title: The ultrastructural features of developing Kveim test granulomas.
abstract: The Kveim test provides a useful model for the ultrastructural study of developing epithelioid cell granulomas in man. We present a controlled prospective study in which 140 patients with possible sarcoidosis had two simultaneous Kveim tests, one being biopsed at a varying interval and the other at the usual 28 days: 52 patients showed a positive test. Controls were provided by the 88 negative tests, Kveim biopsis from 12 healthy subjects, and biopsies of normal spleen injection sites in a further 12 sarcoid patients. In all three groups the initial response (3 to 5 days) was macrophage influx. From 8 to 10 days, in developing positive tests only, mononuclear cells with abundant rough endoplasmic reticulum appeared. Mature epithelioid cells were seen at 12 to 14 days, when lymphocyte numbers and lymphocyte-histiocyte interactions were at a maximum. Epithelioid cells showed marked secretory activity; the ultrastructural features of the developing epithelioid cell vacuoles are identical to those seen in exocrine cells. Mast cells are not involved in the development of granulomas.
authors.affiliation: National Heart and Lung Institute, Brompton Hospital, London, United Kingdom.
authors.forename: E A
authors.initials: EA
authors.lastname: Sheffield
authors.forename: D N
authors.initials: DN
authors.lastname: Mitchell
authors.forename: A
authors.initials: A
authors.lastname: Dewar
authors.forename: B
authors.initials: B
authors.lastname: Corrin
mesh_terms: D006099:Granuloma / Q000473:pathology*; D006801:Humans; D007731:Kveim Test; D011446:Prospective Studies; D012507:Sarcoidosis / Q000473:pathology; D013997:Time Factors