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Conjunctival biopsy in sarcoidosis.J
Chin Med Assoc.2006 Oct;69(10):472-7.
BACKGROUND:
Conjunctival biopsy is considered to be a simple, safe and specific
diagnostic procedure for sarcoidosis. This study was designed to
determine the value of this procedure in Taiwan. METHODS: This study
was conducted from December 2003 to April 2005 at the uveitis clinic
of Taipei Veterans General Hospital. Blind sampling was conducted,
obtaining a biopsy sample measuring 1 cm long by 3 mm wide from both
lower fornices. A positive result was defined as the presence of non-caseating
granuloma when other granuloma-forming processes had been excluded.
RESULTS: Twenty-nine patients (7 men, 22 women) were enrolled. Mean
age at diagnosis was 47.8 +/- 12.4 years. The most common initial
symptom was eye-related problems in 19 (65.5%) patients. Of 58
biopsies, 15 (25.9%) specimens in 11 (37.9%) patients proved to be
positive. Four patients experienced bilateral involvement; 7 patients
had unilateral involvement. No prominent conjunctival nodules or
follicles were noted. Gender, age, presence of uveitis, initial
symptoms, and chest condition comparisons revealed no association
between positive and negative conjunctival biopsies. CONCLUSION: Blind
and bilateral conjunctival biopsy, due to its ease, safety and
specificity, could be the first biopsy inpatients with clinical or
chest X-ray abnormalities suggesting sarcoidosis. None of our patients
with positive biopsy had nodular lesions.
Non-invasive
detection of multinucleated giant cells in the conjunctiva of patients
with sarcoidosis by in-vivo confocal microscopy.Ocul
Immunol Inflamm. 2006 Aug;14(4):203-6.
AIM: To
explore the use of in-vivo confocal microscopy (IVCM) as a potential
non-invasive adjunctive tool for diagnosing sarcoidosis. METHODS:
Conjunctivae were imaged using confocal microscopy in 10 patients with
sarcoidosis and 27 control subjects. We utilized the ASL-1000 Scanning
Confocal Microscope (Advanced Scanning Ltd., New Orleans, LA) and the
Confoscan 3 (Nidek Co. Ltd., Gamagori, Japan). Two masked observers
reviewed the in-vivo confocal images of the conjunctivae in these
subjects. One masked observer was experienced in reviewing confocal
images. The most striking and obvious feature seen in granulomatous
inflammation on confocal microscopy is the presence of multinucleated
giant cells (MGCs). RESULTS: Unmasked observation of the scans
revealed MGCs in six of the 10 sarcoid patients and no MGCs in the
controls. One experienced masked observer found MGCs in five of the 10
patients with sarcoidosis and had no false-positive results (Fisher's
exact test, p = 0.001; specificity = 1; sensitivity = 50% for the
diagnosis of sarcoidosis and 83% compared to the unmasked observer).
The second less-experienced masked observer detected MGCs in three of
the 10 patients and three of the 27 controls (11.1% of the controls)
(p = 0.186; specificity = 0.89; sensitivity = 30% of all patients with
sarcoidosis and 50% compared to the unmasked observer). CONCLUSIONS:
The utilization of IVCM to visualize the basic histology and pathology
in sarcoidosis of the conjunctiva is novel. Initial results indicate
that trained observers can detect MGCs in granulomatous inflammation.
The ASL-1000 microscope tends to have better resolution and deeper
penetration of the conjunctiva compared with the Confoscan 3.
Conjunctival biopsy: a useful procedure for the diagnosis of
sarcoidosis.J
Fr Ophtalmol. 2006 May;29(5):579-82.
