Chen Hsin-Chien, Kang Bor-Hwang, Lai Chuan-Tsai, Lin Yaoh-Shiang
Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.
J Chin Med Assoc. 2005 Jul;68(7):339-42. doi: 10.1016/S1726-4901(09)70172-8.
Sarcoidosis is a multiorgan granulomatous disease, the most common head and neck manifestation of which is cervical lymphadenopathy. Only the presentation of sarcoidal granuloma in cervical lymph nodes without typical manifestations of systemic sarcoidosis poses a diagnostic difficulty. We describe the case of a 39-year-old male who had a 2-month history of a progressively increasing mass with soreness in his right neck. The biopsy from the neck mass demonstrated non-caseating epithelioid cell granuloma of the lymph nodes. The differential diagnoses of mycobacterial or fungal infections were excluded. Thoracic evaluations, including chest X-ray and high-resolution computed tomography, revealed no abnormal findings. Treatment with systemic corticosteroids resulted in improved clinical symptoms. No recurrence of the neck mass or other signs of systemic sarcoidosis were noted during 1.5 years of follow-up. Although our patient's definitive diagnosis could not be determined, the case highlights 2 important issues: sarcoidal granuloma in lymph nodes may be a precursor of sarcoidosis, even in the absence of pulmonary or other systemic involvement; and regular follow-up is recommended in such cases.
结节病是一种多器官肉芽肿性疾病，其在头颈部最常见的表现是颈部淋巴结病。仅颈部淋巴结出现结节样肉芽肿而无系统性结节病的典型表现会造成诊断困难。我们描述了一例39岁男性病例，其右颈部有一个进行性增大的肿块且伴有疼痛，病程2个月。颈部肿块活检显示淋巴结有非干酪样上皮样细胞肉芽肿。排除了分枝杆菌或真菌感染的鉴别诊断。包括胸部X线和高分辨率计算机断层扫描在内的胸部评估未发现异常。全身使用糖皮质激素治疗后临床症状改善。在1.5年的随访中未发现颈部肿块复发或系统性结节病的其他迹象。虽然我们患者的明确诊断无法确定，但该病例突出了两个重要问题：即使没有肺部或其他系统性受累，淋巴结中的结节样肉芽肿也可能是结节病的先兆；对于此类病例建议定期随访。
