Chronic Granulomatous Lymphadenitis

Chronic Granulomatous Lymphadenitis

C. Cameron Yin, MD, PhD

H&E-stained section demonstrates necrotizing chronic granulomatous lymphadenitis. The granulomas are composed of central necrosis surrounded by epithelioid histiocytes and inflammatory cells.

Chronic granulomatous inflammation is formed by a stepwise series of events as listed in this image.



  • Chronic granulomatous inflammation of lymph node


Infectious Agents

  • CGL is usually caused by a wide variety of infectious agents including

    • Mycobacteria, bacteria, viruses, fungi, and parasites

    • Chlamydia, spirochetes

  • Infectious CGL can be classified into 3 subgroups based on its etiology

    • Infections caused by well-recognized organisms

      • Mycobacterium tuberculosis is most common

    • Infections caused by organisms identified by molecular methods but not readily isolated by conventional microbiological methods

    • Infectious etiology strongly suspected but causal organisms not yet identified

  • Advances in molecular diagnostic technology have allowed identification of more organisms

    • Previously, cause of these infections was unknown

Other Causes

  • There are a large number of other causes of CGL

    • Foreign bodies or other irritants/antigens

    • Autoimmune diseases/mechanisms

    • Sarcoidosis

    • Granulomas can occur in patients with lymphoma

    • Granulomas also can occur in lymph nodes draining nonhematopoietic neoplasms


  • CGL is result of complex interplay of events

    • Invading agent (e.g., bacteria) results in recruitment of monocytes-macrophages from circulation

    • Monocytes-macrophages engulf bacteria

      • Bacteria multiply within macrophages

    • Macrophages process bacteria and present them to activated T-helper cells

    • Release of cytokines and chemokines by activated macrophages and T-helper cells; causes cell lysis

    • Macrophages mature into epithelioid cells or fuse to form multinucleated giant cells

    • Granulomas form when bacteria and debris are surrounded by macrophages and inflammatory cells



  • Age

    • CGL can occur in any age group

  • Gender

    • No apparent gender predilection


  • Lymph node group involved depends in part on

    • Initiating agent

    • 1st route of entry into body

  • Cervical lymph nodes are most common

  • Any lymph node or lymph node group can be affected


  • Lymphadenopathy, localized or generalized

  • May be accompanied by systemic symptoms

Laboratory Tests

  • Microbiologic culture and identification by biochemical methods

  • Serologic tests are helpful in

    • Identifying infectious agents

    • Determining timing of exposure to organism

  • PCR detects infectious agents with high sensitivity

    • Identify infectious agents in diseases that were previously of unknown etiology


  • Depends on specific etiology and therapy

  • Benign clinical course with good prognosis


General Features

  • Well-defined lymph nodes

    • Increased in number &/or size

  • CT scans are 1st-line imaging tool to evaluate lymphadenopathy

  • Standard x-rays and CT scans show consolidation

    • ± central necrosis


General Features

  • Cut surface can appear nodular (if macrogranulomas)

  • Yellow areas can be seen corresponding to necrotic foci


Histologic Features

  • CGL may be classified as immune or foreign body type

  • Immune type

    • Caused by insoluble particles (e.g., bacteria) that elicit cell-mediated immune response

    • Can be further divided into caseating and noncaseating granulomas

    • Caseating granulomas

      • Composed of central areas of coagulative necrosis

      • Peripheral concentric layers of epithelioid cells, Langhans giant cells, lymphocytes, and fibroblasts

      • Organisms may be identified using special stains

      • M. tuberculosis is most common cause of caseating granulomas

    • Noncaseating granulomas

      • Composed of collection of epithelioid cells, Langhans giant cells, lymphocytes, and histiocytes

    • Eosinophils can occur in granulomas caused by parasites

    • Acute inflammatory cells common in granulomas caused by fungi

  • Foreign body type

    • Caused by inert substances such as talc, suture, and lipid

    • Granulomas composed of epithelioid cells, Langhans giant cells, lymphocytes, and histiocytes surrounding foreign body

      • No caseation occurs usually

    • Can often detect foreign body using polarized light

Cytologic Features

  • Epithelioid histiocytes and inflammatory cells can be identified in fine-needle aspiration smears

  • In some cases, granulomas can be recognized

  • Special stains can be performed on smears



  • Mycobacterial antigens can be detected and typed with monoclonal antibodies conjugated to peroxidase


  • Highly sensitive and has identified infectious agents in diseases that were previously of unknown etiology

Special Stains

  • Acid-fast bacilli can be demonstrated by Ziehl-Neelsen, Kinyoun, or Fite-Faraco stain

  • Fungal-like organisms can be highlighted with periodic acid-Schiff (PAS) or Grocott methenamine silver stain

  • Gram-positive and gram-negative organisms can be seen with Gram stain

  • Parasites can be highlighted by Giemsa stain


Mycobacterium tuberculosis Lymphadenitis

Jul 8, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Chronic Granulomatous Lymphadenitis
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