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Tuberk Toraks 2018;66(3):212-216
Mediastinal/hiler granülomatöz lenfadenit etyolojisi
212
Mediastinal/hiler granülomatöz
lenfadenit etyolojisi
doi 10.5578/tt.67018
Tuberk Toraks 2018;66(3):212-216
Geliş Tarihi/Accepted: 04.07.2018
KLİNİK ÇALIŞMA
Müge ERBAY1
Savaş ÖZSU1
Emine Sevil AYAYDIN
MÜRTEZAOĞLU1
Atila TÜRKYILMAZ1
Neslihan ÖZÇELİK2
Yılmaz BÜLBÜL1
Şafak ERSÖZ3
1
1 Department of Chest Diseases, Faculty of Medicine, Karadeniz Teknik
University, Trabzon, Turkey
2
2 Clinic of Chest Diseases, Kackar State Hospital, Rize, Turkey
3
3 Department of Pathology, Faculty of Medicine, Karadeniz Teknik University,
Trabzon, Turkey
ÖZET
Mediastinal/hiler granülomatöz lenfadenit etyolojisi
Giriş: Granülom oluşumu çeşitli infeksiyöz ve infeksiyöz olmayan ajanlar tarafından başlatılan kronik bir inflamatuvar yanıtı temsil
etmektedir. Özellikle infeksiyöz dışı nedenlere bağlı granülomatöz nedenler klinisyenleri oldukça zorlamaktadır.
Materyal ve Metod: Bu çalışmada Eylül 2014 ile Aralık 2016 arasında EBUS ya da mediastinoskopiyle mediastinal/hiler lenfadenopa-
tilerin (LAP) histopatolojik değerlendirmesinde granülomatöz lenfadenit tanısı alan hastaların dağılımı araştırılmıştır.Uyumlu histolo-
jik, radyolojik ve klinik bulgularla birlikte kültür negatifliği olduğunda ‘güvenli’ sarkoidoz olarak tanımlandı. Dokuda mikroorganizma
görülmesi, kültür pozitifliği, tutarlı klinikopatolojik durumda pozitif seroloji veya pozitif antijen saptanması durumunda ‘güvenli’
infeksiyöz olarak kaydedildi.
Bulgular: Toplam 110 hastada granülomatöz LAP saptandı. Hastaların %70.9’u kadın cinsiyetindeydi ve ortalama yaş 53 (range
44-61)’tü. Yetmiş dokuz (%71.8) hastada sarkoidoz, 7 (%6.4) hastada tümör ilişkili granülom, 4 (%3.6) hastada tüberküloz, 4
(%3.6) hastada silikozis, 2 hastada (%1.8) ilaç ilişkili granülom, 1 (%0.9) hastada hipersensitivite pnömonisi, 1 (%0.9) hastada
Chron hastalığı, 12 (%10.9) hastada nedeni bilinmeyen granülom saptandı. Tüberküloz tanısı 3 hastada kültür pozitifliğiyle konuldu.
Sonuç: Bu çalışmada granülomatöz lenfadenitin en sık sebebinin sarkoidoz olduğu saptandı. Beklenenin aksine tüberküloz tanısı alan
hasta sayısı oldukça düşüktü.
Anahtar kelimeler: Granülom; lenfadenit; sarkoidoz
SUMMARY
Causes of mediastinal/hilar granulomatous lymphadenitis
Introduction: Granulomatous lung disease (GLD) is caused by a
wide range of conditions and it is challenge for pulmonologist. A
detailed history of exposures is fundamental in GDL and has been
found pivotal to reach a precise diagnosis.
Yazışma Adresi (Address for Correspondence)
Tuberk Toraks 2018;66(3):212-216
Erbay M, Özsu S, Ayaydın Mürtezaoğlu ES, Türkyılmaz A, Özçelik N, Bülbül Y, Ersöz Ş.
213
GİRİŞ
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MATERYAL ve METOD
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Mycobacterium tuberculosis
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di.
