Granulomatous Diseases

1.8.1 Tell us about the different types of Langerhans Cell Histiocytosis including typical age affected and common presentations of each type. What are the head and neck manifestations? How are patients treated? 

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1.8.2 Review symptoms, diagnosis, and treatment of sarcoidosis. 

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deShazo RD, O'Brien MM, Justice WK, Pitcock J. Diagnostic criteria for sarcoidosis of the sinuses. J Allergy Clin Immunol. 1999 May;103(5 Pt 1):789-9. PMID:10329811 

1.8.3 Contrast and compare head and neck manifestations and treatment of tuberculosis vs. nontuberculous mycobacterial infections. What is the appropriate evaluation and management of a pediatric patient with an atypical mycobacterial neck infection? Discuss the role of antibiotics and surgical interventions such as excision and curettage. 

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1.8.4 Tell us about midline lethal granuloma and the-cocaine induced midline granulomas. 

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1.8.5 What are the granulomatous diseases that are associated with animal exposure? 

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1.8.6 Osler once said, "If you know syphilis, you know medicine." Tell us what you know about the stages of syphilis and the head and neck manifestations of this disease process. How is syphilis diagnosed and treated?

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1.8.7 Discuss fungal granulomatous diseases of the head and neck.

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1.8.8 What are the specific locations in the larynx where the different granulomatous diseases manifest. Discuss the management of laryngeal granulomatous diseases.

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1.8.9 Why are intubation granuloma, reparative granuloma, and pyogenic granuloma not granulomatous diseases? Tell us about each and their treatment.

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1.8.10 Describe sinonasal disease in patients with sarcoidosis. Are there special concerns regarding surgical management of sinus disease in sarcoid patients?

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Long CM, Smith TL, Loehrl TA, Komorowski RA, Toohill RJ. Sinonasal disease in patients with sarcoidosis. Am J Rhinol. 2001 May-Jun;15(3):211-5. PMID:11453511

Kay DJ, Har-El G. The role of endoscopic sinus surgery in chronic sinonasal sarcoidosis. Am J Rhinol. 2001 Jul-Aug;15(4):249-5. PMID:11554657

1.8.11 You perform a biopsy of a neck mass. The pathology report shows noncaseating granulomas. What is your differential diagnosis?

• • Granuloma has a large differential

  • Most etiologies are infectious, see table below from 1996: Granulomatous Infections: Etiology and Classification

• • Granulomas are one manifestation of chronic inflammation

    • Granulomas can be caseating or noncaseating, see link

  • Noncaseating granulomas (trying to limit to head and neck) may be from

    • Foreign body reaction, as from silicone or Beryllium

    • Sarcoidosis, see the differential for Sarcoidosis from eMedicine link here

    • Orofacial Granulomatosis (Melkersson-Rosenthal Syndrome)

    • Cat scratch disease

    • Fungal infection, Histoplasmosis

    • Even mycobacterial infection

    • Lymphoma

    • Leprosy

    • Small cell and non-small cell lung cancer

    • Eosinophilic granuloma

Also, see

• • eMedicine: Granulomatous Diseases of the Head and Neck

  • 2014: Granulomatous Disease in the Head and Neck: Developing a Differential Diagnosis

  • UTMB: Granulomatous disease of the head and neck