Alvarez Andres Borja, Lee Augustine S, Mira-Avendano Isabel
Department of Pulmonary Medicine.
Department of Critical Care Medicine at Mayo Clinic, Jacksonville, Florida.
Sarcoidosis Vasc Diffuse Lung Dis. 2017;34(2):115-121. doi: 10.36141/svdld.v34i2.5966. Epub 2017 Apr 28.
Sarcoidosis is an idiopathic granulomatous disease characterized by variable organ involvement and non-necrotizing granulomas. To determine how often non-necrotizing granulomas are not secondary to sarcoidosis. A retrospective review was conducted to evaluate all biopsies performed at Mayo Clinic in Jacksonville, Florida from January 1, 1996, to December 31, 2013, showing non-necrotizing granulomas. Three hundred and eight biopsies showing non-necrotizing granulomas met inclusion criteria. The average age was 58.2 years, 60.7% were female, and 85% were Caucasian. The most common symptoms were pulmonary (74.6% of cases), and the most common objective finding was lymphadenopathy (33.8%). The organs biopsied included lung parenchyma (65.3%), intrathoracic lymph nodes (25%), other lymph nodes (1.6%), liver (1.3%), airway (1.3%), skin (1.3%), kidney (0.7%), bone marrow (0.7%), gastrointestinal (0.7%), and one each from the brain, heart, bone, bladder, spleen, tendon, and eye. The suspected diagnosis was confirmed in 224 cases (72.7%). From the remaining 84 cases (27.3%), suspected sarcoidosis was refuted in 9, the initial diagnosis was changed to sarcoidosis in 37 (44%), and in 38, it was changed to a different diagnosis. Sarcoidosis was the final diagnosis in 173 (56%). Sarcoidosis was the leading cause of non-necrotizing granulomas, but in 44% of cases, there was an alternate diagnosis. We estimate that more than a quarter of the initial diagnoses will be changed based on biopsy results and clinical course. .
结节病是一种特发性肉芽肿性疾病，其特征为器官受累情况多样且存在非坏死性肉芽肿。为确定非坏死性肉芽肿并非继发于结节病的情况有多常见。我们进行了一项回顾性研究，以评估1996年1月1日至2013年12月31日在佛罗里达州杰克逊维尔的梅奥诊所进行的所有显示非坏死性肉芽肿的活检。308例显示非坏死性肉芽肿的活检符合纳入标准。平均年龄为58.2岁，60.7%为女性，85%为白种人。最常见的症状是肺部症状（74.6%的病例），最常见的客观发现是淋巴结病（33.8%）。活检的器官包括肺实质（65.3%）、胸内淋巴结（25%）、其他淋巴结（1.6%）、肝脏（1.3%）、气道（1.3%）、皮肤（1.3%）、肾脏（0.7%）、骨髓（0.7%）、胃肠道（0.7%），以及来自脑、心脏、骨骼、膀胱、脾脏、肌腱和眼睛的各1例。224例（72.7%）的疑似诊断得到证实。在其余84例（27.3%）中，9例排除了疑似结节病，37例（44%）将初始诊断改为结节病，38例改为其他诊断。结节病是最终诊断的有173例（56%）。结节病是非坏死性肉芽肿的主要原因，但在44%的病例中，存在其他诊断。我们估计，超过四分之一的初始诊断将根据活检结果和临床病程而改变。