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Materials and Methods: Between September 2014 and December 2016, the distribution of patients diagnosed with granulomatous
lymphadenitis in the mediastinal/hilar lymph nodes by endobronchial ultrasound (EBUS) or mediastinoscopy was analyzed. To be
listed as ‘confident’, a diagnosis of sarcoidosis required compatible histological, radiological and clinical findings in conjunction with
negative cultures. Infectious entities listed as ‘confident’ had either microorganisms in tissue section, positive culture, positive serology
or positive antigen detection in a consistent clinical pathological setting.
Results: Granulomatous lymphadenitis was detected in 110 patients. The included 110 cases consisted of 70.9% women and median
age of 53 (range 44-61) years. The final diagnosis of the patients was accepted to be sarcoidosis in 79 (71.8%), sarcoid like
granulomas in 7 (6.4%), tuberculosis in 4 (3.6%), silicosis in 4 (3.6%), drug-associated granuloma in 2 (1.8%), hypersensitivity
pneumonitis in 1 (0.9%), Chron disease in 1 (0.9%), unspecified in 12 (10.9%). Three patients were classified as tuberculosis based
on culture.
Conclusion: In this study, we found that the most common cause of granulomatous lymphadenitis was sarcoidosis. Contrary to
expectations, the number of patients diagnosed with tuberculosis was very low.
Key words: Granuloma; lymphadenitis; sarcoidosis
Tuberk Toraks 2018;66(3):212-216
Mediastinal/hiler granülomatöz lenfadenit etyolojisi
214
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İstatistiksel Analiz
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BULGULAR
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TARTIŞMA
G
Tablo 1.
Hasta sayısı (%)
79 (71.8)
7 (6.4)
4 (3.6)
4 (3.6)
2 (1.8)
1 (0.9)
1 (0.9)
12 (10.9)
Tuberk Toraks 2018;66(3):212-216
Erbay M, Özsu S, Ayaydın Mürtezaoğlu ES, Türkyılmaz A, Özçelik N, Bülbül Y, Ersöz Ş.
215
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(7).
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Mycobacterium tuberculo-
sis -
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Tuberk Toraks 2018;66(3):212-216
Mediastinal/hiler granülomatöz lenfadenit etyolojisi
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KAYNAKLAR
1. Nazarullah A, Nilson R, Maselli DJ, Jagirdar J. Incidence
and aetiologies of pulmonary granulomatous inflammation:
A decade of experience. Respirology 2015;20:115-21.
2. Mukhopadhyay S, Wilcox BE, Myers JL, Bryant SC,
Buckwalter SP, Wengenack NL, et al. Pulmonary
necrotizing granulomas of unknown cause: clinical and
pathologic analysis of 131 patients with completely
resected nodules. Chest 2013;144:813-24.
3. GovenderP, Berman JS. Thediagnosisofsarcoidosis. Clin
Chest Med 2015;36:585-602.
4. Brincker H. Sarcoid reactions in malignant tumours.
Cancer Treat Rev 1986;13:147-56.
5. Shigeyuki Asano. Granulomatous lymphadenitis. J Clin
Exp Hematopatho 2012;52:1-16.
6. Brunner A, Kantner J, Tzankov A. Granulomatous reactions
cause symptoms or clinically imitate treatment resistance
in small lymphocytic lymphoma/chronic lymphocytic
leukaemia more frequently than in other non-Hodgkin
lymphomas. J Clin Pathol 2005;58:815-9.
7. DePew ZS, Gonsalves WI, Roden AC, Bungum AO, Mullon
JJ, Maldonado F. Granulomatous inflammation detected
by endobronchial ultrasound-guided transbronchial
needle aspiration in patients with a concurrent diagnosis
of cancer a clinical conundrum. J Bronchol Intervent
Pulmonol 2012;19:176-81.
