Virchows Archiv

, Volume 472, Issue 1, pp 3–14 | Cite as

Granulomas in the gastrointestinal tract: deciphering the Pandora’s box

  • Ian Brown
  • Marian Priyanthi Kumarasinghe
Original Article


Granulomas are organised collection of activated histiocytes induced by a persistent antigen stimulus. A wide variety of antigens encountered by the gastrointestinal tract are of this nature and hence the resulting granulomatous inflammation represents a tissue reaction pattern. The potential causes can be broadly classified as infections or non-infectious immune reactions. There is also a group where a cause is never identified. Granulomas may be of varying morphological appearance, most commonly epithelioid, foreign body type, suppurative and necrotizing. This may provide a clue as to the aetiology; however, in most cases, the cause requires further inquiry. Pathologists may need to cut deeper levels to look for foreign material and apply special stains to look for microorganisms. Pathologists also need to be certain that the process is a true granuloma and not a mimic. The site of occurrence in the gastrointestinal tract and the clinical setting is often paramount in establishing the aetiology. For instance, infections are more likely the cause in developing countries or when there is immunosuppression. Similarly, granulomas in the stomach are usually due to Crohn’s disease; however, it is only rarely the cause of granulomas isolated to the appendix.


Crohn’s disease Sarcoidosis Chronic granulomatous disease Drug reaction Granulomatous appendicitis Gastrointestinal infection 


Compliance with ethical standards

This manuscript complies with local ethics guidelines.


No funding was required for this manuscript.

Conflict of interest

The authors state no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Deutschland 2017

Authors and Affiliations

  1. 1.Envoi PathologyBrisbaneAustralia
  2. 2.Royal Brisbane and Women’s HospitalBrisbaneAustralia
  3. 3.School of Pathology and Laboratory MedicineUniversity of Western AustraliaPerthAustralia
  4. 4.PathWest Laboratory MedicineQueen Elizabeth II Medical CentreNedlandsAustralia

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