Granulomatous Lung Diseases: A Practical Approach and Review of Common Entities

Surg Pathol Clin. 2024 Jun;17(2):173-192. doi: 10.1016/j.path.2023.11.004. Epub 2023 Dec 16.


Granulomas are frequently encountered by pathologists in all types of lung specimens and arise from diverse etiologies. They should always be reported as necrotizing or non-necrotizing, with microorganism stains performed to evaluate for infection. With attention to distribution, quality (poorly vs well-formed), associated features, and correlation with clinical, radiologic, and laboratory data, the differential diagnosis for granulomatous lung disease can usually be narrowed to a clinically helpful "short list." This review describes a practical approach to pulmonary granulomas and reviews the clinicopathological aspects of common entities, including infectious (mycobacteria, fungi) and noninfectious (hypersensitivity pneumonitis, sarcoid, and vasculitis) causes.

Keywords: Granuloma; Infection; Lung; Necrotizing; Pulmonary.

Publication types

  • Review

MeSH terms

  • Alveolitis, Extrinsic Allergic / diagnosis
  • Alveolitis, Extrinsic Allergic / pathology
  • Diagnosis, Differential
  • Granuloma / diagnosis
  • Granuloma / pathology
  • Granuloma, Respiratory Tract / diagnosis
  • Granuloma, Respiratory Tract / pathology
  • Humans
  • Lung / pathology
  • Lung Diseases* / diagnosis
  • Lung Diseases* / pathology
  • Lung Diseases, Fungal / diagnosis
  • Lung Diseases, Fungal / pathology
  • Sarcoidosis, Pulmonary / diagnosis
  • Sarcoidosis, Pulmonary / pathology