Mada Yusuke, Ihara Fumie, Ueki Yuji, Konno Akiyoshi
Department of Otolaryngology, Southern TOHOKU Research Institute for Neuroscience.
Nihon Jibiinkoka Gakkai Kaiho. 2013 May;116(5):592-9. doi: 10.3950/jibiinkoka.116.592.
Sarcoidosis is a multiorgan granulomatous disease of unknown origin, which frequently involves the lung and the eyes. It is rare that sarcoidosis causes cervical lymphadenopathy and a chronic continuous salivary gland swelling. In the present study, we examined how to diagnose sarcoidosis in patients complaining of a cervical mass and its clinical presentation according to 8 cases which we experienced. We undertook biopsy of the cervical lymph nodes in 7 cases, and biopsy of the parotid gland in 1 case. In cases non-caseating epithelioid cell granuloma was proved, diagnosed as sarcoidosis histopathlogically. In 6 patients, the sarcoidal lesion was in other organs, whereas in 2 patients the sarcoidal lesion was confined in the head and neck. Bilateral hilar lymphadenopathy and an elevated level of angiotensin-converting enzyme which are typical in sarcoidosis were confirmed in only one of our patients. Therefore, the diagnostic value of these tests is low for the diagnosis of sarcoidosis in the patients whose chief complaint is a cervical mass. Because 4 out of 7 cases were positive for the tuberculin test, it is imperative to distinguish between sarcoidosis and cervical tuberculous lymphadenitis by combining the culture of acid-bacilli and TB-PCR with histopathological evaluation of the biopsy specimen. We experienced one patient in whom the sarcoidal lesion developed in the skin and the eyes 20 years after the onset of cervical lymphadenopathy. It is important to follow the patients carefully, even if we diagnose the disease as sarcoidosis confined in the head and neck.
结节病是一种病因不明的多器官肉芽肿性疾病，常累及肺和眼。结节病引起颈部淋巴结病和慢性持续性涎腺肿大较为罕见。在本研究中，我们根据所诊治的8例病例，探讨了以颈部肿块为主诉的患者结节病的诊断方法及其临床表现。我们对7例患者进行了颈部淋巴结活检，对1例患者进行了腮腺活检。组织病理学证实为非干酪样上皮样细胞肉芽肿的病例诊断为结节病。6例患者的结节病病变位于其他器官，2例患者的结节病病变局限于头颈部。仅1例患者确诊有结节病典型的双侧肺门淋巴结肿大和血管紧张素转换酶水平升高。因此，对于以颈部肿块为主诉的患者，这些检查对结节病诊断的价值较低。由于7例中有4例结核菌素试验呈阳性，因此必须通过结合抗酸杆菌培养、结核聚合酶链反应以及活检标本的组织病理学评估来鉴别结节病和颈部结核性淋巴结炎。我们诊治过1例患者，其颈部淋巴结病发病20年后，皮肤和眼睛出现了结节病病变。即使诊断为局限于头颈部的结节病，对患者进行仔细随访也很重要。