PURPOSE: To
highlight the advantages of conjunctival biopsy in order to confirm
the diagnosis of sarcoidosis. CASE REPORT: A 78-year-old woman
presented with unilateral vitreitis. The examination of the
conjunctive of right and left eyes revealed multiple, translucent,
pale yellow nodules the size of millet grains located in the lower
fornix. The diagnosis of sarcoidosis was suspected by an increased
level of angiotensin-converting enzyme and bilateral hilar
lymphadenopathies. A biopsy from conjunctival nodules showed
noncaseating epithelioid and gigantocellular granulomas, confirming
the diagnosis of sarcoidosis. CONCLUSION: Although underused,
conjunctival biopsy seems to be both a safe and effective tool in the
diagnosis of sarcoidosis.
Bilateral
large conjunctival tumours as primary manifestation of sarcoidosis--successful
treatment with steroid-depot-injections.Klin
Monatsbl Augenheilkd. 2006
Apr;223(4):326-9.
INTRODUCTION:
Ocular manifestations of sarcoidosis vary enormously. They include the
conjunctiva, lacrimal gland, orbita, intraocular structures and
eye-lid, either isolated or combined. We describe a female patient who
presented with unusually large, bilateral conjunctival tumours as a
primary manifestation of sarcoidosis. PATIENT: A 79-year-old white
woman was referred to us for further management of a persisting
"conjunctivitis", which had been refractory to treatment with multiple
medications. Initial examination disclosed swollen eye-lids and
bilateral large hard tumours of the inferior fornix. The obtained
brush smear, which was cytopathologically evaluated, revealed
epitheloid cells and multinucleate giant cells. After 4 weeks she
developed three reddish-brown maculopapular lesions on her face. The
subsequent biopsy from the left inferior fornix and the skin showed
histopathologically a granulomatous epitheloid cell inflammation
without central necrosis and without acid-proof bacilli. Therefore a
sarcoidosis was included into the differential diagnosis. The systemic
evaluation revealed no other manifestation. At first we tried to
reduce the chronically inflammatory tumours with different
immunomodulating local treatment forms. Only the repeated
intralesional injection of a steroid depot showed a complete
disappearance of all conjunctival and skin tumours. CONCLUSION: An
isolated bilateral primary manifestation of sarcoidosis with large
massive conjunctival tumours is very rare and clinically not typical.
The non-invasive, cytopathological examination by means of brush
smears offers a new perspective in the fast diagnosis of conjunctival
manifestation of sarcoidosis. The tumours respond excellently to the
intralesional injection of steroid depots.
Conjunctival deposits as the first sign of systemic sarcoidosis in a
pediatric patient.
Eur J Ophthalmol. 2006
Jan-Feb;16(1):168-70.
PURPOSE:
Sarcoidosis is an inflammatory disease of unknown cause, characterized
by noncaseating granulomas. In this study, the authors present a
sarcoidosis patient without systemic signs diagnosed by
histopathologic analysis of conjunctival deposits. METHODS: A
10-year-old girl had bilateral, focal, multilobular, multiple pale
yellow deposits in bulbar conjunctiva for a year. In the patient's
biomicroscopic examination, numerous 0.50- to 2-mm diameter pale
yellow deposits were determined in both bulbar conjunctivas. The
patient had no other systemic or ocular complaints. A conjunctival
biopsy was performed. RESULTS: The biopsy specimens showed
noncaseating granulomas with prominent asteroid bodies. Serum
angiotensin-converting enzyme levels were increased in the patient.
Conjunctival deposits were the first manifestation of sarcoidosis in
the patient and the diagnosis of sarcoidosis was confirmed with a
conjunctival biopsy. CONCLUSIONS: To the authors' knowledge, this is
the second study that reports a sarcoidosis patient with non-systemic
involvement diagnosed after histopathologic analysis of conjunctival
deposits.
Value of
conjunctival biopsy in the diagnosis of sarcoidosis.Wiad
Lek. 2005;58(3-4):252-4.
The eye signs
of sarcoidosis may be observed in patients with no evidence of any
other symptoms. In this paper a patient with diagnosis of sarcoidosis
was presented. The proper diagnosis and treatment were possible after
results of conjunctival biopsy. Conjunctival biopsy could be a useful
method in the diagnosis of many systemic diseases, including
sarcoidosis.
