Granulomatous inflammation is a distinctive pattern of chronic inflammation that is encountered in a limited number of infectious and non-infectious conditions. Recognisation of granulomatous pattern and finding the etiology in a biopsy specimen is very important for specific treatment and outcome of the disease. We aimed at finding the etiology of all granulomatous lesions on tissue biopsy sent for histopathogical examination. A study was done at K S Hegde Medical Academy of Nitte University, Mangalore from January 2009 to December 2010. All the cases which were diagnosed as granulomas on Hematoxylin and Eosin stained sections were selected. Special stains like Ziehl-Neelsen stain, Gomori's Methenamine silver, PAS, Fite Faraco were done whenever required. We encountered 275 granulomatous lesions in our study. The most common sites were skin and subcutaneous tissue, lymph nodes, bones and joints. The commonest cause of granulomas was tuberculosis, followed by leprosy, foreign body granulomas, fungal infections, rhinoscleroma, parasites, tumor granulomas and actinomycosis. The morphological features and special staining helped us to find the specific etiology of granulomas in 253 cases whereas it could not be determined in 22 cases even after special stains. Thus we conclude that histopathological examination of granulomatous lesions helped us to find the exact etiology of granulomas in 92 % of cases. The correlation of histopathology with polymerase chain reaction (PCR) serological tests and culture correlation would have helped to find the specific etiology in the remainder of cases.

Bilateral breast cancer is a rare event accounting for 2-5% of all breast malignancies. A second tumor in contralateral breast may be either synchronous or metachronous lesion. Synchronous bilateral invasive ductal carcinoma is known but medullary carcinoma is rare. The etiology of bilateral breast cancer is uncertain and prognosis in these cases once thought to be poor but recent data suggest a similar survival compared to unilateral disease. We report a case of triple negative synchronous bilateral medullary carcinoma in a 38-year-old female who presented with lump in both the breasts for three months. Multidetector computed tomography breast scan revealed bilateral heterogeneously enhancing well-defined lesion in both the breasts. Fine needle aspiration cytology from both the breast lump was suggestive of malignancy. Patient underwent bilateral modified radical mastectomy with axillary clearance in a single sitting. Histopathology showed synchronous bilateral medullary carcinoma of breast with ER, PR and HER- 2/ neu negativity. Patient was treated with chemoradiation and she is on regular follow up for one year without any recurrence or metastasis.

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Intracranial xanthogranulomas are rare benign tumors and occur most commonly as choroid plexus xanthogranulomas, which rarely become symptomatic. Exact etiology is still a matter of debate. We present a case of xanthogranuloma of the choroid plexus of the third ventricle, causing obstructive hydrocephalus of the lateral ventricles.