CLINICOPATHOLOGICAL PROFILE AND DIFFERENTIAL DIAGNOSIS OF ORAL GRANULOMATOUS LESIONS

Abstract

Introduction: Oral granulomatous lesions comprise a heterogeneous group of chronic inflammatory conditions microscopically characterized by the formation of granulomas. Due to their clinical similarity to various pathologies, diagnosis represents a significant challenge and may be the initial manifestation of serious systemic diseases. Objective: To analyze the clinico-pathological profile of oral granulomatous lesions, discuss the main differential diagnoses, and evaluate the role of immunohistochemistry in diagnostic accuracy. Methodology: A literature review was conducted using the PubMed database (2021–2026). Sixteen articles addressing anatomical distribution, histological features, and etiologies (infectious, immune-mediated, and systemic) of these lesions were selected. Results: Findings demonstrate that oral granulomas often mimic non-specific ulcerations or gingival enlargements. Histologically, the presence of central necrosis and the type of giant cell aid in etiological distinction. Conditions such as sarcoidosis, Crohn's disease, tuberculosis, and leishmaniasis were identified as the main differential diagnoses. Immunohistochemistry and molecular methods proved fundamental for elucidating cases inconclusive by hematoxylin-eosin staining. Discussion: The literature reinforces that the granuloma is not pathognomonic of a single disease, requiring close correlation between clinical, histopathological, and laboratory findings. The dentist acts as a sentinel agent, as the oral cavity can reveal early signs of systemic vasculitis and granulomatosis. Conclusion: Accurate diagnosis of granulomatous lesions depends on a multidisciplinary and integrated approach. Correct identification of these entities is crucial to avoid inadequate therapeutic measures and ensure early systemic management of the patient, significantly improving their prognosis.