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Semin Respir Crit Care Med 2007; 28(1): 036-052
DOI: 10.1055/s-2007-970332
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Pathology of Sarcoidosis

Yale Rosen1 , 2
  • 1Department of Pathology, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
  • 2Department of Pathology, Winthrop University Hospital, Mineola, New York
Further Information

Publication History

Publication Date:
28 February 2007 (online)

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ABSTRACT

The role of pathology in the diagnosis of sarcoidosis is identification of granulomas in tissue specimens and performance of studies to exclude known causes of granulomatous inflammation. The granulomas of sarcoidosis are nonspecific lesions that, by themselves and in the absence of an identifiable etiologic agent, are not diagnostic of sarcoidosis or any other specific disease.

Among the diseases to be excluded are mycobacterial, fungal, and parasitic infections, chronic beryllium disease and other pneumoconiosis, hypersensitivity pneumonitis, and Wegener's granulomatosis. Even after extensive workup a substantial number of granulomas will remain unclassified. Not every disease that features nonnecrotizing granulomas of undetermined etiology is sarcoidosis.

The granulomas of sarcoidosis may exhibit focal necrosis of minimal amount. In cases with granulomas that exhibit a greater degree of necrosis an infectious or other nonsarcoid etiology should be strongly suspected.

Strict clinical, radiological, and pathological criteria must be used for diagnosis. In cases that exhibit necrotizing granulomas with more than minimal, focal necrosis, extrathoracic involvement only, and/or incompatible clinical and radiological findings, the diagnosis of sarcoidosis should be approached with great caution. The diagnosis is most secure when compatible clinical and radiological findings are supported by the demonstration of microorganism-negative, nonnecrotizing granulomas in a biopsy specimen accompanied by biopsy evidence or strong clinical evidence of multisystem involvement, and negative cultures for bacteria, mycobacteria, and fungi. A positive Kveim-Siltzbach test provides strong support for the diagnosis of sarcoidosis.

