Granulomatous inflammation in lymph nodes draining cancer: significant association or just coincidence- Diagnostic dilemma

Causes of granulomatous inflammation are broadly divided into infective and non infective. Infective causes Includes myocbacterial, fungal or parasitic origin. Non infective includes: Foreign body granuloma, sarcoidosis, crohn's disease. Granuloma formation seen in cancer patients may be due to previous chemotherapy or radiation therapy. However in many cases mechanism in granuloma formation and its therapeutic outcome in cancer patients remains unknown. Careful scrutiny in all cases is required where coexisting malignancy was suspected along with granuloma formation in lymph nodes draining cancers. Exact cause of granuloma formation in lymph nodes draining cancer remains unknown however immunological reaction to tumour antigens is proposed theory .These granuloma may represent impending metastasis or already existing metastasis in patients who received neoadjuvant chemoradiation.