Molecular analysis of sarcoidosis lymph nodes for microorganisms: a case–control study with clinical correlates

Robinson, Lary A; Smith, Prudence; SenGupta, Dhruba J; Prentice, Jennifer L; Sandin, Ramon L

By searching the Moffitt Cancer Center surgical pathology database between January 1, 2000 and April 1, 2010, we retrospectively identified 30 randomly-chosen patients who were diagnosed with sarcoidosis based on the typical radiographic and clinical presentation, and the histologic finding of non-caseating epitheliod granulomata in lymph nodes obtained sterilely only by mediastinoscopy, to avoid possible microorganism contamination by endoscopic biopsies. Special stains for microorganisms were negative on the specimens. For inclusion in 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 F o r p e e r r e v i e w o n l y this group, the following criteria were used to make the diagnosis of sarcoidosis: 1) chest radiograph and chest CT findings of symmetrical mediastinal and hilar adenopathy with or without reticulonodular infiltrates in the lung fields (see Figure 1 ); 2) when performed, PET scans demonstrated glucose avidity in the enlarged lymph nodes (see Figure 2) ; 3) asymptomatic presentation or typical symptoms of dyspnea, cough, chest tightness/pain, night sweats, fevers, fatigue, malaise, skin rash or weight loss; 4) lymph nodes showing histologic features of confluent, non-caseating granulomata; and 5) any known microorganism causes of granulomata were excluded by history or culture. All histopathologic specimens were reviewed by one of us (P.S.) to reconfirm the diagnosis made originally by departmental pathologists at Moffitt.