KEYWORDS

Sarcoidosis - pathology - granuloma - biopsy - diagnosis

REFERENCES

  • 1 Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999.  Am J Respir Crit Care Med. 1999;  160 736-755
    PubMedSearch in Google Scholar
  • 2 Reich J M. What is sarcoidosis?.  Chest. 2003;  124 367-371
    CrossrefPubMedSearch in Google Scholar
  • 3 Judson M A. The etiologic agent of sarcoidosis.  Chest. 2003;  124 6-8
    CrossrefPubMedSearch in Google Scholar
  • 4 Adams D O. The biology of the granuloma. In: Ioachim HL Pathology of Granulomas. New York; Raven 1983: 1-20
    Search in Google Scholar
  • 5 Rosen Y, Athanassiades T J, Moon S, Lyons H A. Non-granulomatous interstitial pneumonitis in sarcoidosis: relationship to the development of epithelioid granulomas.  Chest. 1978;  74 122-125
    CrossrefPubMedSearch in Google Scholar
  • 6 Poletti V, Patelli M, Spiga L, Ferracini R, Manetto V. Transbronchial lung biopsy in pulmonary sarcoidosis: is it an evaluable method in detection of disease activity?.  Chest. 1986;  89 361-365
    PubMedSearch in Google Scholar
  • 7 Ginns L C, Goldenheim P D, Burton R C et al.. T-lymphocyte subsets in peripheral blood and lung lavage in idiopathic pulmonary fibrosis and sarcoidosis: analysis by monoclonal antibodies and flow cytometry.  Clin Immunol Immunopathol. 1982;  25 11-20
    CrossrefPubMedSearch in Google Scholar
  • 8 Semenzato G, Pezzutto A, Chisoli M, Pizzola G. Redistribution of lymphocytes in the lymph nodes of patients with sarcoidosis.  N Engl J Med. 1982;  306 48-49
    PubMedSearch in Google Scholar
  • 9 Modlin R L, Hofman F M, Meyer P R, Sharma O P, Taylor C R, Rea T H. In situ demonstration of T lymphocyte subsets in granulomatous inflammation: leprosy, rhinoscleroma and sarcoidosis.  Clin Exp Immunol. 1983;  51 430-438
    PubMedSearch in Google Scholar
  • 10 Modlin R L, Hofman F M, Sharma O P, Gottlieb B, Taylor C R, Rea T H. Demonstration in situ of subsets of T-lymphocytes in sarcoidosis.  Am J Dermatopathol. 1984;  6 423-427
    PubMedSearch in Google Scholar
  • 11 Maarsseven A C, Mullink H, Alons C, Stam J. Distribution of T-lymphocyte subsets in different portions of sarcoid granulomas: immunohistologic analysis with monoclonal antibodies.  Hum Pathol. 1986;  17 493-500
    CrossrefPubMedSearch in Google Scholar
  • 12 Ricker W, Clark M. Sarcoidosis: a clinico-pathologic review of 300 cases, including 22 autopsies.  Am J Clin Pathol. 1949;  19 725-749
    CrossrefPubMedSearch in Google Scholar
  • 13 Rosen Y, Vuletin J C, Pertschuk L P, Silverstein E. Sarcoidosis from the pathologist's vantage point.  Pathol Annu. 1979;  14(Part 1) 405-439
    PubMedSearch in Google Scholar
  • 14 Cree I A, Nurbhai S, Milne G, Beck J S. Cell death in granulomata: the role of apoptosis.  J Clin Pathol. 1987;  40 1314-1319
    PubMedSearch in Google Scholar
  • 15 Kunitake R, Kuwano K, Miyazaki H, Hagimoto N, Nomoto Y, Hara N. Apoptosis in the course of granulomatous inflammation in pulmonary sarcoidosis.  Eur Respir J. 1999;  13 1329-1337
    CrossrefPubMedSearch in Google Scholar
  • 16 Jones Williams W. The nature and origin of Schaumann bodies.  J Pathol Bacteriol. 1960;  79 193-201
    CrossrefPubMedSearch in Google Scholar
  • 17 Reid J D, Andersen M E. Calcium oxalate in sarcoid granulomas.  Am J Clin Pathol. 1988;  90 545-558
