Difference between revisions of "Sarcoidosis"

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| Micro      =
| Micro      =
| Subtypes  =
| Subtypes  =
| LMDDx      = fungal infection, [[tuberculosis]], other infections, drug reactions  
| LMDDx      = fungal infections, [[MAC]], [[tuberculosis]], other infections, drug reactions  
| Stains    = AFB -ve, GMS -ve, PASD -ve
| Stains    = AFB -ve, GMS -ve, PASD -ve
| IHC        =
| IHC        =  
| EM        =
| EM        =
| Molecular  =
| Molecular  =  
| IF        =
| IF        =
| Gross      =  
| Gross      =  
Line 21: Line 21:
| Symptoms  =
| Symptoms  =
| Prevalence = uncommon
| Prevalence = uncommon
| Bloodwork  =
| Bloodwork  = +/-ACE elevated
| Rads      = +/-bilateral hilar lymphadenopathy (very common), +/-interstitial pattern, +/- pulmonary infiltrates, +/-cystic/bullous changes
| Rads      = +/-bilateral hilar lymphadenopathy (very common), +/-interstitial pattern, +/- pulmonary infiltrates, +/-cystic/bullous changes
| Endoscopy  =
| Endoscopy  =
| Prognosis  =
| Prognosis  =
| Other      = flow cytometry to r/o lymphoma
| Other      =  
| ClinDDx    = [[lymphoma]], [[metastatic carcinoma]], [[Wegener's granulomatosis]], others
| ClinDDx    = [[lymphoma]], [[metastatic carcinoma]], [[Wegener's granulomatosis]], others
}}
}}
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==General==
==General==
*Diagnosis of exclusion - infection must be excluded.
*[[Diagnosis of exclusion]] - infection, neoplasms, and drugs must be excluded.
*Rare.
*Uncommon.


Serology:
*Angiotensin-converting enzyme (ACE) - used for diagnosis and to monitor activity.<ref name=pmid24047001>{{Cite journal  | last1 = Kaura | first1 = V. | last2 = Kaura | first2 = NV. | last3 = Kaura | first3 = BN. | last4 = Kaura | first4 = CS. | title = Angiotensin-converting enzyme inhibitors in the treatment of sarcoidosis and association with ACE gene polymorphism: case series. | journal = Indian J Chest Dis Allied Sci | volume = 55 | issue = 2 | pages = 105-7 | month =  | year =  | doi =  | PMID = 24047001 }}</ref><ref name=pmid23897103>{{Cite journal  | last1 = Stouten | first1 = K. | last2 = Werken | first2 = MV. | last3 = Tchetverikov | first3 = I. | last4 = Saboerali | first4 = M. | last5 = Vermeer | first5 = HJ. | last6 = Castel | first6 = R. | last7 = Verheijen | first7 = FM. | title = Extreme elevation of serum angiotensin-converting enzyme (ACE) activity: always consider familial ACE hyperactivity. | journal = Ann Clin Biochem | volume =  | issue =  | pages =  | month = Jul | year = 2013 | doi = 10.1177/0004563213489812 | PMID = 23897103 }}</ref>
**Elevated in approximately 65% of patients in one series.<ref name=pmid9327039>{{Cite journal  | last1 = Shorr | first1 = AF. | last2 = Torrington | first2 = KG. | last3 = Parker | first3 = JM. | title = Serum angiotensin converting enzyme does not correlate with radiographic stage at initial diagnosis of sarcoidosis. | journal = Respir Med | volume = 91 | issue = 7 | pages = 399-401 | month = Aug | year = 1997 | doi =  | PMID = 9327039 }}</ref>
==Gross==
==Gross==
*Lungs - classic location.<ref name=pmid23597964>{{Cite journal  | last1 = Rao | first1 = DA. | last2 = Dellaripa | first2 = PF. | title = Extrapulmonary manifestations of sarcoidosis. | journal = Rheum Dis Clin North Am | volume = 39 | issue = 2 | pages = 277-97 | month = May | year = 2013 | doi = 10.1016/j.rdc.2013.02.007 | PMID = 23597964 }}
*Lungs - classic location.<ref name=pmid23597964>{{Cite journal  | last1 = Rao | first1 = DA. | last2 = Dellaripa | first2 = PF. | title = Extrapulmonary manifestations of sarcoidosis. | journal = Rheum Dis Clin North Am | volume = 39 | issue = 2 | pages = 277-97 | month = May | year = 2013 | doi = 10.1016/j.rdc.2013.02.007 | PMID = 23597964 }}

Revision as of 03:16, 26 November 2013

Sarcoidosis
Diagnosis in short

Sarcoidosis-like granulomas in a lymph node. H&E stain.
LM DDx fungal infections, MAC, tuberculosis, other infections, drug reactions
Stains AFB -ve, GMS -ve, PASD -ve
Site lung, hilar lymph nodes of the lung, other sites
Prevalence uncommon
Blood work +/-ACE elevated
Radiology +/-bilateral hilar lymphadenopathy (very common), +/-interstitial pattern, +/- pulmonary infiltrates, +/-cystic/bullous changes
Clin. DDx lymphoma, metastatic carcinoma, Wegener's granulomatosis, others

Sarcoidosis is non-necrotizing granulomatous disease of unknown etiology. It classically associated with (pulmonary) hilar lymphadenopathy. It may be found in almost any organ, e.g. heart, appendix.

