About unimproved opportunities of differentiation of sarcoidosis and tuberculosis
https://doi.org/10.18093/0869-0189-2016-26-3-309-315
Abstract
This study was aimed at analysis of own experience of differentiation between pulmonary tuberculosis and sarcoidosis.
Methods. We evaluated VATS biopsy samples from 250 patients with disseminated lesion of the lungs and/or intrathoracic lymph nodes of unknown origin. Previous examination excluded any known granulomatosis excepting pulmonary tuberculosis and sarcoidosis. The biopsy samples were collected in different regions of Russia in 2010–2014.
Results. Typical epithelioid cell granulomas with giant multinucleated cells were seen in lymph nodes and the lung tissue in all cases. Necrosis and/or presence of acid"fast mycobacteria were necessary and sufficient sign of tuberculosis. Granulomas without necrosis and mycobacteria in slice series, but not in one or two incident slices, were considered as highly specific for sarcoidosis.
Conclusion. We suppose that differentiation between tuberculosis and sarcoidosis should be based on complex clinical and morphological analysis with the determinant role of morphological examination
About the Authors
B. M. Ariel
Saint-Petersburg Federal Research Institute of Phthisiology and Pulmonology, Healthcare Ministry of Russia: 2 – 4, Ligovskiy av., Saint-Petersburg, 191036, Russia;
Saint-Petersburg City State Pathological Bureau: 5, Uchebnyy side street, Saint-Petersburg, 194354, Russia
Russian Federation
Russian Federation
MD, Professor, Chief of Council Board of Saint Petersburg Pathological Service in SaintPetersburg City State Pathological
Bureau; tel.: (812) 5136098
I. V. Dvorakovskaya
Research Pulmonology Institute, Academician I.P.Pavlov First Saint-Petersburg State Medical University, Healthcare Ministry of Russia: 6 – 8, L'va Tolstogo str., Saint-Petersburg, 197022, Russia
Russian Federation
Russian Federation
MD, Chief Scientist at Laboratory of Pathomorphology, Research Pulmonology Institute, Academician I.P.Pavlov First SaintPetersburg State Medical University, Healthcare Ministry of Russia; tel.: (812) 3387890
E. K. Zil'ber
Saint-Petersburg Federal Research Institute of Phthisiology and Pulmonology, Healthcare Ministry of Russia: 2 – 4, Ligovskiy av., Saint-Petersburg, 191036, Russia
Russian Federation
Russian Federation
MD, Deputy Director for Science, SaintPetersburg Federal Research Institute of Phthisiology and Pulmonology, Health care Ministry of Russia; tel.: (921) 0992767
M. Yu. Mayskaya
«Elizavetinskaya bol'nitsa» Saint-Petersburg City State Hospital: 14, Vavilovykh str., Saint-Petersburg, 195257, Russia
Russian Federation
Russian Federation
PhD, Head of Pathological Department of Saint Petersburg «Elizavetinskaya bol'nitsa» City State Hospital; tel.: (812) 555 1273
G. B. Koval'skiy
Saint-Petersburg City State Pathological Bureau: 5, Uchebnyy side street, Saint-Petersburg, 194354, Russia
Russian Federation
Russian Federation
MD, Professor, Head of SaintPetersburg City State Pathological Bureau; tel.: (812) 3384860
References
1. Dvorakovskaya I.V., Akopov A.L., Ariel' B.M. et al. Biopsy in Pulmonology. A Pathologist’s Library. Saint"Petersburg; 2011 (in Russian).
2. Strukov A.I., Kaufman O.Ya. Granulomatous Inflammation and Granulomatous Disease. Moscow: Meditsina; 1989 (in Russian).
3. Mechnikov I.I. Lectures on Comparative Pathology of Inflammation. Мoscow: Izd"vo AN SSSR; 1951 (in Russian).
4. Borisov S.E., Solov'eva I.P., Evfim'evskiy V.P. et al. Diagnosis and Treatment of Pulmonary Sarcoidosis. A Practical Handbook for Phthisiatricians and Pneumologists. Problemy tuberkuleza. 2003; 6: 51–64 (in Russian).
5. Visel A.A., ed. Sarcoidosis: from theory to practice. Kazan’: FEN, 2004 (in Russian).
6. Dvorakovskaya I.V., Ariel' B.M..Diagnosis of Sarcoiidosis. A Practical Handbook. A Pathologist’s Library. Saint-Petersburg: VVN; 2005 (in Russian).
7. Makarova O.V. Sarcoidosis. In: Pal'tsev M.A., Kakturskiy L.V., Zayrat'yants O.V., eds. Pathological Anatomy. A National Guidelines. Moscow: GEOTAR"Media; 2011: 149–154 (in Russian).
8. Dvorakovskaya I.V., Mayskaya M.Yu., Nasyrov R.A. et al. Morphological examination in differentiation of tuberculosis and sarcoidosis. Arkhiv patologii. 2014; 1: 27–31 (in Russian).
9. Ellinidi V.N., Ariel' B.M., Samusenko I.A., Tugolukova L.V. Immunohistochemical method for diagnosis of tuberculosis. Arkhiv patologii. 2007; 5: 36–38 (in Russian).
10. Ariel' B.M. About unimproved opportunities of theoretical analysis in morphology. In: Bekhtereva N.P., ed. Methodological aspects of theoretical medicine. Leningrad: Meditsina; 1975: 154–167 (in Russian).
11. Travis W.D., Colby T.V., Koss M.M. et al. Atlas of nontumor pathology. Fasc. 2. Non"neoplastic disorders of the lower respiratory tract. Washington: AFIP; 2002.
12. Strukov A.I. Variants of pulmonary tuberculosis from a pathologist’s point of view. A Pathologist’s Library. Nauchno#prakticheskiy zhurnal im. N.N.Anichkova. 2014; Issue 151–152 (in Russian).
13. Mayskaya M.U., Otten T.F., Ariel B.M. et al. Morphological manifestations of the atypical mycobacteriosis caused by nontuberculous mycobacteria in the HIV infected patients. Ann. Clin. Lab. Sci. 2014; 44 (2): 131–133.
14. Abrikosov A.I. Special Pathology: Respiratory System. Moscow: Medgiz; 1947 (in Russian).
15. Pletnev D.D. A problem of visceral neurosis. Klinicheskaya meditsina. 1931; 9 (7, 8): 337–344 (in Russian).
Review
For citations:
Ariel B.M., Dvorakovskaya I.V., Zil'ber E.K., Mayskaya M.Yu., Koval'skiy G.B. About unimproved opportunities of differentiation of sarcoidosis and tuberculosis. PULMONOLOGIYA. 2016;26(3):309-315. (In Russ.) https://doi.org/10.18093/0869-0189-2016-26-3-309-315
Views:
1257
Email this article 