    PubMedSearch in Google Scholar
  • 18 Hamazaki T. Uber ein neues, sauerfeste Substanz fuhrendes Spindelkorperchen der Menschlichen Lymphdrüsen.  Virchows Arch A Pathol Pathol Anat. 1938;  301 490-522
    PubMedSearch in Google Scholar
  • 19 Wesenberg W. On acid-fast Hamazaki spindle bodies in sarcoidosis of lymph nodes and on double refractile cell inclusions in sarcoidosis of the lungs.  Arch Klin Exp Dermatol. 1966;  227 101-107
    PubMedSearch in Google Scholar
  • 20 Senba M, Kawai K. Nature of yellow-brown bodies: histochemical and ultrastructural studies on the brown pigment.  Zentralbl Allg Pathol. 1989;  135 351-355
    PubMedSearch in Google Scholar
  • 21 Ro J Y, Luna M A, Mackay B, Ramos O. Yellow-brown (Hamazaki-Wesenberg) bodies mimicking fungal yeasts.  Arch Pathol Lab Med. 1987;  111 555-559
    PubMedSearch in Google Scholar
  • 22 Rosen Y, Amorosa J K, Moon S, Cohen J, Lyons H A. Occurrence of lung granulomas in patients with stage 1 sarcoidosis.  AJR Am J Roentgenol. 1977;  129 1083-1085
    PubMedSearch in Google Scholar
  • 23 Sharma O P. Sarcoidosis.  Dis Mon. 1990;  36 469-535
    PubMedSearch in Google Scholar
  • 24 Laohaburanakit P, Chan A. Obstructive sarcoidosis.  Clin Rev Allergy Immunol. 2003;  25 115-129
    CrossrefPubMedSearch in Google Scholar
  • 25 Kieszko R, Krawczyk P, Michnar M, Milanowski J. The yield of endobronchial biopsy in pulmonary sarcoidosis.  Respiration. 2004;  71 72-76
    CrossrefPubMedSearch in Google Scholar
  • 26 Shorr A F, Torrington K G, Hnatiuk O W. Endobronchial biopsy for sarcoidosis: a prospective study.  Chest. 2001;  120 109-114
    CrossrefPubMedSearch in Google Scholar
  • 27 Torrington K G, Shorr A F, Parker J W. Endobronchial disease and racial differences in pulmonary sarcoidosis.  Chest. 1997;  111 619-622
    PubMedSearch in Google Scholar
  • 28 Littler L PW. Bronchoscopy in sarcoidosis. In: Levinsky L, Macholda F Proceedings of the fifth international conference on sarcoidosis and other granulomatous disorders. Prague; Universita Karlova 1971: 463-465
    Search in Google Scholar
  • 29 Siltzbach L E, Cahn L R. Random biopsy of bronchial and palatal mucosa in the diagnosis of sarcoidosis.  Acta Med Scand Suppl. 1964;  425 230-233
    PubMedSearch in Google Scholar
  • 30 Sharma O P, Izumi T. The importance of airway obstruction in sarcoidosis.  Sarcoidosis. 1988;  5 119-120
    PubMedSearch in Google Scholar
  • 31 Miller A, Teirstein A S, Jackler I, Siltzbach L E. Evidence of airway involvement in late pulmonary sarcoidosis using flow-volume curves and nitrogen washout. In: Iwai K, Hosoda Y Proceedings of the Sixth International Conference on Sarcoidosis. Baltimore; University Park Press 1974: 421-424
    Search in Google Scholar
  • 32 Olsson T, Björnstad-Petersen H, Stjernberg N L. Bronchostenosis due to sarcoidosis.  Chest. 1979;  75 663-666
    PubMedSearch in Google Scholar
  • 33 Kumbasar O O, Kaya A, Ulger F, Alper D. Multiple endobronchial mass lesions due to sarcoidosis.  Tuberk Toraks. 2003;  51 190-192
    PubMedSearch in Google Scholar
  • 34 Rosen Y. Sarcoidosis. In: Dail DH, Hammar SP Pulmonary Pathology. New York; Springer-Verlag 1994: 615-645
    Search in Google Scholar
  • 35 Wilen S B, Rabinowitz J G, Ulreich S, Lyons H A. Pleural involvement in sarcoidosis.  Am J Med. 1974;  57 200-209
