Granuloma vs Granulation

Introduction

Granulation tissue and granuloma are two terms used in pathology for diseases. The new connective tissue and blood vessels formed on the surface of a wound are called granulation tissue. This is formed in response to tissue repair. On the contrary, a granuloma is a collection of macrophages surrounded by lymphocytes. Granuloma is a sign of chronic inflammation and usually occurs in the middle of necrosis.

What Is Granuloma?

The process of granulomatous inflammation forms granuloma. Inflammation is the body's response to an infection or a harmful substance. Granulomatous inflammation is a chronic inflammatory process responding to a cellular injury in response to the released mediators. It is an area of tightly clustered immune cells in the body. They are commonly seen in the lungs, though they can be seen in many other parts of the body.

What Are the Types of Granuloma?

There are many types of granulomas, which are;

• Caseating Granuloma: There are dead cells inside a caseating granuloma. Tuberculosis and other infectious diseases cause caseating granuloma.

• Non-Caseating Granuloma: Conversely, non-caseating granulomas are caused by non-infectious diseases like sarcoidosis or foreign bodies. Suh granulomas occur when a foreign body penetrates the skin, eye, or other body parts. Bee stings, spider bites, and other irritating things like silica can cause on-caseating granulomas.

• Skin Granuloma: Some types of skin granuloma can include;

  • Granuloma Annulare: This skin condition causes bumps under the skin. They are pink, yellow, or flesh-colored. It is usually ring-shaped.

  • Subcutaneous Granuloma Annulare: It is usually one lump under the skin. It usually does not hurt and is found in children.

  • Perforating Granuloma Annulare: They cause a lump that is yellow at the center. Often, clear fluid may leak from the lump before they crust over. The lumps join together to form a big lesion.

  • Linear Granuloma: These are very rare. They are usually found on the fingers in a line.

• Internal Granulomas: Granulomas develop inside the body at times. They affect the lungs, intestines, or blood vessels. Autoimmune conditions usually cause these.

What Are the Symptoms of Granuloma?

Granulomas are usually asymptomatic, or the symptoms depend on the location of the granuloma. There can be symptoms of an infection that causes the granuloma. They can include;

• Fever.

• Cough.

• Shortness of breath.

• Night sweats.

• Swollen lymph nodes.

• Headaches.

• Vision issues.

How Is Granuloma Diagnosed?

Granuloma can be diagnosed based on a physical examination. Imaging tests like X-ray, ultrasound, and CT (computed tomography) scans. However, granulomas might require a biopsy to confirm it.

How Is Granuloma Managed?

To treat granuloma, the underlying cause must be diagnosed and treated. However, the symptoms can be managed with medication. Corticosteroids can be used to reduce inflammation. If an autoimmune condition causes granuloma, immunosuppressants can be used. If some infections cause it, an anti-fungal or anti-bacterial drug can be used.

What Is Granulation?

Granulation tissue, or the process of granulation formation, is one of the critical steps in healing. Healing occurs in two ways - healing by primary intention (edges of the wound approximate quickly) and healing by secondary intention (edges of the wound do not approximate). In healing by secondary intention, granulation tissue fills in the wound. Granulation tissues are also found in chronic wounds.

How Is Granulation Tissue Formed?

The process of wound healing is different in babies and adults. In babies, healing occurs with minimal or no scarring, minimal inflammation, rapid epithelialization, high amounts of type III collagen, faster migration of fibroblasts, and less degranulation of fibroblasts. On the contrary, healing occurs in an average adult human in four stages, which are;

1. Hemostasis or scab formation.

2. Inflammatory stage.

3. Proliferative stage, in which the formation of granulation tissue occurs.

4. The remodeling stage is where scar formation occurs.

What Is the Pathophysiology of Granulation Tissue?

In several circumstances, the process of wound healing can get delayed. With chronic inflammation and granulation tissue formation, the wound healing process can be complex. It can be due to wound infection, resulting in the excessive requirement of inflammatory cells. This causes the release of reactive oxygen species, which can damage the tissue and result in biofilms forming, which delay wound healing.

What Is the Difference Between Granuloma and Granulation?

Granuloma and granulation tissues are two terms in pathological conditions. The main difference is that granulation tissue is the newly formed connective tissue and blood vessels in chronic wound healing. At the same time, the granuloma is the collection of macrophages formed in response to chronic inflammation. Granulation tissue consists of connective tissue and microscopic blood vessels, while the latter contains an organized collection of immune cells, especially macrophages. Lymphocytes usually surround them. Granulation tissue is an example of fibrovascular proliferation (a part of the tissue repair mechanism), while granuloma is a type of chronic inflammation. Granulation tissue is a vital part of chronic wound healing, while granulomas can be found as a part of many diseases. Granulation tissue is reddish in color, soft, and moist, while granuloma is cheese-like and visible in the central part of a lesion when viewed under a microscope. Granulation tissue is usually painless, while the latter causes signs of inflammation like fever, loss of appetite, and loss of function in severe cases. Granulation tissue is found at the base of a wound and helps in healing, while a granuloma surrounds and digests foreign bodies.

What Are the Similarities Between Granuloma and Granulation?

Despite their differences, they have some similarities as well. Granuloma and granulation tissue are both part of a pathologic process. Some granulation tissues can be misunderstood as granulomas. Vocal cord granuloma, pyogenic granuloma, and intubation granuloma are examples. Both conditions are formed in response to inflammation. Both conditions are preventive mechanisms against infections. Immune cells play a role in both processes.

Conclusion

Granulation tissue is a collection of connective tissue and blood vessels formed in response to tissue repair. It plays a significant role in the process of wound healing. In contrast, a granuloma is a collection of macrophages surrounded by lymphocytes. It is a type of chronic inflammation and occurs in the middle of necrosis. Granuloma is responsible for destroying foreign substances.