Ali Amjad S, Abdullah Bashar H
Department of Oral Diagnostic Sciences, College of Dentistry, University of Baghdad, Baghdad 10071, Iraq.
Diagnostics (Basel). 2025 Aug 16;15(16):2055. doi: 10.3390/diagnostics15162055.
: Granulomatous lesions of the head and neck arise from diverse infectious and non-infectious causes, with tuberculosis (TB) being a predominant etiology. This retrospective study analyzed 42 cases from the archives of university of Baghdad, College of Dentistry (1975-2025). This study aimed to characterize the clinicopathological features of these lesions and to assess the diagnostic performance of histochemical stains and real-time PCR in identifying infectious etiologies-particularly -in formalin-fixed, paraffin-embedded (FFPE) tissue samples. : Definitive diagnoses included 25 TB cases confirmed through clinical, microbiological, and therapeutic follow-up at the Baghdad Tuberculosis Institute, and 17 non-TB cases classified by predefined clinicopathological criteria supported by relevant clinical data. Zieh-Neelsen (ZN), Periodic acid-Schiff (PAS), and Grocott methenamine silver (GMS) stains were employed to identify acid-fast bacilli and fungal organisms. Statistical analysis was performed using SPSS version 26, with significance set at ≤ 0.05. : The mean patient age was 36.28 years (SD = 20.6), with a female predominance (59.5%). Necrotizing granulomas were identified in 69% of cases and were strongly associated with tuberculosis, which was detected in 59.5% of specimens. ZN staining showed a sensitivity of 16.7% for tuberculosis, while PCR sensitivity was highly dependent on sample age. The detection rate was 33.3% in samples archived for less than 10 years but only 10% in older samples, resulting in an overall sensitivity of 24.0% for tuberculous cases. Langhans-type giant cells were significantly more frequent in necrotizing granulomas and strongly associated with tuberculosis infection ( = 0.001). Fungal infections, predominantly aspergillosis, were confirmed by PAS and GMS in 11.9% and 9.5% of cases, respectively, and were confined to non-necrotizing granulomas. The mandible was the most commonly affected site, and soft tissue lesions were significantly associated with necrotizing granulomas ( = 0.004). : These findings underscore the complementary role of histopathology, histochemical stains, and molecular diagnostics in improving the evaluation and diagnosis of granulomatous inflammation in head and neck lesions.
头颈部的肉芽肿性病变由多种感染性和非感染性原因引起，其中结核病（TB）是主要病因。这项回顾性研究分析了巴格达大学牙科学院档案中的42例病例（1975年至2025年）。本研究旨在描述这些病变的临床病理特征，并评估组织化学染色和实时聚合酶链反应（PCR）在识别感染性病因方面的诊断性能，特别是在福尔马林固定、石蜡包埋（FFPE）组织样本中的诊断性能。：确诊诊断包括通过巴格达结核病研究所的临床、微生物学和治疗随访确诊的25例结核病病例，以及根据预定义的临床病理标准并结合相关临床数据分类的17例非结核病病例。采用齐-尼（ZN）染色、过碘酸-希夫（PAS）染色和格罗科特甲胺银（GMS）染色来识别抗酸杆菌和真菌。使用SPSS 26版进行统计分析，显著性设定为≤0.05。：患者的平均年龄为36.28岁（标准差=20.6），女性占多数（59.5%）。69%的病例中发现坏死性肉芽肿，且与结核病密切相关，59.5%的标本检测到结核病。ZN染色对结核病的敏感性为16.7%，而PCR敏感性高度依赖于样本保存时间。保存时间少于10年的样本检测率为33.3%，而保存时间较长的样本仅为10%，结核病病例的总体敏感性为24.0%。朗汉斯型巨细胞在坏死性肉芽肿中明显更常见，且与结核感染密切相关（P=0.001）。真菌感染主要为曲霉病，分别在11.9%和9.5%的病例中通过PAS和GMS染色得到证实，且局限于非坏死性肉芽肿。下颌骨是最常受累的部位，软组织病变与坏死性肉芽肿显著相关（P=0.004）。：这些发现强调了组织病理学、组织化学染色和分子诊断在改善头颈部病变肉芽肿性炎症评估和诊断中的互补作用。