    CrossrefPubMedSearch in Google Scholar
  • 36 Beekman J F, Zimmet S M, Chun B K, Miranda A A, Katz S. Spectrum of pleural involvement in sarcoidosis.  Arch Intern Med. 1976;  136 323-330
    CrossrefPubMedSearch in Google Scholar
  • 37 Haitsch R, Frank W, Evers H, Pauli R. Chylothorax as a complication of sarcoidosis.  Pneumologie. 1996;  50 912-914
    PubMedSearch in Google Scholar
  • 38 Loughney E, Higgins B G. Pleural sarcoidosis: a rare presentation.  Thorax. 1997;  52 200-201
    CrossrefPubMedSearch in Google Scholar
  • 39 Carrington C B, Gaensler E A, Mikus J P, Schachter A W, Burke G W, Goff A M. Structure and function in sarcoidosis. In: Siltzbach LE Seventh International Conference on Sarcoidosis and Other Granulomatous Disorders. Ann NY Acad Sci 1976;278:265-283
  • 40 Rosen Y, Moon S, Huang C T, Gourin A, Lyons H A. Granulomatous pulmonary angiitis in sarcoidosis.  Arch Pathol Lab Med. 1977;  101 170-174
    PubMedSearch in Google Scholar
  • 41 Takemura T, Matsui Y, Saiki S, Mikami R. Pulmonary vascular involvement in sarcoidosis: a report of 40 autopsy cases.  Hum Pathol. 1992;  23 1216-1223
    CrossrefPubMedSearch in Google Scholar
  • 42 Hsu R M, Connors Jr A F, Tomashefski Jr J F. Histologic, microbiologic, and clinical correlates of the diagnosis of sarcoidosis by transbronchial biopsy.  Arch Pathol Lab Med. 1996;  120 364-368
    PubMedSearch in Google Scholar
  • 43 Takemura T, Matsui Y, Oritsu M et al.. Pulmonary vascular involvement in sarcoidosis: granulomatous angiitis and microangiopathy in transbronchial lung biopsies.  Virchows Arch A Pathol Anat Histopathol. 1991;  418 361-368
    CrossrefPubMedSearch in Google Scholar
  • 44 Nunes H, Humbert M, Capron F et al.. Pulmonary hypertension associated with sarcoidosis: mechanisms, hemodynamics and prognosis.  Thorax. 2006;  61 68-74
    CrossrefPubMedSearch in Google Scholar
  • 45 Levine B W, Saldana M, Hutter A M. Pulmonary hypertension in sarcoidosis.  Am Rev Respir Dis. 1971;  103 413-417
    PubMedSearch in Google Scholar
  • 46 Smith L J, Lawrence J B, Katzenstein A A. Vascular sarcoidosis: a rare cause of pulmonary hypertension.  Am J Med Sci. 1983;  285 38-44
    PubMedSearch in Google Scholar
  • 47 Crissman J D, Koss M, Carson R P. Pulmonary veno-occlusive disease secondary to granulomatous venulitis.  Am J Surg Pathol. 1980;  4 93-99
    PubMedSearch in Google Scholar
  • 48 Hoffstein V, Ranganathan N, Mullen J BM. Sarcoidosis simulating pulmonary veno-occlusive disease.  Am Rev Respir Dis. 1986;  134 809-811
    PubMedSearch in Google Scholar
  • 49 Mikami R, Sekiguchi M, Ryuzin Y et al.. Changes in the peripheral vasculature of various organs in patients with sarcoidosis: possible role of microangiopathy.  Heart Vessels. 1986;  2 129-139
    CrossrefPubMedSearch in Google Scholar
  • 50 Fernandes S RM, Singsen B H, Hoffman G S. Sarcoidosis and systemic vasculitis.  Semin Arthritis Rheum. 2000;  30 33-46
    CrossrefPubMedSearch in Google Scholar
  • 51 Kirks D R, McCormick V D, Greenspan R H. Pulmonary sarcoidosis. Roentgenologic analysis of 150 patients.  Am J Roentgenol Radium Ther Nucl Med. 1973;  117 777-786
    PubMedSearch in Google Scholar
  • 52 Sharma O P, Hewlett R, Gordonson J. Nodular sarcoidosis: an unusual radiographic appearance.  Chest. 1973;  64 189-192
