<prompt> Which of the following is most characteristics of granulomaEpitheliod cellGiant cellsFibroblastEndothelial cells  <response>: ref Robbins 9e p97-78 a granuloma is an organized collection of macrophages. In medical practice, doctors occasionally use the term granuloma in its more literal meaning: a small nodule. Since a small nodule can represent anything from a harmless nevus to a malignant tumor, this usage of the term is not very specific. Examples of this use of the term granuloma are the lesions known as vocal cord granuloma known as contact granuloma, pyogenic granuloma and intubation granuloma, all of which are examples of granulation tissue, not granulomas. Pulmonary hyalinizing granuloma is a lesion characterized by keloid-like fibrosis in the lung, and is not granulomatous. Similarly, radiologists often use the term granuloma when they see a calcified nodule on X-ray or CT scan of the chest. They make this assumption since granulomas usually contain calcium, although the cells that form a granuloma are too tiny to be seen by a radiologist. The most accurate use of the term granuloma requires a pathologist to examine surgically removed and specially colored stained tissue under a microscope. Histiocytes specifically macrophages are the cells that define a granuloma. They often, but not invariably, fuse to form multinucleated giant cells Langhans giant cell. The macrophages in granulomas are often referred to as epithelioid. This term refers to the vague resemblance of these macrophages to epithelial cells. Epithelioid macrophages differ from ordinary macrophages in that they have elongated nuclei that often resemble the sole of a slipper or shoe. They also have larger nuclei than ordinary macrophages and their cytoplasm is typically more pink when stained with eosin. These changes are thought to be a consequence of activation of the macrophage by the offending antigen. 