Diagnosing granulomatous inflammation of the skin - A cytomorphologic approach based on evaluation of cellular reaction patterns

OBJECTIVE: To determine the applicability of recognizing cellular reaction patterns in the cytologic diagnosis of granulomatous inflammation of the sk irt. STUDY DESIGN: Prospective. Two hundred seventeen cases of clinically suspec ted granulomatous dermatitis formed the data for this study. May-Grunwald-G iemsa, Ziehl-Neelsen, periodic acid-Schiff, silver impregnation nod Gram st aining methods were employed. RESULTS: Five cytomorphologic patterns of granulomatous inflammation were i dentified: epithelioid cell granulomas (77), histiocytic granulomas (20), e pithelioid cell granulomas with polymorphous exudate (77), foreign body gra nulomas (3) and fat necrosis with granulomas (9). CONCLUSION: Correlating clinical presentation with cytomorphologic patterns Often yields diagnostic information in the workup of granulomatous inflamm ation of the skin and frequently obviates the need for biopsy.