    PubMedSearch in Google Scholar
  • 53 Sharma O P. Sarcoidosis: unusual pulmonary manifestations.  Postgrad Med. 1977;  61 67-73
    PubMedSearch in Google Scholar
  • 54 Romer F K. Sarcoidosis with large nodular lesions simulating pulmonary metastases: an analysis of 126 cases of intrathoracic sarcoidosis.  Scand J Respir Dis. 1977;  58 11-16
    PubMedSearch in Google Scholar
  • 55 Rose R M, Lee R GL, Costello P. Solitary nodular sarcoidosis.  Clin Radiol. 1985;  36 589-592
    CrossrefPubMedSearch in Google Scholar
  • 56 Liebow A A. The J Burns Amberson Lecture: Pulmonary angiitis and granulomatosis.  Am Rev Respir Dis. 1973;  108 1-18
    PubMedSearch in Google Scholar
  • 57 Saldana M J. Necrotizing sarcoid granulomatosis: clinico-pathologic observations in 24 patients [abstract].  Lab Invest. 1978;  38 364
    PubMedSearch in Google Scholar
  • 58 Churg A, Carrington C B, Gupta R. Necrotizing sarcoid granulomatosis.  Chest. 1979;  76 406-413
    CrossrefPubMedSearch in Google Scholar
  • 59 Koss M N, Hochholzer L, Feigin D S, Garancis J C, Ward P A. Necrotizing sarcoid-like granulomatosis: clinical, pathologic, and immunopathologic findings.  Hum Pathol. 1980;  (Suppl 5) 510-519
    PubMedSearch in Google Scholar
  • 60 Popper H H, Klemen H, Colby T V, Churg A. Necrotizing sarcoid granulomatosis: is it different from nodular sarcoidosis?.  Pneumologie. 2003;  57 268-271
    Thieme ConnectPubMedSearch in Google Scholar
  • 61 Rolfes D B, Weiss M A, Sanders M A. Necrotizing sarcoid granulomatosis with suppurative features.  Am J Clin Pathol. 1984;  82 602-607
    PubMedSearch in Google Scholar
  • 62 Weiss M, Gokel J M. Die nekrotisierende sarkoide Granulomatose der Lunge.  Pathologe. 1990;  11 178-182
    PubMedSearch in Google Scholar
  • 63 Gibbs A R, Jones William W. Necrotising sarcoidal granulmatosis. In: International Committee on Sarcoidosis. Tenth International Conference on Sarcoidosis and Other Granulomatous Disorders. Abstracts Baltimore; 1984: 1-2
    Search in Google Scholar
  • 64 Vracko R. Significance of basal lamina for regeneration of injured lung.  Virchows Arch A Pathol Pathol Anat. 1972;  355 264-274
    PubMedSearch in Google Scholar
  • 65 Rennard S I, Hunninghake G W, Bitterman P B, Crystal R G. Production of fibronectin by the human alveolar macrophage: mechanism for the recruitment of fibroblasts to the site of tissue injury in interstitial lung diseases.  Proc Natl Acad Sci USA. 1981;  78 7147-7151
    CrossrefPubMedSearch in Google Scholar
  • 66 Judson M A, Strange C. Bullous sarcoidosis: a report of three cases.  Chest. 1998;  114 1474-1478
    CrossrefPubMedSearch in Google Scholar
  • 67 Tomlinson J R, Sahn S A. Aspergilloma in sarcoid and tuberculosis.  Chest. 1987;  92 505-508
    CrossrefPubMedSearch in Google Scholar
  • 68 Treaba D O, Benson M D, Assad L W, Dainauskas J R. Sarcoidosis and immunoglobulin lambda II light-chain amyloidosis diagnosed after orthoptic heart transplantation.  Mod Pathol. 2005;  18 451-455
    CrossrefPubMedSearch in Google Scholar
  • 69 Komatsuda A, Wakui H, Ohtani H et al.. Amyloid A-type renal amyloidosis in a patient with sarcoidosis.  Clin Nephrol. 2003;  60 284-288
    PubMedSearch in Google Scholar
