[Radio-pathological manifestations of pulmonary sarcoidosis]

Abstract

Objective: To investigate the radio-pathological features of pulmonary sarcoidosis.

Method: Forty six consecutive patients from January 2000 to August 2005 in Peking Union Medical College Hospital with pathologic features of epithelioid cell granuloma were enrolled in the study.

Results: All the cases were confirmed by pathological findings consistent with sarciodosis. Bronchoalveolar lavage (BAL) fluid analysis showed that, the differential count of lymphocytes was 0.47 +/- 0.18, and the CD(4)/CD(8) ratio was 6.63 +/- 4.51. Serum angiotensin converting enzyme level was (47 +/- 16) U/L. Chest computed tomography scan showed bilateral hilar adenopathy (33%, 12/46), well circumscribed pulmonary nodules (35%, 16/46) distributed randomly or along the bronchovascular bundle, patchy areas of alveolar consolidation (28%, 13/46), and bilateral ground glass infiltrations (11%, 5/46). Open lung biopsy, video-assistant thoracoscopic biopsy or mediastinoscopic biopsy were performed in 13 patients, and percutaneous lung biopsy or transbronchial lung biopsy in 33 patients. The characteristic pathologic finding was noncaseating epithelioid cell granulomas, which were embedded in the substance of hyalinization. The granulomas were distributed around blood vessels, lymphatics, or in the bronchial submucosa. Granulomatous vasculitis was noted in some cases.

Conclusion: The diagnosis of sarcoidosis can be proposed by clinico-radiologic and BAL fluid findings. However, histologic evidence of noncaseating epithelioid cell granulomas and the therapeutic efficacy of glucocorticoids are essential to the final diagnosis.