**Core Concept**
Granulomas are a type of chronic inflammatory lesion characterized by the presence of tightly packed, often caseating, aggregates of macrophages and other immune cells. They are typically seen in response to persistent infections, foreign bodies, or autoimmune diseases. The key features of granulomas include a chronic inflammatory infiltrate, the presence of epithelioid cells, and the formation of giant cells.

**Why the Correct Answer is Right**
The correct answer, PMN's with fibrinoid necrosis with cellular infiltrates, is not characteristic of granulomas because granulomas are typically associated with a chronic inflammatory response, not an acute inflammatory response. The presence of polymorphonuclear leukocytes (PMNs) with fibrinoid necrosis with cellular infiltrates is more characteristic of an acute inflammatory reaction, such as that seen in vasculitis or rheumatoid arthritis. In contrast, granulomas are characterized by a chronic inflammatory response, which includes the presence of epithelioid cells and giant cells.

**Why Each Wrong Option is Incorrect**
**Option A:** A chronic inflammatory infiltrate is a characteristic feature of granulomas, as they are typically seen in response to persistent infections or foreign bodies.
**Option B:** Epithelioid cells are a key component of granulomas, and their presence is a hallmark of this type of inflammatory lesion.
**Option C:** Giant cells are also a characteristic feature of granulomas, and their formation is an important aspect of the granulomatous response.

**Clinical Pearl / High-Yield Fact**
When evaluating a biopsy specimen, it's essential to distinguish between a granulomatous reaction and an acute inflammatory reaction. The presence of epithelioid cells and giant cells is a key feature that can help differentiate between these two types of inflammatory responses.

**✓ Correct Answer: D. PMN's with fibrinoid necrosis with cellular infiltrates**