[SOME VARIANTS OF DIFFERENTIAL DIAGNOSTIC DIFFICULTIES IN PULMONARY TUBERCULOSIS AND SARCOIDOSIS].
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Three hundred and thirty-two patients with pulmonary sarcoidosis were examined in 2005 to 2008. Atypical disposition of chest X-ray changes was found in 32 patients. In these cases physicians encounter the greatest difficulties in the differential diagnosis of sarcoidosis. The patients with pulmonary sarcoidosis were found to have 2 clinical and X-ray variants according to the location of X-ray changes. Four clinical histories of difficult cases of the differential diagnosis of pulmonary sarcoidosis are given.Keywords:
Pulmonary sarcoidosis
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Introduction. Diagnosis of tuberculous and sarcoid granulomas is frequent in routine pathological practice. Tuberculosis and sarcoidosis have lately been considered to be the same disease but with different manifestations or two different diseases with the same manifestations because of the presence of the same antigens that stimulate formation of granulomas. That is why the differential diagnosis of sarcoidosis and tuberculosis could be difficult on biopsies. The aim of this study was to point to the difficulties met by a pathologist in diagnosing tuberculosis and sarcoidosis. Results. In case of typical morphology, the differentiation of sarcoidosis and tuberculosis is simple. In the presence of productive granulomas in tuberculosis or necrotizing granulomas in sarcoidosis, it is difficult to establish the pathological diagnosis without clinical data. The role of the pathologist in diagnosing sarcoidosis and tuberculosis is to establish the presence of granulomas and to suggest the diagnosis according to its morphology. The definitive diagnosis requires a multidisciplinary approach of pulmonologists, radiologists, microbiologists, immunologists, biochemists and pathologists.
Pulmonologists
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Pulmonary tuberculosis (TB) is currently one of the most important infection related morbidity and mortality causes in the world. The differential diagnosis between TB and some others pathologic conditions is an emerging problem, as pulmonary TB may easily show etherogenous aspects. Differential diagnosis can be particularly challenging when TB mimicks sarcoidosis, lymphoma and pulmonary neoplasms.
Pulmonary sarcoidosis
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Pulmonary sarcoidosis
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We report the case of a 75 years old man who insidiously developed a unusual presentation of tuberculosis. The story began with a tuberculous arthritis of the foot, later associated with pulmonary, endobronchial, mediastinal and cervical lymphadenitis tuberculosis. Because the microscopic examination was negative for acid-fast bacilli (AFB) in all involved sites, the diagnosis of sarcoidosis was suggested. We discuss the diagnosis difficulties of tuberculosis in the elderly, the extrapulmonary manifestations of tuberculosis and some aspects of its differential diagnosis with sarcoidosis.
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Foot (prosody)
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SOME pathologists believe that sarcoidosis is a type of noncaseating tuberculosis, while others maintain that it is a separate disease entity of unknown origin. The similarity of the clinical manifestations of sarcoidosis and tuberculosis and the resemblance of the biopsy findings frequently make the differential diagnosis of these diseases difficult. In cases in which the presence of acid-fast bacilli can be demonstrated, there is no question about the diagnosis; but in the absence of clinical signs of tuberculosis and in cases in which examination fails to disclose Mycobacterium tuberculosis, the biopsy findings may be considered characteristic of either tuberculosis or sarcoidosis. I shall report 2 cases of sarcoidosis of the orbit which have been observed at the Mayo Clinic. REPORT OF CASES Case 1. —A white woman aged 54, a native of Puerto Rico, came to the Mayo Clinic on Jan. 21, 1926 because of a mass in the left
Orbit (dynamics)
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Pulmonary sarcoidosis
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Objective To verify and evaluate the clinical application value of pre-established Real-Time quantitative PCR to detect Mycobacterium tuberculosis DNA in the differential diagnosis of sarcoidosis and atypical tuberculosis.Method Forty-nine patients with granulomatosis disciformis but no final diagnosis as sarcoidosis or tuberculosis were enrolled into this study from Jun 2008 to Jun 2009.Real-Time quantitative PCR pre-established were used to detect Mycobacterium tuberculosis DNA(TB-PCR)in 49 patients' paraffin blocks with the optimal cut-off value 1.14×10~3 copies/ml. Clinical,imaging,pathology and other data were combined to make differential diagnosis and give guidance of therapy.The clinical appearance,imaging changes,therapeutic effects were followed up till Aug 1st,2009 and the clinical application value of this method were evaluated.Result Ten samples of TB-PCR were positive(2.01×10~3 -7.98×10~4 copy/ml),the positive rate was 20.41%,39 samples were negative. Combined with clinical data and TB-PCR results,33 cases were diagnosed as sarcoidosis,2 were tuberculosis. The percentage of definite diagnosis achieved was 72%(35/49).Patients with definite diagnosis were followed up for 2～14 months in which 33 patients with sarcoidosis and 2 cases with tuberculosis got stable or improved after the therapy,none of them worsen.Conclusion The Real-Time quantitative PCR for detection of Mycobacterium tuberculosis DNA in paraffin-embedded tissues can sensitively and effectively detect Mycobacterium tuberculosis from tuberculosis proliferative granulomatous lesions.It is effective to help to differentiat sarcoidosis and atypical tuberculosis.
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The case of sarcoidosis of the lungs is described in a 50 years old female who presented with symptoms similar to pulmonary tuberculosis. As she showed no improvement on anti-tubercular therapy, sarcoidosis was suspected and confirmed by endobronchial biopsy and she responded well to treatment.
Pulmonary sarcoidosis
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The paper considers the results of histological and bacterioscopic examinations of biopsy specimens from the lung and mediastinal lymph nodes of 120 patients with an unclear diagnosis of tuberculosis and sarcoidosis and with problem of their differential diagnosis. One hundred and five of these patients were microscopically diagnosed as having either tuberculosis or sarcoidosis. Additional examination of differently stained sections and that using immunohistochemical M. tuberculosis detection were conducted in 15 cases, which could diagnose tuberculosis and sarcoidosis in 7 and 8 patients, respectively. Bacterioscopic examination, in terms of extreme variability the phenotypic properties of mycobacteria, is of decisive importance in the differential diagnosis of tuberculosis and sarcoidosis.
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