General

Serology:

  • Angiotensin-converting enzyme (ACE) - used for diagnosis and to monitor activity.[1][2]
    • Elevated in approximately 65% of patients in one series.[3]

Gross

  • Lungs - classic location.[4]
  • Bilateral hilar lymphadenopathy.

DDx (radiologic):

  • Carcinomatosis - interstitial pattern.[5]
  • Lymphoma - bilateral lymphadenopathy +/- mediastinal lymphadenopathy.[6]

Microscopic

Features:

  • Granulomata, well-formed, non-necrotizing.
    • Negative for microorganisms with special stains (PAS-D, GMS, AFB).
  • Usu. minimal (lymphoid) inflammation; sarcoid granulomas are known as "naked granulomas".[7]
  • In lung: interstitial location.

DDx:

Images

  • Sarcoidosis - lung. (WC)

  • Granulomata in sarcoidosis with asteroid bodies. (WC)

www:

Stains

  • ZN -ve.
  • PASD -ve.
  • GMS -ve.

Note:

  • Done to r/o infection.

Sign out

  • Should be something like sarcoid-like granulomas and clinical correlation required.

See also

References

  1. ↑ Kaura, V.; Kaura, NV.; Kaura, BN.; Kaura, CS.. "Angiotensin-converting enzyme inhibitors in the treatment of sarcoidosis and association with ACE gene polymorphism: case series.". Indian J Chest Dis Allied Sci 55 (2): 105-7. PMID 24047001.
  2. ↑ Stouten, K.; Werken, MV.; Tchetverikov, I.; Saboerali, M.; Vermeer, HJ.; Castel, R.; Verheijen, FM. (Jul 2013). "Extreme elevation of serum angiotensin-converting enzyme (ACE) activity: always consider familial ACE hyperactivity.". Ann Clin Biochem. doi:10.1177/0004563213489812. PMID 23897103.
  3. ↑ Shorr, AF.; Torrington, KG.; Parker, JM. (Aug 1997). "Serum angiotensin converting enzyme does not correlate with radiographic stage at initial diagnosis of sarcoidosis.". Respir Med 91 (7): 399-401. PMID 9327039.
  4. ↑ Rao, DA.; Dellaripa, PF. (May 2013). "Extrapulmonary manifestations of sarcoidosis.". Rheum Dis Clin North Am 39 (2): 277-97. doi:10.1016/j.rdc.2013.02.007. PMID 23597964.
  5. ↑ URL: http://www.radiologyassistant.nl/en/46b480a6e4bdc. Accessed on: 23 May 2010.
  6. ↑ Boujaoude, Z.; Dahdel, M.; Pratter, M.; Kass, J. (Jan 2012). "Endobronchial ultrasound with transbronchial needle aspiration in the diagnosis of bilateral hilar and mediastinal lymphadenopathy.". J Bronchology Interv Pulmonol 19 (1): 19-23. doi:10.1097/LBR.0b013e3182442b89. PMID 23207258.
  7. ↑ Brinster, NK. (Nov 2008). "Dermatopathology for the surgical pathologist: a pattern-based approach to the diagnosis of inflammatory skin disorders (part II).". Adv Anat Pathol 15 (6): 350-69. doi:10.1097/PAP.0b013e31818b1ac6. PMID 18948765.
  8. ↑ Tong, D.; Manolios, N.; Howe, G.; Spencer, D. (Jan 2012). "New onset sarcoid-like granulomatosis developing during anti-TNF therapy: an under-recognised complication.". Intern Med J 42 (1): 89-94. PMID 22389903.
  9. ↑ Reule, RB.; North, JP. (Nov 2013). "Cutaneous and pulmonary sarcoidosis-like reaction associated with ipilimumab.". J Am Acad Dermatol 69 (5): e272-3. doi:10.1016/j.jaad.2013.07.028. PMID 24124863.
  10. ↑ Hervier, B.; Wastiaux, H.; Freour, T.; Masseau, A.; Corvec, S.; Armingeat, T.; Hamidou, M. (Sep 2009). "[Sarcoidosis-like granulomatosis revealing a tertiary syphilis].". Rev Med Interne 30 (9): 806-8. doi:10.1016/j.revmed.2009.01.003. PMID 19249139.
  11. ↑ Vultaggio, A.; Matucci, A.; Parronchi, P.; Rossi, O.; Filì, L.; Giudizi, MG.; Palandri, F.; Agostini, C. et al. (Sep 2007). "Association between sarcoidosis-like disease and common variable immunodeficiency (CVI): a new CVI variant showing an activation of the immune system.". Sarcoidosis Vasc Diffuse Lung Dis 24 (2): 127-33. PMID 18496983.
  12. ↑ Jankilevich, G.; Mendizabal, J.; Massa, MA.; Pedernera, A.; Galmes, M.; Spizzamiglio, N. (2006). "[Mediastinal sarcoidal reaction in follow up for seminoma].". Medicina (B Aires) 66 (6): 552-4. PMID 17240627.
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