[A study of epithelioid cell granulomas in transbronchial lung biopsy specimens of sarcoidosis patients--correlation between granulomas and clinical activity or chest X-ray lesions]

Abstract

The 565 pulmonary tissue specimens taken from 155 sarcoidosis patients by transbronchial lung biopsy (TBLB) were studied by light microscopy. Particular attention was paid to the mean number and type of epithelioid cell granulomas, the mean number of giant cells, and the degree of lymphocyte cuffing, perigranulomal fibrosis, and granuloma confluence. The granulomas were divided into three types, hypertrophic, atrophic, and hyalinofibrous. In stage II and III patients, the mean number of granulomas and giant cells, the positive rate of hyalinofibrous granuloma, the relative proportion of the hyalinofibrous granuloma group, and the degree of fibrosis and confluence were significantly higher than those in stage O and I patients. The mean number of granulomas was related to the serum level of angiotensin converting enzyme and 67Ga uptake into lung parenchyma, but not to the cellular findings of bronchoalveolar lavage fluid (BALF). The lymphocyte count of BALF in the hypertrophic granuloma group was significantly higher than that in the atrophic and hyalinofibrous granuloma groups. CD4/CD8 ratio of lymphocytes in BALF was significantly lower in the hyalinofibrous granuloma group than in the other groups. In stage I patients, the resolution of intrathoracic lesions on chest X-ray was significantly more frequent in the atrophic granuloma group than in the hypertrophic granuloma group, 2 and 5 years after TBLB was performed. The pulmonary lesions had a tendency to persist for a long time in stage II and III patients with hyalinofibrous granuloma or granuloma confluence. Newly appearing pulmonary lesions showed hypertrophic granulomas as well as marked lymphocyte cuffing.