and imaging features, risk factors and route of spread, geographical location and travel history are important. However, diagnosis may remain unresolved despite the application of all available techniques, highlighting the need for better diagnostic techniques.

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