Received by the Editorial Office: 11.06.2026
Accepted for publication: 19.06.2026
Published online: 30.06.2026
UDC: 616-002.8;616-002.592
DOI: 10.26212/2227-1937.2026.59.40.001
PATHOMORPHOLOGICAL ASPECTS OF THE DIFFERENTIAL DIAGNOSIS OF TUBERCULOSIS AND OTHER GRANULOMATOUS DISEASES (LITERATURE REVIEW)
Makhneva A.F.1, Bekisheva A.N.1, Satmurzaev S.A.1, Serikbai M.K.2
1 National Scientific Center for Phthisiopulmonology, Almaty, Kazakhstan
2 Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
Introduction: granulomatous diseases represent a large heterogeneous group of disorders of various etiologies, the main tissue manifestation of which is the granuloma. The article describes historical aspects of granuloma research, reviews the mechanisms of granulomatous inflammation, and outlines the challenges of differential diagnosis of diverse clinical forms of granulomatoses depending on the etiological factor of the granuloma.
The objective of this study is to draw the attention of specialists from different fields to the diversity of granulomatous diseases, as well as to describe the main pathological features of granulomas and to define an approach to their differential diagnosis.
Materials and methods of the research: an analysis of scientific and regulatory sources from 1903 to 2025 was performed. The search for scientific publications was conducted in PubMed, Google Scholar, CyberLeninka, and other official internet resources.
Results: the literature analysis showed that granulomatous inflammation is a nonspecific morphological response to persistent infectious and non-infectious stimuli. The most informative pathomorphological features for differential diagnosis are the presence or absence of necrosis, cellular composition, type of multinucleated giant cells, degree of fibrosis, and results of special stains and molecular tests. Tuberculous granulomas are most often characterized by epithelioid-cell architecture, Langhans-type giant cells, and caseous necrosis; however, similar patterns may occur in nontuberculous mycobacterial infections, fungal diseases, sarcoidosis, autoimmune disorders, and foreign-body reactions. The main morphological types of granulomas were summarized, including necrotizing, non-necrotizing, suppurative, foreign-body, xanthogranulomatous, necrobiotic, and other variants, which helps narrow the range of clinical differential diagnoses.
Discussion: from a pathomorphological perspective, an inflammatory disease is considered “granulomatous” if the inflammatory infiltrate consists predominantly of histiocytes, including macrophages, which are currently regarded as tissue immune cells. Pathogenetically, granuloma formation is the result of a tissue response to immunogenic substances that the organism is either unable to destroy or can only degrade slowly; however, the exact mechanisms of this process are not yet fully understood. Although infectious and non-infectious granulomas are traditionally distinguished, there is now evidence that microbiological factors may be involved even in “classical” granulomatoses without the detection of an infectious pathogen.
Keywords: tuberculosis; granuloma; granulomatous inflammation; granulomatous diseases; differential diagnosis; pathomorphology; caseous necrosis; sarcoidosis; nontuberculous mycobacteria; histochemical staining; molecular diagnostics.
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