Evaluation of the Role of Pathology in the Diagnosis and Differential Diagnosis of Pulmonary and Extrapulmonary Sarcoidosis

Abstract

Introduction Sarcoidosis is a multisystem, granulomatous disease of unknown etiology. Sarcoid granulomas appear as immunological response to a particular but still unknown agent of the human body.

Objective The main purpose of this study was to point out the important fact that the exact diagnosis of sarcoidosis must be estimated by clinical and pathological correlation, and team cooperation between the clinician and the pathologist.

Methods Of 751 patients referred with the suspected diagnosis of sarcoidosis, from 1995 to1999, 663 (431 female and 232 male) were analyzed and confirmed as having sarcoidosis stage I-III based on biopsy findings obtained by bronchoscopy, open lung biopsy, skin biopsy, liver biopsy or splenectomy.

Results Diagnosis of sarcoidosis was made in 663 patients, 431 females and 232 males (ratio 1.9:1). The average age of patients varied from 16 to 67 years, with those below age 50 years being predominant (78.4%). The highest number of patients was diagnosed in stage I of lung sarcoidosis (81.7%). Sarcoidosis was the most common cause of hilar and mediastinal lymphadenopathy (72.2%).

Conclusion Biopsy is a necessary diagnostic procedure for pathological diagnosis of sarcoid granuloma before treatment even in patients where clinical, radiological, biochemical and immunological tests imply the diagnosis of sarcoidosis.

Keywords: granulomatous disease; mediastinal lymph nodes; diagnostic procedures