Aydogan Eroglu Selma, Yildiz Tekin, Sonkaya Esin, Kavas Murat, Ozbaki Fatma, Sertçelik Lale, Sen Aycim, Sevim Tulin
University of Health Sciences Istanbul Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
Acibadem Taksim Hospital, Istanbul, Turkey.
Sarcoidosis Vasc Diffuse Lung Dis. 2022;38(4):e2021048. doi: 10.36141/svdld.v38i4.11914. Epub 2022 Jan 13.
Granulomatous inflammation is found in a wide range of diseases, and most commonly associated with sarcoidosis and tuberculosis. Granulomas are pathologically classified into two main groups; necrotic and non-necrotic.
The aim of this study was to evaluate the radiological, laboratory, and pathological findings of a large patient population with granuloma in biopsy samples, to determine the final diagnostic distribution.
This study was designed as a retrospective, descriptive, observational, cross-sectional study. It was conducted in patients with granulomatous inflammation detected in lung, pleural, mediastinal, hilar, and/or peripheral lymph node biopsies. Demographic information, radiological, microbiological, and laboratory results of the patients were obtained via the information processing system of the hospital. The diagnoses recorded were re-evaluated by at least two experienced clinicians and the final diagnosis distributions were made.
A total of 392 patients were included in the study. Non-necrotizing inflammation was detected in 268 patients, and necrotizing granulomatous inflammation was found in 124 patients. The most common cause of non-necrotizing inflammation was sarcoidosis, and tuberculosis in the case of necrotizing inflammation. A total of 77.2% of sarcoidosis patients had non-necrotizing inflammation and 54.3% of the tuberculosis patients had necrotizing inflammation. In the diagnosis distribution of granulomatous inflammation sarcoidosis, mycobacterium infections (especially tuberculosis), sarcoid reaction due to malignancy, pneumoconiosis, granulomatosis with polyangiitis and hypersensitivity pneumonitis were detected, respectively. A total of 392 patients were diagnosed with 13 different diseases. In 15 patients (3.8%) no specific diagnosis could be made.
The diagnosis of granulomatous inflammation detected in biopsy samples is common for clinicians and a differential diagnosis is difficult in many cases. A patient's clinical findings, laboratory results, and radiological appearance, should be evaluated in detail and a final diagnosis only made following a multidisciplinary discussion. The presence of necrosis in tissue samples alone is not a reliable finding for a final diagnosis.
肉芽肿性炎症见于多种疾病，最常见于结节病和结核病。肉芽肿在病理上分为两大类；坏死性和非坏死性。
本研究旨在评估大量活检样本中有肉芽肿的患者群体的影像学、实验室和病理结果，以确定最终诊断分布。
本研究设计为一项回顾性、描述性、观察性横断面研究。研究对象为在肺、胸膜、纵隔、肺门和/或外周淋巴结活检中检测到肉芽肿性炎症的患者。通过医院信息处理系统获取患者的人口统计学信息、影像学、微生物学和实验室结果。记录的诊断由至少两名经验丰富的临床医生重新评估，并确定最终诊断分布。
本研究共纳入392例患者。268例患者检测到非坏死性炎症，124例患者发现坏死性肉芽肿性炎症。非坏死性炎症最常见的原因是结节病，坏死性炎症则是结核病。结节病患者中共有77.2%有非坏死性炎症，结核病患者中有54.3%有坏死性炎症。在肉芽肿性炎症的诊断分布中，分别检测到结节病、分枝杆菌感染（尤其是结核病）、恶性肿瘤引起的结节样反应、尘肺、显微镜下多血管炎和过敏性肺炎。392例患者被诊断为13种不同疾病。15例患者（3.8%）无法做出明确诊断。
活检样本中检测到的肉芽肿性炎症诊断对临床医生来说很常见，在许多情况下鉴别诊断困难。应详细评估患者的临床表现、实验室结果和影像学表现，仅在多学科讨论后做出最终诊断。仅组织样本中存在坏死并不是最终诊断的可靠依据。
