Diagnosis of infections caused by mycobacteria, especially nontuberculous mycobacteria still represents a difficult task both in microbiology and pathology. The aim of this study was to determine the frequency of mycobacterial DNA detectable by PCR in formalin-fixed paraffin-embedded tissues showing suspicious granulomatous lesions. A total of 190 archival specimens were analyzed, using a nested PCR protocol, which amplifies a fragment of the mycobacterial 65-kDa heat-shock protein gene. Restriction fragment-length polymorphisms and sequencing were utilized to further analyze the obtained PCR products. Corresponding microbiological culture results were available for 41 cases. We detected mycobacterial DNA in 119 cases (63%), of which 71 (60%) were positive for Mycobacterium tuberculosis complex DNA and 41 (34%) for DNA of nontuberculous mycobacteria. Seven cases (6%) could not be subtyped for technical reasons. The largest group of nontuberculous mycobacteria comprised 29 cases (25% of the 119 positive cases), which were assigned to Mycobacterium fortuitum complex. Mycobacterium avium-intracellulare complex was detected in eight (7%) cases, Mycobacterium gordonae in three (2.5%) and Mycobacterium rhodesiae in a single case (0.8%). All cases of Mycobacterium tuberculosis were unequivocally identified by restriction fragment-length polymorphism analysis. In contrast, sequencing provided a gain of information over restriction fragment-length polymorphism analysis in 37% of the nontuberculous mycobacteria cases (15 of 41). Alignment studies on DNA of nontuberculous mycobacteria showed frequent sequence variations, supporting the existence of sequevars. Comparison of molecular data to available results of microbiological culture assays showed a good concordance of 83%. In conclusion, amplification and sequencing of the mycobacterial 65-kDa heat-shock protein gene is an excellent tool for species identification of mycobacteria, especially nontuberculous mycobacteria, in formalin-fixed paraffin-embedded tissues. Keywords: nontuberculous mycobacteria; NTM; 65-kDa heat-shock protein; formalin-fixed paraffin-embedded tissue; FFPE; molecular pathology; granulomatous reactionsThe diagnosis of mycobacterial infections in archival pathological specimens still represents a challenge. This is especially true for infections caused by nontuberculous mycobacteria, which frequently show nonspecific clinical symptoms. 1,2 Furthermore, microbiological culture assays can have a fairly low sensitivity in nontuberculous mycobacteria especially in the setting of cervical lymphadenitis, where detection rates are between 50 and 60%. 3 Morphologically, caseating and noncaseating granulomatous reactions can occur, which often do not allow a differentiation between various infectious etiologies and hypersensitivity reactions. Stains for acid-fast bacilli remain frequently negative. 4 In order to improve the diagnostic sensitivity, many different PCR protocols have been developed