Öztomurcuk Derya, Terzi Özlem, Demirci Canan, Kılıçaslan Zeki
Samsun Tuberculosis Dispensary of Health Directorate, Samsun, Turkey.
Department of Public Health, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey.
Turk Thorac J. 2022 Jan;23(1):11-16. doi: 10.5152/TurkThoracJ.2022.20314.
Granulomatous inflammation showing "caseification necrosis" is considered pathognomonic for tuberculosis. This study aimed to evaluate patients with granulomatous inflammation and some characteristics to diagnose tuberculosis.
This is a cross-sectional descriptive study. The study includes all pathology laboratories in Samsun between the years 2012 and 2017. Pathology reports that contained the term granulomatous were selected between all patient reports of these laboratories. The patient reports were examined by comparing the dispensary records and the presence of a diagnosis of tuberculosis.
In the 703 pathology reports, it was found that 38% were only granulomatous and 33% were caseous granulomatosis lesions. When the prevalence of tuberculosis according to the presence of microscopic necrosis was observed in granulomatous tissue samples, 85% tuberculosis was found in patients with necrotic granulomatous tissue and 14% tuberculosis was found with non-necrotic lesions. The presence of tuberculosis in necrotic granulomatous tissues was statistically significantly higher (P < .00001).
As a result, when examining a pathology report for the presence of tuberculosis, the existence of a granulomatous reaction should be considered first. Getting stuck on the definition of caseification necrosis will cause the case to be skipped. An indication of necrosis in the pathologic evaluation will guide the diagnosis of tuberculosis.
显示“干酪样坏死”的肉芽肿性炎症被认为是结核病的特征性表现。本研究旨在评估患有肉芽肿性炎症并具有某些特征的患者以诊断结核病。
这是一项横断面描述性研究。该研究纳入了2012年至2017年间萨姆松的所有病理实验室。在这些实验室的所有患者报告中，选取包含“肉芽肿性”一词的病理报告。通过比较药房记录和结核病诊断情况来检查患者报告。
在703份病理报告中，发现38%仅为肉芽肿性病变，33%为干酪样肉芽肿病变。当观察肉芽肿组织样本中根据微观坏死情况的结核病患病率时，在坏死性肉芽肿组织患者中发现85%患有结核病，在非坏死性病变患者中发现14%患有结核病。坏死性肉芽肿组织中结核病的存在在统计学上显著更高（P < .00001）。
因此，在检查病理报告中是否存在结核病时，应首先考虑肉芽肿反应的存在。拘泥于干酪样坏死的定义会导致病例被漏诊。病理评估中坏死的迹象将指导结核病的诊断。
