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Difference between revisions of "Sarcoidosis"
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| Line 14: | Line 14: | ||
| Gross = | | Gross = | ||
| Grossing = | | Grossing = | ||
| Site = [[lung]], hilar lymph nodes of the lung, other sites | | Site = [[lung]], hilar lymph nodes of the lung, [[skin]], [[cardiac sarcoidosis|heart]], other sites | ||
| Assdx = | | Assdx = | ||
| Syndromes = | | Syndromes = | ||
| Line 33: | Line 33: | ||
*[[Diagnosis of exclusion]] - infection, neoplasms, and drugs must be excluded. | *[[Diagnosis of exclusion]] - infection, neoplasms, and drugs must be excluded. | ||
*Uncommon. | *Uncommon. | ||
*Afflicits skin ~25% of the time.<ref name=pmid24138972>{{Cite journal | last1 = Noiles | first1 = K. | last2 = Beleznay | first2 = K. | last3 = Crawford | first3 = RI. | last4 = Au | first4 = S. | title = Sarcoidosis can present with necrotizing granulomas histologically: two cases of ulcerated sarcoidosis and review of the literature. | journal = J Cutan Med Surg | volume = 17 | issue = 6 | pages = 377-83 | month = | year = | doi = | PMID = 24138972 }}</ref> | |||
Serology: | 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> | *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> | **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 }} | ||
| Line 42: | Line 44: | ||
*Bilateral hilar lymphadenopathy. | *Bilateral hilar lymphadenopathy. | ||
DDx | DDx lungs - radiologic: | ||
*Carcinomatosis - interstitial pattern.<ref>URL: [http://www.radiologyassistant.nl/en/46b480a6e4bdc http://www.radiologyassistant.nl/en/46b480a6e4bdc]. Accessed on: 23 May 2010.</ref> | *Carcinomatosis - interstitial pattern.<ref>URL: [http://www.radiologyassistant.nl/en/46b480a6e4bdc http://www.radiologyassistant.nl/en/46b480a6e4bdc]. Accessed on: 23 May 2010.</ref> | ||
*Lymphoma - bilateral lymphadenopathy +/- mediastinal lymphadenopathy.<ref name=pmid23207258>{{Cite journal | last1 = Boujaoude | first1 = Z. | last2 = Dahdel | first2 = M. | last3 = Pratter | first3 = M. | last4 = Kass | first4 = J. | title = Endobronchial ultrasound with transbronchial needle aspiration in the diagnosis of bilateral hilar and mediastinal lymphadenopathy. | journal = J Bronchology Interv Pulmonol | volume = 19 | issue = 1 | pages = 19-23 | month = Jan | year = 2012 | doi = 10.1097/LBR.0b013e3182442b89 | PMID = 23207258 }}</ref> | *Lymphoma - bilateral lymphadenopathy +/- mediastinal lymphadenopathy.<ref name=pmid23207258>{{Cite journal | last1 = Boujaoude | first1 = Z. | last2 = Dahdel | first2 = M. | last3 = Pratter | first3 = M. | last4 = Kass | first4 = J. | title = Endobronchial ultrasound with transbronchial needle aspiration in the diagnosis of bilateral hilar and mediastinal lymphadenopathy. | journal = J Bronchology Interv Pulmonol | volume = 19 | issue = 1 | pages = 19-23 | month = Jan | year = 2012 | doi = 10.1097/LBR.0b013e3182442b89 | PMID = 23207258 }}</ref> | ||
| Line 48: | Line 50: | ||
==Microscopic== | ==Microscopic== | ||
Features: | Features: | ||
*[[Granulomata]], well-formed, non-necrotizing. | *[[Granulomata]], well-formed, non-necrotizing. ‡ | ||
**Negative for microorganisms with special stains ([[PAS-D]], [[GMS]], [[AFB]]). | **Negative for microorganisms with special stains ([[PAS-D]], [[GMS]], [[AFB]]). | ||
*Usu. minimal (lymphoid) inflammation; sarcoid granulomas are known as "naked granulomas".<ref name=pmid18948765>{{Cite journal | last1 = Brinster | first1 = NK. | title = Dermatopathology for the surgical pathologist: a pattern-based approach to the diagnosis of inflammatory skin disorders (part II). | journal = Adv Anat Pathol | volume = 15 | issue = 6 | pages = 350-69 | month = Nov | year = 2008 | doi = 10.1097/PAP.0b013e31818b1ac6 | PMID = 18948765 }}</ref> | *Usu. minimal (lymphoid) inflammation; sarcoid granulomas are known as "naked granulomas".<ref name=pmid18948765>{{Cite journal | last1 = Brinster | first1 = NK. | title = Dermatopathology for the surgical pathologist: a pattern-based approach to the diagnosis of inflammatory skin disorders (part II). | journal = Adv Anat Pathol | volume = 15 | issue = 6 | pages = 350-69 | month = Nov | year = 2008 | doi = 10.1097/PAP.0b013e31818b1ac6 | PMID = 18948765 }}</ref><ref name=pmid24138972>{{Cite journal | last1 = Noiles | first1 = K. | last2 = Beleznay | first2 = K. | last3 = Crawford | first3 = RI. | last4 = Au | first4 = S. | title = Sarcoidosis can present with necrotizing granulomas histologically: two cases of ulcerated sarcoidosis and review of the literature. | journal = J Cutan Med Surg | volume = 17 | issue = 6 | pages = 377-83 | month = | year = | doi = | PMID = 24138972 }}</ref> | ||
*In lung: interstitial location. | *In lung: interstitial location. | ||
Notes: | |||
*‡ Reported with necrosis - uncommon.<ref name=pmid24138972>{{Cite journal | last1 = Noiles | first1 = K. | last2 = Beleznay | first2 = K. | last3 = Crawford | first3 = RI. | last4 = Au | first4 = S. | title = Sarcoidosis can present with necrotizing granulomas histologically: two cases of ulcerated sarcoidosis and review of the literature. | journal = J Cutan Med Surg | volume = 17 | issue = 6 | pages = 377-83 | month = | year = | doi = | PMID = 24138972 }}</ref> | |||
DDx: | DDx: | ||