Mikhail J R, Drury R A
Postgrad Med J. 1970 Aug;46(538):515-8. doi: 10.1136/pgmj.46.538.515.
Sixty-nine patients with a chest radiograph showing enlargement of the hilar and/or paratracheal lymph nodes were analysed. Ten of these, mainly Asian, were found to be suffering from tuberculosis. Of the remaining fifty-nine, who had sarcoidosis, 12% were tuberculin-positive. All the cases diagnosed as sarcoidosis had either a positive Kveim test and/or mediastinal lymph node histology compatible with sarcoidosis. 10% of cases with sarcoidosis showed evidence of uveitis and 10% showed bone cysts and there was also a high proportion of other extrathoracic lesions. From these studies we conclude that, whilst the currently accepted radiological staging of sarcoidosis serves as a convenient form of reference, these stages do not in any way relate to the clinical stage of disease, or to the histological appearance of affected lymph node tissue. There is a correlation between a strongly positive Kveim test of three or more granulomas and mediastinal lymph nodes showing confluent granulomata (predominantly of the epithelioid cell-type) with fibrosis. The presence of intra- or peri-granulomatous fibrosis, or even gross diffuse fibrosis, does not seem in itself to be related to the nature of onset, clinical or accepted radiological staging of disease. However the mediastinal lymph nodes in patients with erythema nodosum were predominantly of giant cell-type; these patients were also Kveim-positive. Similar instances of giant cell predominance in the mediastinal lymph nodes were seen in each of the groups examined. Further studies are required to determine whether these cellular characteristics, or other histological features in the mediastinal lymph nodes, might be of prognostic significance.
对69例胸部X线片显示肺门和/或气管旁淋巴结肿大的患者进行了分析。其中10例主要为亚洲患者，被发现患有结核病。在其余59例患有结节病的患者中，12%结核菌素试验呈阳性。所有被诊断为结节病的病例均有Kveim试验阳性和/或纵隔淋巴结组织学表现符合结节病。10%的结节病患者有葡萄膜炎表现，10%有骨囊肿，并且还有很高比例的其他胸外病变。从这些研究中我们得出结论，虽然目前公认的结节病放射学分期是一种方便的参考形式，但这些分期与疾病的临床分期或受累淋巴结组织的组织学表现毫无关系。Kveim试验强阳性且有三个或更多肉芽肿与纵隔淋巴结出现融合性肉芽肿（主要为上皮样细胞型）并伴有纤维化之间存在相关性。肉芽肿内或肉芽肿周围纤维化的存在，甚至是广泛的弥漫性纤维化，其本身似乎与疾病的起病性质、临床或公认的放射学分期无关。然而，结节性红斑患者的纵隔淋巴结主要为巨细胞型；这些患者Kveim试验也呈阳性。在所检查的每组中都观察到纵隔淋巴结中巨细胞占优势的类似情况。需要进一步研究以确定这些细胞特征或纵隔淋巴结中的其他组织学特征是否可能具有预后意义。
