椎体穿刺活检中的骨髓肉芽肿是一种罕见且通常是偶然的发现。可能的原因包括感染性原因（尤其是结核菌和更罕见的非结核分枝杆菌，但也包括许多其他细菌、病毒、真菌和寄生虫）和非感染性原因（尤其是药物、自身免疫疾病、结节病、血液系统和非血液系统恶性肿瘤）。坏死性肉芽肿通常暗示有感染性病因（结核病为最常见），而纤维环肉芽肿与Q热和巨细胞病毒相关，尽管也可能有例外情况。对于怀疑有感染性病因的每一例病例都应进行进一步的分析，如特殊染色（针对抗酸杆菌的浸涂染色）或分子研究。组织形态学应始终与临床相关联。在无法确定感染性病因的情况下，非定向的元基因组学可能成为骨髓病理学中未来的标准诊断工具。在本综述中，我们分析了从1956年到今天发表的数据，并报告了肉芽肿骨髓活检中的流行病学、病因学、诊断算法、鉴别诊断和元基因组学的作用。©作者（或其雇主）2023年。不得进行商业再利用。请参阅权利和权限。由BMJ出版。

Bone marrow granulomas in trephine biopsies are a rare and usually incidental finding. Possible causes include infectious (especially tuberculous and rarer non-tuberculous mycobacteria, but also many other bacterial, viral, fungal and parasitic agents) and non-infectious causes (especially medications, autoimmune disease, sarcoidosis, haematological and non-haematological malignancy). 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.© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.