Diagnosis of sarcoidosis.
ABSTRACT To describe the recent advances in the diagnostic procedures for sarcoidosis and explore future directions.
Novel imaging techniques have been explored in sarcoidosis, such as positron emission tomography using L-[3-F]-alpha-methyltyrosine, which is more specific for malignancy than F-fluorodeoxyglucose positron emission tomography. The combined modality of L-[3-F]-alpha-methyltyrosine-positron emission tomography with fluorodeoxyglucose-positron emission tomography could successfully discriminate sarcoidosis from malignancy. The finding of delayed enhancement in cardiac magnetic resonance imaging could identify cardiac involvement of sarcoidosis with higher sensitivity than echocardiography, thallium scintigraphy, and gallium scintigraphy. Endobronchial ultrasonograpy-guided transbronchial needle aspiration is a safe and useful tool for diagnosing sarcoidosis with a diagnostic accuracy, sensitivity and specificity of 85-93, 78-89, and 92-96%, respectively. Developments in genetics have demonstrated that 99% of the human leukocyte antigen DRB1*0301/DQB1*0201-positive patients with Löfgren's syndrome show a spontaneous remission, in contrast to only 55% of the human leukocyte antigen DRB1*0301/DQB1*0201-negative patients. These alleles could be novel promising factors for discriminating a prognosis in Löfgren's syndrome.
Recent development including novel imaging techniques, novel biopsy procedures, and genetic analyses could be of value for the diagnosis of sarcoidosis.
Article: Bilateral epididymal sarcoidosis.[show abstract] [hide abstract]
ABSTRACT: To report a case of bilateral epididymal sarcoidosis. Case report. University hospital. An azoospermic 29-year-old Caucasian male who had had an illness 2 years earlier with acute onset and progressive course of weight loss, fatigue, and cough with painless subcutaneous nodules on the arms, upper thighs, and eyelids. Physical examination, scrotal ultrasonography, scrotal magnetic resonance imaging, chest x-ray and computed tomography (CT), urine and semen Ziehl-Neelsen stain, and epididymal/testicular biopsies. Clinical, laboratory, radiologic, and histopathologic data. The patient had bilateral epididymal firm masses with normal sized testes and bilateral enlarged, firm, nonpainful inguinal lymph nodes. Scrotal ultrasonography showed diffuse, bilateral, epididymal enlargement with heterogeneous echo pattern and increased vascularity. Scrotal magnetic resonance imaging revealed diffuse, enlarged epididymis with no focal masses. The chest x-ray revealed prominent hilar shadows, and the chest computed tomography showed mediastinal and hilar lymphadenopathy. Urine and semen Ziehl-Neelsen stains were negative for acid-fast bacilli. Epididymal histopathology revealed multiple noncaseating epithelioid granulomas with concentric arrangement of reticular fibers by reticulin stain. Scrotal involvement in sarcoidosis with its variable presentations should be considered.Fertility and sterility 03/2009; 91(5):1957.e1-4. · 3.97 Impact Factor
Article: [Sarcoidosis and tobacco smoking--clinical picture, diagnostic tests results and bronchoalveolar lavage fluid composition].[show abstract] [hide abstract]
ABSTRACT: Sarcoidosis is a multiorgan granulomatous disease of unknown aetiology. Bronchoalveolar lavage (BAL) is approved in diagnostics of sarcoidosis. The aim of the study was to assess epidemiological data, demographic status, clinical picture of sarcoidosis patients and to correlate above-mentioned findings with smoking status. The study included 101 patients hospitalized due to suspicion of pulmonary sarcoidosis. The results of clinical assessment and smoking status data were obtained by retrospective analysis of 78 confirmed sarcoidosis case records. Investigated group comprised 54 non-smokers (NS) and 24 smokers (S), including 9 (11.5%) active smokers (AS). Smokers were significantly younger than nonsmokers. Most of the smokers were males. The mean number of pack-years was 8.2. Respiratory symptoms occurred with similar frequency among non-smokers and smokers. The incidence of the Loefgren's syndrome was similar in S and NS . The pulmonary function tests results were comparable in both groups, however, the obstruction was more frequent among smokers. Composition of BAL fluid (BALf) differed significantly between S and NS. The total cell count was significantly higher among active smokers than among nonsmokers (29.3 +/- 19.2 x 10(6) vs 13.7 +/- 6.3 x 10(6)). Compared to non-smokers, smokers had higher number of macrophages and lower percentage of lymphocytes (11.3 +/- 11 x 10(6) vs 6.5 +/- 3.9 x 10(6), 29 +/- 19 vs 41 +/- 17%, respectively). A significantly lower proportion of smokers is observed among sarcoidosis patients than in general population. The influence of smoking on clinical picture and results of pulmonary function tests is not evident in sarcoidosis. However, tobacco smoking causes significant alteration in the composition of BALf, which should be taken into account in diagnostics of sarcoidosis.Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego 05/2012; 32(191):298-301.
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ABSTRACT: Sarcoidosis is a disease characterized by granuloma formation in many organs, but mostly in lung and lymph nodes. The immunopathogenic background of the disease is probably based on disregulation of immune response to different antigens. The imbalance of immune reactivity might be influenced by genetic background. In our study, we have investigated cytokine genetic polymorphisms in sarcoidosis group and compared the results with that of a group of healthy volunteers. Thirty one sarcoidosis patients were enrolled to our study. Basic demographic data were collected. Polymorphisms in the promoter regions of the IL-1alpha, IL-1beta, IL-1R, IL-1RA, IL-2, IL-4, IL-6, IL-10, IL-12, TNF-alpha, IFN-gamma and in the translated regions of the TGF-beta, IL-1 beta, IL-2, IL-4 and IL-4RA genes were characterized. For IL-10, the (-819) and (-592) CC homozygosity was statistically more frequent in the sarcoidosis group compared to healthy controls. According to the haplotypes, the majority of sarcoidosis patients had IL-10 (-1082)(-819)(-592) ACC haplotype 2 compared to controls with ATA in most of the cases. The results of our study support the hypothesis of a genetically encoded immune regulation imbalance in sarcoidosis. The high-producer IL-10 (-819) and (-592) CC genotypes and intermediate- producer IL-10 (-1082) (-819) (-592) ACC haplotype 2 present in the majority of our sarcoidosis patients could support the role of genetically encoded disregulation of cell- mediated immune response to an unknown antigen.Sarcoidosis, vasculitis, and diffuse lung diseases: official journal of WASOG / World Association of Sarcoidosis and Other Granulomatous Disorders 07/2010; 27(1):70-5. · 1.27 Impact Factor