8. Kennedy M, Jimenez C, Mhatre A, Morice RC, Eapen GA.
Clinical implications of granulomatous inflammation
detected by endobronchial ultrasound transbronchial
needle aspiration in patients with suspected cancer
recurrence in the mediastinum. J Cardiothorac Surg
2008;3:8-12.
9. Yakar F,Yakar A,Büyükpınarbaşılı N,Erelel M. Does every
necrotizing granulomatous inflammation identified by
NSCLC resection material require treatment? Med Sci
Monit 2016;22:1218-22.
10. Mukhopadhyay S, Farver CF, Vaszar LT, Dempsey OJ,
Popper HH, Mani H, et al. Causes of pulmonary
granulomas: a retrospective study of 500 cases from seven
countries. J Clin Pathol 2012;65:51-7.
11. Gürün Kaya A, Çiledag A, Çiftçi F, Sen E, Ceyhan K, Kaya
A, et al. The underlying causes of granulomatous
lymphadenitis detected by EBUS-TBNA. European
Respiratory Journal2015;46:788.
12. Musellim B, Okumus G, Uzaslan E, Akgün M, Cetinkaya E,
Turan O, et al. Turkish interstitial lung diseases group.
Epidemiology and distribution of interstitial lung
diseasesinTurkey. Clin Respir J 2014;8:55-62.
13. Senturk A, Arguder E, Hezer H, Babaoglu E, Kilic
H, Karalezli A, et al. Rapid diagnosis of mediastinal
tuberculosis with polymerase chain reaction evaluation of
aspirated material taken by endobronchial ultrasound-
guided transbronchial needle aspiration. J Investig
Med2014;62:885-9.
14. Denkinger CM, Schumacher SG, Boehme CC, Dendukuri
N, Pai M, Steingart KR. Xpert MTB/RIF assay for the
diagnosis of extrapulmonary tuberculosis: a systematic
review and meta-analysis. Eur Respir J 2014;44:435±46.
15. Chakravorty S, Sen MK, Tyagi JS. Diagnosis of
extrapulmonary tuberculosis by smear, culture, and PCR
using universal sample processing technology. J Clin
Microbiol 2005;43:4357±62.
16. Goel MM, Ranjan V, Dhole TN, Srivastava AN, Mehrotra
A, Khushwaha MR, et al. Polymerase chain reaction versus
conventional diagnosis in aspirates of tuberculous lymph
nodes. Acta Cytol 2001;45:333-40.
17. Baek CH, Kim SI, Ko YH, Chu KC. Polymerase chain
reaction detection of Mycobacterium from FNA for
diagnosis of cervical tuberculosis. Laryngoscope
2000;110:30-4.
18. Daley P, Thomas S, Pai M. Nucleic acid amplification tests
for the diagnosis of tuberculous lymphadenitis: a
systematic review. Int J Tuberc Lung Dis 2007;11:1166±76.
19. Mustafa T, Wiker HG, Mfinanga SG, Morkve O, Sviland L.
Immunohistochemistry using a Mycobacterium
tuberculosis complex specific antibody for improved
diagnosis of tuberculous lymphadenitis. Mod Pathol
2006;19:1606±14.
20. Purohit MR, Mustafa T, Wiker HG, Morkve O, Sviland L.
Immunohistochemical diagnosis of abdominal and lymph
node tuberculosis by detecting Mycobacterium
tuberculosis complex specific antigen MPT64. Diagn
Pathol 2007;2:36.
21. Jørstad MD, Marijani M, Dyrhol-Riise AM, Sviland
L, Mustafa T. MPT64 antigen detection test improves
routine diagnosis of extrapulmonary tuberculosis in a low-
resource setting: A study from the tertiary care hospital in
Zanzibar. PLoS One 2018;13:e0196723.
22. Karabay O, Kilic S, Gurcan S, Pelitli T, Karadenizli
A,Bozkurt H,et al. Cervical lymphadenitis: tuberculosis
or tularaemia? Clin Microbiol Infect2013;19:113-7.