  • 70 Sharma O P, Koss M, Buck F. Sarcoidosis and amyloidosis. Is the association causal or coincidental?.  Sarcoidosis. 1987;  4 139-141
    PubMedSearch in Google Scholar
  • 71 Artinian V, Kvale P A. Cancer and interstitial lung disease.  Curr Opin Pulm Med. 2004;  10 425-434
    CrossrefPubMedSearch in Google Scholar
  • 72 Reich J M. Mortality of intrathoracic sarcoidosis in referral vs. population-based settings.  Chest. 2002;  121 32-39
    CrossrefPubMedSearch in Google Scholar
  • 73 Huang C T, Heurich A E, Sutton A L, Rosen Y, Lyons H A. Mortality in sarcoidosis. In: Williams JW, Davies BH Eighth International Conference on Sarcoidosis and Other Granulomatous Diseases. Cardiff; Alpha Omega 1980: 522-526
    Search in Google Scholar
  • 74 Iwai K, Taschibana T, Hosoda Y, Matsui Y. Sarcoidosis autopsies in Japan.  Sarcoidosis. 1988;  5 60-65
    PubMedSearch in Google Scholar
  • 75 Perry A, Vuitch F. Causes of death in patients with sarcoidosis.  Arch Pathol Lab Med. 1995;  119 167-172
    PubMedSearch in Google Scholar
  • 76 Winterbauer R H, Moore K D. A clinical interpretation of bilateral hilar adenopathy.  Ann Intern Med. 1973;  78 65-71
    CrossrefPubMedSearch in Google Scholar
  • 77 Ulbright T M, Katzenstein A LA. Solitary necrotizing granulomas of the lung.  Am J Surg Pathol. 1980;  4 13-28
    PubMedSearch in Google Scholar
  • 78 Teirstein A S, Judson M A, Baughman R P et al.. The spectrum of biopsy sites for the diagnosis of sarcoidosis.  Sarcoidosis Vasc Diffuse Lung Dis. 2005;  22 139-146
    PubMedSearch in Google Scholar
  • 79 Koerner S K, Sakowitz A J, Appelman R I, Becker N H, Schoenbaum S W. Transbronchial lung biopsy for the diagnosis of sarcoidosis.  N Engl J Med. 1975;  293 268-270
    CrossrefPubMedSearch in Google Scholar
  • 80 Koontz C H, Joyner L R, Nelson R A. Transbronchial lung biopsy via the fiberoptic bronchoscope in sarcoidosis.  Ann Intern Med. 1976;  85 64-66
    PubMedSearch in Google Scholar
  • 81 Khan M A, Corona F, Masson R G. Transbronchial lung biopsy for sarcoidosis.  N Engl J Med. 1976;  295 225
    PubMedSearch in Google Scholar
  • 82 Poletti V, Patelli M, Spiga L, Ferracini R, Manetto V. Transbronchial lung biopsy in pulmonary sarcoidosis: is it an evaluable method in detection of disease activity?.  Chest. 1986;  89 361-365
    PubMedSearch in Google Scholar
  • 83 Gilman M J, Wang K P. Transbronchial lung biopsy in sarcoidosis: an approach to determine the optimal number of biopsies.  Am Rev Respir Dis. 1980;  122 721-724
    PubMedSearch in Google Scholar
  • 84 Chapman J T, Mehta A C. Bronchoscopy in sarcoidosis: diagnostic and therapeutic interventions.  Curr Opin Pulm Med. 2003;  9 402-407
    CrossrefPubMedSearch in Google Scholar
  • 85 Roethe R A, Fuller P B, Byrd R B, Hafermann D R. Transbroncial lung biopsy in sarcoidosis.  Chest. 1980;  77 400-402
    PubMedSearch in Google Scholar
  • 86 Anders G T, Linville K C, Johnson J E, Blanton H M. Evaluation of the float sign for determining adequacy of specimens obtained with transbronchial biopsy.  Am Rev Respir Dis. 1991;  144 1406-1407
    PubMedSearch in Google Scholar
  • 87 Shorr A F, Torrington K G, Hnatiuk O W. Endobronchial biopsy for sarcoidosis: a prospective study.  Chest. 2001;  120 109-114
    CrossrefPubMedSearch in Google Scholar
