granuloma

definition

The term "granuloma" comes from the Latin and means "nodule". This word origin explains the frequent use of the word, even if strictly speaking it is not always correct. Because originally the granuloma merely describes an inflammatory reaction of our body.

Under the microscope - not visible to the naked eye - cells react to a long-lasting inflammatory stimulus, which can not be completely eliminated. "Fresszellen" of the immune system, called phagocytes, try to destroy the harmful substances, such as bacteria, in vain. In response, a conversion of the adjacent tissue happens. Granulomas that develop in this way are often seen as "nodules" with the naked eye.

Causes of a granuloma

Causes of granulomas are very diverse and can affect almost every part of the body.

Common causes are:

  • tuberculosis
  • sarcoidosis
  • arthritis
  • Crohn's disease
  • operations
  • foreign body
  • Autoimmune diseases
  • syphilis
  • Lyme disease

In some cases, no definite cause can be determined for the occurrence of a granuloma. This includes the "granuloma annulare" of the skin. Especially young people suffer from the painless, circular and sublime nodules on the skin. Although a connection with diabetes mellitus ("diabetes") and the harmless skin appearance is suspected, but this could not be sufficiently proven.

Symptoms of a granuloma

Skin granulomas are usually asymptomatic, while granulomas in the lungs can trigger severe symptoms, such as bloody cough.

As varied as granulomas appear, so different are the symptoms. Decisive factors are certainly both localization and the causative disease of the granuloma. Possible concomitant diseases and the general state of health of the person affected also play a role.

Some granulomas, such as the aforementioned granuloma annulare of the skin, are completely harmless and do not cause any symptoms.

On the other hand, granulomas in the lungs, eg triggered by tuberculosis, can lead to serious complaints. These include bloody cough, shortness of breath and heavy weight loss.

Granulomas in the area of ​​a surgical scar, so-called "filament granulomas", can cause pain and pressure in the affected area.

Pregnant women occasionally suffer from a so-called "pyogenic granuloma". It is believed that the altered hormonal balance leads to the development of benign, blood sponge-like skin lesions. Apart from the possibly cosmetically disturbing aspect, the pyogenic granuloma causes no symptoms. Fortunately, it forms after the pregnancy back on its own.

diagnosis

Since granulomas can be seen in many diseases, the diagnosis is not always easy to make.

This can be distinguished from granulomas of the skin, such as granuloma annulare or foreign body granules. They can often be identified by your doctor by "eye diagnosis" and rarely require further diagnostic resources.

In granulomas of the internal organs, however, are often taken further steps to clarify the diagnosis.

The first step in the diagnosis is the questioning of the patient. By describing previous complaints, the doctor can first make guesses. Thus, the occurrence of a "nodule" in a fresh surgical scar can be groundbreaking.

In the subsequent physical examination, the overall condition of the person affected is recorded. If there is a suspicion of a granuloma of the lungs, the stethoscope is used to listen to the organ.

In addition to the physical examination is very often an imaging of the affected organ. With X-ray, MRI, or CT examinations, any existing granulomas can usually be detected. Final certainty, however, only provides an examination of tissue samples through the microscope. Here characteristic signs of a granuloma can be clearly identified, classified and assigned to the corresponding disease.

The correct therapy of the granuloma

For granulomas deep in the body, for example in the lungs, surgery may be necessary.

Self-explanatory, there is no uniform therapy for the granuloma. It addresses the underlying condition and can in principle take any form.

Important pillars include both surgical procedures and drug therapy.

Some granulomas, especially "skin nodules", are often only an aesthetic problem and are not in need of treatment per se. However, if sufferers suffer from the appearance of the skin, treatment can also be given here. Cryotherapy, also called "kyrotherapy", can for example help with granuloma annulare. Also various ointments, such as cortisone-containing preparations, are used.

Other granulomas, such as large foreign body granulomas in the former surgical site, may require re-surgery.

Tuberculosis granulomas of the lungs, on the other hand, must be treated with severe, complicated and sometimes very lengthy antibiotic therapy. Already the first suspicion of the sometimes highly infectious disease is enough to initiate the therapy!

Granuloma after surgery

In a postoperative granuloma, our organism reacts with a defense reaction to foreign material. Thus, for example, the thread material of a surgical wound is "encapsulated" and there is a painful, nodular swelling. In this context we speak of a foreign body or filament granuloma. Often the unpleasant nodules disappear after a few weeks by themselves, so no therapy is needed. However, if the pain is severe or there is a risk of inflammation, surgical removal of the granuloma may be required.

Granuloma in the lungs

Granulomas in the lungs are always highly suspicious of a serious disease of the organ. In principle, two causative diseases come into question: tuberculosis or sarcoidosis.

Tuberculosis, also known as "consumption, " is a bacterially transmitted disease. It is typical of a course with a slight fever, unwanted weight loss, night sweats and persistent cough with Blutbeimengungen. An x-ray of the lungs shows the typical granulomas in the lungs. As tuberculosis can be very contagious and lethal if left untreated, it is important to isolate affected individuals. So the risk of infection can be minimized. With the administration of several antibiotics over a period of up to seven months, the disease can usually be cured in the Western world. Due to continuously improved hygienic conditions and medical progress tuberculosis is almost completely contained in our latitudes. In many developing countries, but also in countries of the former Soviet Union, the disease still plays a very important role!

In contrast, sarcoidosis is not an infectious disease. From previously unexplained cause affected granulomas form throughout the body, but especially in the lungs. Cough, fatigue, joint pain, fever, skin symptoms or lymph node swelling are just a few symptoms of "chameleon-like sarcoidosis".

Granuloma on the navel

In particular, newborn infants are prone to a granuloma of the belly button. Within the first days of life, the remaining umbilical cord should fall off by itself.

However, if the navel becomes moist, for example due to urine from the diaper, the risk for a navel granuloma, popularly also called "wild meat" increases. In this nodular proliferation, the surroundings of the navel may be red, overheated, and swollen. In order to prevent a possible spread of the inflammation, affected parents should consult the pediatrician. Local antibiotic ointments can help quickly.

Granuloma on the finger

Small, annular and raised nodules on the finger may constitute a so-called granuloma annulare . The harmless papules usually do not itch or ache and are particularly like on the fingers, as well as the back of the hand and foot settled. Above all, children and young adults are affected.

In most cases, the small granulomas disappear again by themselves and do not need to be treated. Occasionally, a cold therapy or cortisone ointment trial may be used. However, surgical removal is not common.

Granuloma on the tooth

Our teeth are firmly anchored in the jawbone with their strong roots. If it comes to an inflammation of the root tip, a granuloma of the tooth can arise. Often, bacteria get into the root apex through damage to the tooth, such as tooth decay. There, the body reacts with already described defense mechanisms, so that small nodules or granulomas develop. Often they go unnoticed for a long time and lead to symptoms only at an advanced size. Affected then suffer from increased sensitivity to pain, pressure, throbbing pain to pain in the entire head area.

Often a root canal treatment is sufficient to remove the granuloma from the tooth. In some cases, however, your dentist also has to resort to root tip resection.

Granuloma on the eye

In rare cases, a granuloma can be observed on the eye. Due to their unfavorable position, they can disturb the eyesight of those affected impressively, so that granulomas in the eye area are usually removed with a small operation. Occasionally they may be confused with barley grains by sufferers, but the ophthalmologist ought to make the distinction well.

Very often they are "pyogenic granulomas". They belong to the group of Blutschwämmchen and are completely benign. Particularly unpleasant, but very rare, are granulomas of the connective or cornea.

What are Granulomas? - Pathology mini tutorial (December 2019).


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