Sarcoidosis - Diagnosis and Management by M. Motamedi

By M. Motamedi

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6. Invasive diagnostic modalities and appropriate biopsy sites Most patients with suspected sarcoidosis require histologic confirmation for diagnosis. Since sarcoidosis is a multi-system disorder, evidence of granulomatous inflammation in at least 2 organs is required to distinguish it from granulomatous disorders of individual organs such as granulomatous hepatitis and idiopathic panuveitis (2, 11). However, biopsy confirmation 42 Sarcoidosis Diagnosis and Management from one organ is deemed sufficient if compatible clinical, laboratory, or radiologic findings are consistent with the diagnosis in at least one additional organ and alternative diagnoses have been excluded (2, 11).

That is, cellular and discrete granulomas in the early stages of the disease may resolve with little consequence, or become more fibrotic as the disease advances (Fig. , 2007). Several characteristic histological features have been proposed that are useful in the differential diagnosis of various granulomatous disorders. It is well known that tuberculous granulomas are accompanied by caseous necrosis, and Crohn’s disease is usually manifested as small-sized granulomas (Fig. 4a). Toxoplasmic lymphadenopathy is characterized by the presence of microgranulomas without multinucleated giant cells (Fig.

The Kveim test has been reported to be fairly specific, but the sensitivity is low (11). It is not in general use because both sensitivity and specificity vary with the splenic material used, and it is not approved by the Food and Drug Administration in the United States (11).. Since over 90% of patients present with intra-thoracic involvement, bronchoscopy is often the diagnostic procedure of choice. Flexible fiberoptic bronchoscopy provides multiple options for obtaining diagnostic material. Lung parenchyma can be sampled by transbronchial lung biopsy (TBLB).

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