  • 88 Morales C F, Patefield A J, Strollo Jr P J, Schenk D A. Flexible transbronchial needle aspiration in the diagnosis of sarcoidosis.  Chest. 1994;  106 709-711
    CrossrefPubMedSearch in Google Scholar
  • 89 Trisolini R, Lazzari A L, Cancellieri A et al.. Transbronchial needle aspiration improves the diagnostic yield of bronchoscopy in sarcoidosis.  Sarcoidosis Vasc Diffuse Lung Dis. 2004;  21 147-151
    PubMedSearch in Google Scholar
  • 90 Wang K P, Fuenning C, Johns C J, Terry P B. Flexible transbronchial needle aspiration for the diagnosis of sarcoidosis.  Ann Otol Rhinol Laryngol. 1989;  98 298-300
    PubMedSearch in Google Scholar
  • 91 Cetinkaya E, Yildiz P, Altin S, Yilmaz V. Diagnostic value of transbronchial needle aspiration by Wang 22-gauge cytology needle in intrathoracic lymphadenopathy.  Chest. 2004;  125 527-531
    CrossrefPubMedSearch in Google Scholar
  • 92 Wang K P, Britt E J, Haponik E F, Fishman E K, Siegelman S S, Erozan Y S. Rigid transbronchial needle aspiration biopsy for histological specimens.  Ann Otol Rhinol Laryngol. 1985;  94 382-385
    PubMedSearch in Google Scholar
  • 93 Bilaceroglu S, Perim K, Gunel O, Cagirici U, Buyuksirin M. Combining transbronchial aspiration and endobronchial and transbronchial biopsy in sarcoidosis.  Monaldi Arch Chest Dis. 1999;  54 217-223
    PubMedSearch in Google Scholar
  • 94 Cetinkaya E, Yildiz P, Kadakal F et al.. Transbronchial needle aspiration in the diagnosis of intrathoracic lymphadenopathy.  Respiration. 2002;  69 335-338
    CrossrefPubMedSearch in Google Scholar
  • 95 Annema J T, Veselic M, Rabe K F. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis.  Eur Respir J. 2005;  25 405-409
    CrossrefPubMedSearch in Google Scholar
  • 96 Siltzbach L E. The Kveim test in sarcoidosis. A study of 750 patients.  JAMA. 1961;  178 476-482
    CrossrefPubMedSearch in Google Scholar
  • 97 Chase M W. The preparation and standardization of Kveim antigen.  Am Rev Respir Dis. 1961;  84(Part 2) 86-88
    PubMedSearch in Google Scholar
  • 98 Siltzbach L E. Qualities and behavior of satisfactory Kveim suspensions. In: Siltzbach LE Seventh International Conference on Sarcoidosis and Other Granulomatous Disorders. Ann NY Acad Sci 1976;278:665-669
  • 99 Teirstein A S. Kveim antigen: what does it tell us about the causation of sarcoidosis?.  Semin Respir Infect. 1998;  13 206-211
    PubMedSearch in Google Scholar
  • 100 Kommareddi S, Abramovsky C R, Swinehart G L, Hrabak L. Nontuberculous mycobacterial infections: comparison of the fluorescent auramine-O and Ziehl-Neelsen techniques in tissue diagnosis.  Hum Pathol. 1984;  15 1085-1089
    CrossrefPubMedSearch in Google Scholar
  • 101 Ulukanligil M, Aslan G, Tasci S. A comparative study on the different staining methods and number of specimens for the detection of acid fast bacilli.  Mem Inst Oswaldo Cruz. 2000;  95 855-858
    PubMedSearch in Google Scholar
  • 102 Koch M L, Cote R. Comparison of fluorescence microscopy with Ziehl-Neelsen stain for demonstration of acid-fast bacilli in smear preparations and tissue sections.  Am Rev Respir Dis. 1965;  91 283-284
    PubMedSearch in Google Scholar
  • 103 Tang Y W, Procop G W, Zheng X, Myers J L, Roberts G D. Histologic parameters predictive of mycobacterial infection.  Am J Clin Pathol. 1998;  109 331-334
    PubMedSearch in Google Scholar
