ObjectiveTo improve the diagnosis and treatment of multiple systemic sarcoidosis (MSS) and avoid misdiagnosis. MethodsTo analyze the diagnosis and treatment of a MSS patient misdiagnosed as lymphoma. Related literatures were also reviewed. ResultsThe patients' clinical manifestations were not specific including cough and stethocatharsis. Lung and thoracic lymph nodes were most commonly involved in MSS. MSS was characterized by symmetrical lymph nodes enlargement in the bilateral lung hilus and/or mediastinum. The enlarged lymph nodes had a clear boundary and showed homogeneous enhancement. Symmetrical fluorodeoxyglucose (FDG) uptake in the hilar and/or mediastinal node was a typical finding of sarcoidosis on FDG PET/CT. Mucosal inflammation and mucosal nodules could be seen in the bronchoscope. Sarcoidosis was characterized by the presence of noncaseating groanulomas histologically. Hormonal therapy was effective for MSS. ConclusionSarcoidosis is a kind of disease involving multiple systems and organs with unknown etiology. The clinical manifestation of sarcoidosis is nonspecific,so it's likely to be misdiagnosed. Imaging examination and laboratory examination are helpful to the diagnosis of MSS. The definitive diagnosis depends on the pathologic biopsy.
Abstract： Sarcoidosis is a common systemic disease with noncaseating granulomatous epithelioid nodule and coexisting granulomatous inflammation. Although sarcoidosis can affect any organ of the body， more than 90% of the patients demonstrate thoracic involvement， which is often confusing with lung cancer and other diseases. Therefore, thoracic surgeons must have a clear understanding of sarcoidosis. Moreover， due to the special role of surgery in obtaining pathological specimens， thoracic surgeon plays an important role in the diagnosis and treatment of sarcoidosis. It is not difficult to make diagnosis for patients with typical clinical features of sarcoidosis. However， the majority of patients do not have specific manifestations of sarcoidosis. The cause of sarcoidosis remains unknown， and there is also no specific treatment strategy for it. But recent research has shown that annexin A11 gene may be involved in the pathogenesis of sarcoidosis， and tumor necrosis factor （TNF） inhibitor is effective in the treatwent of sarcoidosis.
Objective To investigate the expression of Th17 cells in peripheral blood of patients with sarcoidosis at different stage. Methods Flow cytometry was used to detect the Th17 cells in peripheral blood of 38 patients with sarcoidosis, including 18 cases of newly diagnosed active patients with obvious symptoms such as cough, fever, fatigue and weight loss, and 20 stable cases who were followed up regularly.15 cases of healthy volunteers were enrolled as control. Serumangiotensin-converting enzyme ( SACE) of the patients with sarcoidosis was detected by ultraviolet spectrophotometry. The cell classification and CD4 + /CD8 + T in the BALF of the newly diagnosed active patients were calculated. Results The expression of Th17 cells in peripheral blood in the patients with active sarcoidosis were higher than that in the sable patients and the controls [ ( 1. 59 ±0. 44) % vs. ( 0. 56 ±0. 32) % and ( 0. 49 ±0. 23) % , all P lt; 0. 05] . Th17 cells in peripheral blood in the patients with stable sarcoidosis and the controls were not different significantly ( P gt;0. 05) . The levels of SACE in the patients with active sarcoidosis were higher than that in the patients with stable sarcoidosis [ ( 56. 6 ±14. 6) IU/L vs. ( 35. 8 ±18. 3) IU/L, P lt; 0. 05) . There was not significant correlation between the Th17 cells in peripheral blood and SACE in the patients with sarcoidosis ( P gt;0. 05) . In the patients with active sarcoidosis, the Th17 cells in peripheral blood were not significantly correlated with lymphocyte percentages in BALF( P gt; 0. 05) , but significantly correlated with CD4 + /CD8 + in BALF ( r=0. 63, P lt;0. 05) .Conclusion In patients with active sarcoidosis, the increased expression of Th17 cells in peripheral blood may correlate with the activity of sarcoidosis.
ObjectiveTo assess the prognosis of asymptomatic pulmonary sarcoidosis with normal lung function. MethodsEighty-two patients with asymptomatic pulmonary sarcoidosis,diagnosed in Guangzhou Institute of Respiratory Diseases between July 2007 and November 2013,were followed for 24 months.The clinical data were collected and analyzed. Results31.7% of the patients showed spontaneous remission without therapy,whereas 39.0% deteriorated and 29.3% remain stable.There was no significant difference between the remission group and the progressive sarcoidosis group with regard to FEV1.17.1% of patients in the progressive sarcoidosis group had a decline in FEV1,while 73.8% had a reduced FVC,and 28.3% had a reduced DLCO.At the beginning of observation,TNF-α level was higher in the progressive sarcoidosis group compared with the remission group and the stable group[(173.5±37.8) μg/mL vs.(102.6±82.7) μg/mL and(131.7±57.9) μg/mL,P<0.05].In the progressive sarcoidosis group,TNF-α at the end time of the observation was higher than that at the beginning[(229.2±76.7) μg/mL vs.(173.5±37.8) μg/mL,P<0.05].The neutrophil in BALF was significantly higher in the progressive sarcoidosis group compared with the remission group[(10.6±4.6)% vs.(8.68±5.2)%,P<0.01). There were no significant differences between the progressive sarcoidosis group and the remission group with regard to CD4/CD8 T-cell ratio and the expression of angiotensin converting enzyme(ACE) in lung tissue.Non-necrotizing granulomas rate in endobronchial biopsy was 63.6% in the progressive sarcoidosis group,54.9% in the remission group,and 58.4% in the stable group,respectively,without significant difference between three groups(P>0.05) but was significantly different between three groups at the end time of the observation(69.1% vs.12.7% and 36.2%,P<0.05). ConclusionNearly 40% asymptomatic pulmonary sarcoidosis are likely to deteriorate.The increase of TNF-α and BALF neutrophils may indicate the progress of sarcoidosis.
Endobronchial ultrasound guided tranbronchial needle aspiration (EBUS-TBNA) is a new technology developed in the past 10 years. In the USA, EBUS-TBNA has been recommended as an important means for preoperative lymph node staging of lung cancer, and becomes a new standard for mediastinal staging of lung cancer. A large number of clinical data shows that EBUS-TBNA is a novel approach which owes the advantages of accuracy in diagnosis and safety in operating. What's more, its value in the diagnosis of some disease in chest has been widely recognized. The aim of this article is to review the current application of EBUS-TBNA in the diagnosis of early lung cancer, diagnosis and tumor staging of advanced lung cancer, the relationship between EBUS-TBNA and traditional inspection including CT, positron emission tomography/computed tomography (PET) and mediastinoscopy, and the application value of EBUS-TBNA for superior vena cava syndrome and some non-neoplastic diseases.