Conjunctival biopsy in the diagnosis of ocular sarcoidosis.
Ocul Immunol Inflamm. 2001
Mar;9(1):59-64.
Sarcoidosis is
a multisystem granulomatous disease of unknown etiology that can
affect almost every organ in the body, particularly the lungs, skin,
eyes, and thoracic lymph nodes. A definitive diagnosis of sarcoidosis
requires that a biopsy be performed. A specimen can be obtained from
any affected ocular structure, including conjunctiva, lacrimal gland,
eyelid skin, and orbit. Among them, conjunctival biopsy has been
suggested as a sensible and safe procedure for confirming suspected
sarcoidosis. We describe three patients in whom ocular symptoms were
the sole initial manifestations of sarcoidosis and who were diagnosed
based on the results of a conjunctival biopsy. We also discuss the
efficacy of and indications for conjunctival biopsy.
Value of
conjunctival biopsy in diagnosis of sarcoidosis.Ophthalmologe.
1999 Nov;96(11):728-30.
PURPOSE:
Retrospective study concerning the value of conjunctival biopsy in the
diagnosis of sarcoidosis. PATIENTS AND METHODS: Between 1990 and 1996
we performed conjunctival biopsy in 11 patients (mean age 42.7 +/-
16.4 years) with suspect of sarcoidosis. RESULTS: In 8 of the 11
patients the diagnosis of sarcoidosis was established during the
clinical course. In four of these eight patients conjunctival biopsy
was positive. Five of the eight were under systemic steroids at the
time of biopsy. Of the four patients with clinically established
sarcoidosis and negative biopsy, three were under systemic steroids at
the time of biopsy. In two patients diagnosis of sarcoidosis was
established primarily by conjunctival biopsy. CONCLUSION: Conjunctival
biopsy is a simple tool in the diagnostic of sarcoidosis. If possible,
biopsy should be undertaken before systemic steroid treatment. We
consider conjunctival biopsy to be useful as the first diagnostic tool
before other invasive methods.
Conjunctival deposits as an initial manifestation of sarcoidosis.Am
J Ophthalmol. 1999 Sep;128(3):361-2.
PURPOSE: To
report conjunctival deposits as an initial manifestation of
sarcoidosis. METHODS: Case reports. RESULTS: Two patients with
bilateral bulbar conjunctival white deposits underwent conjunctival
biopsy. The biopsy specimens showed noncaseating granulomas with
prominent Schaumann bodies. Serum angiotensin-converting enzyme levels
were increased in both patients. The first patient had abnormal
results of pulmonary function tests. Sarcoidosis was diagnosed in both
patients. CONCLUSIONS: Conjunctival deposits may represent the initial
clinical manifestation of sarcoidosis.
Phenotypes of
conjunctival inflammatory cells in sarcoidosis.Br
J Ophthalmol. 1992 Feb;76(2):101-6.
Phenotypes of
the infiltrating mononuclear cells of the lower fornix conjunctiva of
nine patients with sarcoidosis and six controls were studied using
monoclonal antibodies and a modified immunoperoxidase method. Four
patients had sarcoidosis of recent onset (duration of 2 years or less)
and five patients had a chronic disease (duration of 3 or more years).
The inflammatory cells in the sarcoid conjunctival specimens were
predominantly T lymphocytes, the vast majority of which were of T
helper/inducer subtype expressing Leu-3a + 3b positivity. The ratio of
T helper/inducer cells to T suppressor/cytotoxic cells was 3.9 on
average but only 0.9 in controls. Epithelioid cell granulomas were
seen in three specimens in one case of recent onset and in two chronic
cases comprising a marked amount (more than 15 cells/visual field) of
cells bearing phenotypes of macrophages, T cells, T helper/inducer
cells and HLA-DR antigen, and in smaller quantities of T suppressor/cytotoxic
cells. The mean number of all immunocompetent cell subtypes of
specimens from newly diagnosed patients exceeded that of specimens
from chronic patients. We believe that the sarcoid immune reaction in
the conjunctiva is a dynamic process in which proliferation of
immunocompetent mononuclear cells precedes the stage of granuloma
formation.