  • 104 Hillemann D, Galle J, Vollmer E, Richter E. Real-time PCR assay for improved detection of Mycobacterium tuberculosis complex in paraffin-embedded tissues.  Int J Tuberc Lung Dis. 2006;  10 340-342
    PubMedSearch in Google Scholar
  • 105 Hofman V, Selva E, Landraud L et al.. Value of PCR amplification from formalin-fixed paraffin-embedded tissues in the diagnosis of Mycobacterium tuberculosis infection.  Ann Pathol. 2003;  23 206-215
    PubMedSearch in Google Scholar
  • 106 Kommareddi S, Abramovsky C R, Swinehart G L, Hrabak L. Comparison of the fluorescent auramine-O and Ziehl-Neelsen techniques in tissue diagnosis.  Hum Pathol. 1984;  15 1085-1089
    CrossrefPubMedSearch in Google Scholar
  • 107 Woodard B H, Rosenberg S I, Farnham R, Adams D O. Incidence and nature of primary granulomatous inflammation in surgically removed material.  Am J Surg Pathol. 1982;  6 119-129
    PubMedSearch in Google Scholar
  • 108 Azov A G, Koch J, Hamilton-Dutoit S J. Improved diagnosis of mycobacterial infections in formalin-fixed and paraffin-embedded sections with nested polymerase chain reaction.  APMIS. 2005;  113 586-593
    CrossrefPubMedSearch in Google Scholar
  • 109 Fidler H M, Rook G A, Johnson N M, McFadden J. Mycobacterium tuberculosis DNA in tissue affected by sarcoidosis.  BMJ. 1993;  306 546-549
    PubMedSearch in Google Scholar
  • 110 Popper H H, Winter E, Höfler G. DNA of Mycobacterium tuberculosis in formalin-fixed, paraffin-embedded tissue in tuberculosis and sarcoidosis detected by polymerase chain reaction.  Am J Clin Pathol. 1994;  101 738-741
    PubMedSearch in Google Scholar
  • 111 Grosser M, Luther T, Muller J et al.. Detection of M. tuberculosis DNA in sarcoidosis: correlation with T-cell response.  Lab Invest. 1999;  79 775-784
    PubMedSearch in Google Scholar
  • 112 Drake W P, Pei Z, Pride D T, Collins R D, Cover T L, Blaser M J. Molecular analysis of sarcoidosis tissues for mycobacterium species DNA.  Emerg Infect Dis. 2002;  8 1334-1341
    PubMedSearch in Google Scholar
  • 113 Fite E, Fernandez-Figueras M T, Prats R, Vaquero M, Morera J. High prevalence of Mycobacterium tuberculosis DNA in biopsies from sarcoidosis patients from Catalonia, Spain.  Respiration. 2006;  73 20-26
    CrossrefPubMedSearch in Google Scholar
  • 114 Ghossein R A, Ross D G, Salomon R N, Rabson A R. A search for mycobacterial DNA in sarcoidosis using the polymerase chain reaction.  Am J Clin Pathol. 1994;  101 733-737
    PubMedSearch in Google Scholar
  • 115 Wilsher M L, Menzies R E, Croxson M C. Mycobacterium tuberculosis DNA in tissues affected by sarcoidosis.  Thorax. 1998;  53 871-874
    PubMedSearch in Google Scholar
  • 116 Vokurka M, Lecossier D, du Bois R M et al.. Absence of DNA from mycobacteria of the M. tuberculosis complex in sarcoidosis.  Am J Respir Crit Care Med. 1997;  156 1000-1003
    PubMedSearch in Google Scholar
  • 117 Mohr L C. Hypersensitivity pneumonitis.  Curr Opin Pulm Med. 2004;  10 401-411
    CrossrefPubMedSearch in Google Scholar
  • 118 Brincker H. Granulomatous lesions of unknown significance: the GLUS syndrome. In: James DG Sarcoidosis and Other Granulomatous Disorders. New York; Marcel Dekker 1994: 69-86
    Search in Google Scholar

Yale RosenM.D. 

854 Oakland Ct.

North Bellmore, NY 11710

Email: yrosen@optonline.net