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Necrotising granulomas are generally suggestive of an infectious aetiology (tuberculosis being the most common), whereas fibrin ring granulomas are associated with Q-fever and Epstein Barr Virus, although exceptions are possible. Every case suspicious for infectious aetiology should undergo further analysis like special staining (Ziehl-Neelsen for acid-fast rods) or molecular studies. The histomorphology should always be clinically correlated. In cases in which no infectious cause can be identified, untargeted metagenomics may represent a valid diagnostic tool that may become standard in the near future for bone marrow diagnostics. In this review, we have analysed the published data from 1956 up to today, and we report aspects of epidemiology, aetiology, diagnostic algorithms, differential diagnosis and the role of metagenomics in bone marrow biopsies with granulomas.<\/jats:p>","DOI":"10.1136\/jcp-2023-209104","type":"journal-article","created":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T13:20:17Z","timestamp":1693228817000},"page":"8-15","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Granulomas in bone marrow biopsies: clinicopathological significance and new perspectives"],"prefix":"10.1136","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3253-3787","authenticated-orcid":false,"given":"Umberto","family":"Maccio","sequence":"first","affiliation":[{"name":"Pathology and Molecular Pathology, University Hospital Zurich, Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Gianolio","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, University of Turin, Torino, Piemonte, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton V","family":"Rets","sequence":"additional","affiliation":[{"name":"Department of Hematopathology, ARUP Laboratories Inc, Salt Lake City, Utah, USA"},{"name":"Pathology, The University of Utah School of Medicine, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,8,28]]},"reference":[{"key":"2025092505001739000_77.1.8.1","first-page":"164","article-title":"The granulomatous inflammatory response. 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