The clinical spectrum of the sarcoid peripheral lymph node.
BACKGROUND
The finding of sarcoid-type granulomas in a peripheral lymph node (PLN) without clinical evidence of changes suggestive of sarcoidosis elsewhere poses a diagnostic problem. The long term follow-up of these patients has never been described in adults. AIMS OF THE WORK: 1. To describe in the above population whether and when a definite diagnosis of sarcoidosis was eventually made, and the time required to make the diagnosis. 2. To study the percentage of peripheral lymph node presentation in sarcoidosis.


METHODS
A peripheral lymph node presentation, with lymph node biopsy demonstrating sarcoid granulomas, was seen in 127 patients over the last 20 years. Detailed investigation permitted the early diagnosis of sarcoidosis in 76, and of sarcoid reaction in 8 patients. The other 43-patients with granulomatous lymph node and no clinical evidence of changes outside the lymphatic system at the onset are the subject of the present study.


METHODS
Periodic examination at our Sarcoid Clinic every 2 to 4 months, in a long term median follow-up of 36 months (range 1 to 203) and workup according to clinical need, including chest X ray and Computed Axial Tomography (CAT), pulmonary function tests, total body 67Ga scan, Broncho Alveolar Lavage (BAL) studies, blood cell counts, 24 h calciuria and urine analysis, serological tests for liver function, calcaemia, Angiotensin Converting Enzyme (ACE).


RESULTS
The diagnosis of sarcoidosis (chronic in all) could be made in 33 patients (25 pulmonary, 8 extrapulmonary), after a median time from presentation of 5 years (range 3-288 months). In the other 10, in spite of a median duration of the illness of 62 months (range 20-487), our diagnosis has been idiopathic granulomatous disease of peripheral lymph nodes. Thus, we observed 109 patients in 20 years presenting with lymph nodes that were surgically removed and provided the diagnosis of sarcoidosis sooner (76 patients) or later (33 patients).


CONCLUSIONS
1. In patients presenting only sarcoid granulomas in peripheral lymph nodes, sarcoidosis may be diagnosed months or years later, but a subpopulation of them still exists where granulomatous lesions remain unexplained. 2. In our series of patients, peripheral lymph node presentation occurred in 11.7% of cases of sarcoidosis.
Rizzato
G
G
Sarcoidosis Clinic, Niguarda Hospital, Milan, Italy. rizzatog@tin.it
Montemurro
L
L
D000328:Adult; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008206:Lymphatic Diseases / Q000473:pathology*; D008297:Male; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000473:pathology*; D017565:Sarcoidosis, Pulmonary / Q000473:pathology; D013997:Time Factors