Conjunctival
biopsy in the diagnosis of sarcoidosis.Br
J Ophthalmol. 1990 Aug;74(8):469-71.
We
prospectively studied 47 sarcoidosis suspects and compared
conjunctival and transbronchial lung biopsies in these patients.
Thirty-four patients had positive findings on biopsy by either method.
The transbronchial biopsy was positive in 31 patients, and the
conjunctival was positive in 19. The transbronchial lung biopsy was
more likely to be positive in black patients (p = 0.009) and in
patients with pulmonary infiltrates on chest x ray (p = 0.0044). In
comparison, the conjunctival biopsy was more likely to be positive in
patients with conjunctival follicles (p = 0.036), ocular abnormalities
consistent with sarcoidosis (p = 0.02), and in patients with pulmonary
infiltrates on chest x ray (p = 0.029). Iritis was present in 12
patients, enlarged lacrimal glands in three, and vitritis in five. We
conclude that the conjunctival biopsy is an effective means of
diagnosing sarcoidosis and that every sarcoidosis patient should have
an ophthalmic examination.
Immunopathology of ocular sarcoidosis.Int
Ophthalmol. 1990;14(1):1-11.
Sarcoidosis is a multisystem disease characterized by enhanced immune
responses at sites of involvement. To elucidate the immunopathogenesis
of ophthalmic lesions, cell infiltrates in biopsies from conjunctiva
and other tissues involved (lungs, lymph nodes, skin) were studied in
26 patients with active sarcoidosis in order to define the surface
phenotype and the distribution of cells in granulomatous lesions.
Biopsy specimens were also stained for detection of immunoglobulins,
complement and fibrinogen deposits. The data demonstrate a
lymphocytes/macrophages interaction in the central core of
granulomatous areas as the crucial event that initiates the maintains
the state of inflammation: at all sites of disease activity is present
a compartmentalization of T-cells expressing a helper-related
phenotype which account for the great majority of infiltrating cells
both in the early lesions (aggregate of macrophages surrounded by
lymphocytic infiltrate) and in well-organized sarcoid granulomata. The
presence of plasma cells and immunoglobulin deposits may represent an
epiphenomenon in line with the helper infiltration, suggesting a local
hyper-reactivity of the B-cells immune system. This study suggests
some immunopathogenetic mechanisms leading to the formation and growth
of conjunctival sarcoid granulomata.
Ophthalmologic
peculiarities of sarcoidosis.Klin
Monatsbl Augenheilkd. 1987
Oct;191(4):253-9
The present
paper deals with the frequency of different ophthalmic sarcoid changes
and their morphological and photographic characteristics. In addition,
the diagnostic value of conjunctival biopsy is evaluated. The findings
were based on repeated ophthalmological examinations of an unselected
group of 281 patients with histologically confirmed sarcoidosis.
Conjunctival (37/218) and lacrimal gland (33/254) changes were
encountered more often than sarcoid uveitis (22/281), and a
conjunctival granuloma was the most frequent single sarcoid ophthalmic
finding. Sarcoid changes in the eyes and the adnexae were often
characterized by a scarcity of symptoms and a typical outward
appearance. In some cases of sarcoid uveitis fluorescein angiography
revealed in the iris and the retina nodules which showed features
suggesting the proliferative nature of the disease. The iris infrared
transillumination technique illustrated the affinity of sarcoid
nodules in the pupillary area. Conjunctival biopsy showed epithelioid
cell granulomas compatible with sarcoidosis in nearly half of the
patients in whom it was suspected in a slit-lamp examination of the
conjunctivae. In the diagnosis of sarcoidosis, conjunctival biopsy is
a procedure to be recommended before more demanding methods are tried.
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