Granulomas are a pathologic feature of Crohn’s disease (CD). However, they only occur in a subset of individuals. Although well-formed granulomas were associated with an aggressive nature, it was uncertain if microgranulomas had a similar pattern. For a study, researchers sought to determine the prevalence of microgranulomas in pediatric CD and compare the clinical course of patients with and without granulomatous inflammation.

They conducted a single-center, retrospective research of juvenile CD patients who had been followed for at least three years. A gastrointestinal pathologist meticulously re-examined the first diagnostic samples. The criteria of a priori granuloma (10+ histiocytes) and microgranuloma (4–9 histiocytes) were utilized. Kaplan-Meier survival plots were used to analyze the outcomes of hospitalization, the development of complex disease behavior, perianal disease, and anti-tumor necrosis factor (anti-TNF) medication.

The research comprised 138 patients who were followed for an average of 4.6 years. Granulomas were found in 38 of 138 participants (27.5%), with an additional 38 subjects (27.5%) having at least one microgranuloma (in the absence of granulomas). When compared to those without granulomatous inflammation, escalation to anti-TNF medication was greater in CD with granulomas (P=0.001) and microgranulomas (P=0.0001).

Microgranulomas affected a high proportion of pediatric CD patients (in the absence of well-defined granulomas). Children with CD who had microgranulomas were more likely to be started on anti-TNF medication than those who do not have granulomatous inflammation (and at a similar rate to those with granulomas). Therefore, pathologists should have a low threshold for reporting microgranulomas since they may aid in disease prediction.