The comparative characteristics of mediastinal lymphadenopathies in granulomatous pulmonary diseasesMakaryants N., Lepekha L., Sivokozov I., Semenova A. Central TB Research Institute, Moscow, Russia

Aim: To determine the frequency of detection and the peculiarities of radiological and morphological changes due to mediastinal lymphadenopathies in patients with disseminated pulmonary TB (DPT), pulmonary sarcoidosis (PS), hypersensitivity pneumonitis (HP).Materials and Methods: We studied 303 patients: 214 had PS, 79 had HP, and 10 had DPT. All the diagnoses were morphologically verified. Additionally, we studied histological sections of different groups of intrathoracic lymph nodes (ITLN) and detected diagnostic signs of each disease.Results: In 97.5% of PS patients, we observed mediastinal lymphadenopathy of 20±1.9 mm in bronchopulmonary, paratracheal, paraaortic ITLN. The main histological sign was productive epithelioid cell granulomas, which never merged and sometimes had sites of fibrinoid necrosis. In 39% of HP (predominantly subacute HP) patients, we observed lymph nodes increase to 13±1.2 mm in bifurcational and bronchopulmonary ITLN. The diagnostic sign was single-type histiocytic macrophagal granulomas. They did not contain epithelioid cells, had the signs of organization in the form of fibrosis and hyalinosis. The latter had the focal character, especially in the chronic variant. In DPT patients, lymphadenopathy up to 16±0.9 mm affected all groups of ITLN. We could verify epithelioid cell granulomas with necrosis and caseation signs tending to merge. Rarely, granulomas were productive, without expressed signs of necrotic changes, though infi...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Sarcoidosis and other granulomatous ILD/DPLD Source Type: research