Etiologies of consecutive series of non-necrotizing granulomas

Andres Borja Alvarez, Augustine S. Lee, Isabel Mira-Avendano

Research output: Contribution to journalArticle

Abstract

Background: Sarcoidosis is an idiopathic granulomatous disease characterized by variable organ involvement and non-necrotizing granulomas. Objectives: To determine how often non-necrotizing granulomas are not secondary to sarcoidosis. Methods: A retrospective review was conducted to evaluate all biopsies performed at Mayo Clinic in Jacksonville, Florida from January 1, 1996, to December 31, 2013, showing non-necrotizing granulomas. Results: Three hundred and eight biopsies showing non-necrotizing granulomas met inclusion criteria. The average age was 58.2 years, 60.7% were female, and 85% were Caucasian. The most common symptoms were pulmonary (74.6% of cases), and the most common objective finding was lymphadenopathy (33.8%). The organs biopsied included lung parenchyma (65.3%), intrathoracic lymph nodes (25%), other lymph nodes (1.6%), liver (1.3%), airway (1.3%), skin (1.3%), kidney (0.7%), bone marrow (0.7%), gastrointestinal (0.7%), and one each from the brain, heart, bone, bladder, spleen, tendon, and eye. The suspected diagnosis was confirmed in 224 cases (72.7%). From the remaining 84 cases (27.3%), suspected sarcoidosis was refuted in 9, the initial diagnosis was changed to sarcoidosis in 37 (44%), and in 38, it was changed to a different diagnosis. Sarcoidosis was the final diagnosis in 173 (56%). Conclusion: Sarcoidosis was the leading cause of non-necrotizing granulomas, but in 44% of cases, there was an alternate diagnosis. We estimate that more than a quarter of the initial diagnoses will be changed based on biopsy results and clinical course.

Original languageEnglish (US)
Pages (from-to)115-121
Number of pages7
JournalSarcoidosis Vasculitis and Diffuse Lung Diseases
Volume34
Issue number2
StatePublished - 2017

Fingerprint

Sarcoidosis
Granuloma
Biopsy
Lymph Nodes
Lung
Tendons
Urinary Bladder
Spleen
Bone Marrow
Kidney
Bone and Bones
Skin
Liver
Brain

Keywords

  • Mycobacteria
  • Non-necrotizing granulomas
  • Sarcoidosis
  • Vasculitis

ASJC Scopus subject areas

  • Internal Medicine
  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine

Cite this

Alvarez, A. B., Lee, A. S., & Mira-Avendano, I. (2017). Etiologies of consecutive series of non-necrotizing granulomas. Sarcoidosis Vasculitis and Diffuse Lung Diseases, 34(2), 115-121.

Etiologies of consecutive series of non-necrotizing granulomas. / Alvarez, Andres Borja; Lee, Augustine S.; Mira-Avendano, Isabel.

In: Sarcoidosis Vasculitis and Diffuse Lung Diseases, Vol. 34, No. 2, 2017, p. 115-121.

Research output: Contribution to journalArticle

Alvarez, AB, Lee, AS & Mira-Avendano, I 2017, 'Etiologies of consecutive series of non-necrotizing granulomas', Sarcoidosis Vasculitis and Diffuse Lung Diseases, vol. 34, no. 2, pp. 115-121.
Alvarez, Andres Borja ; Lee, Augustine S. ; Mira-Avendano, Isabel. / Etiologies of consecutive series of non-necrotizing granulomas. In: Sarcoidosis Vasculitis and Diffuse Lung Diseases. 2017 ; Vol. 34, No. 2. pp. 115-121.
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abstract = "Background: Sarcoidosis is an idiopathic granulomatous disease characterized by variable organ involvement and non-necrotizing granulomas. Objectives: To determine how often non-necrotizing granulomas are not secondary to sarcoidosis. Methods: A retrospective review was conducted to evaluate all biopsies performed at Mayo Clinic in Jacksonville, Florida from January 1, 1996, to December 31, 2013, showing non-necrotizing granulomas. Results: Three hundred and eight biopsies showing non-necrotizing granulomas met inclusion criteria. The average age was 58.2 years, 60.7{\%} were female, and 85{\%} were Caucasian. The most common symptoms were pulmonary (74.6{\%} of cases), and the most common objective finding was lymphadenopathy (33.8{\%}). The organs biopsied included lung parenchyma (65.3{\%}), intrathoracic lymph nodes (25{\%}), other lymph nodes (1.6{\%}), liver (1.3{\%}), airway (1.3{\%}), skin (1.3{\%}), kidney (0.7{\%}), bone marrow (0.7{\%}), gastrointestinal (0.7{\%}), and one each from the brain, heart, bone, bladder, spleen, tendon, and eye. The suspected diagnosis was confirmed in 224 cases (72.7{\%}). From the remaining 84 cases (27.3{\%}), suspected sarcoidosis was refuted in 9, the initial diagnosis was changed to sarcoidosis in 37 (44{\%}), and in 38, it was changed to a different diagnosis. Sarcoidosis was the final diagnosis in 173 (56{\%}). Conclusion: Sarcoidosis was the leading cause of non-necrotizing granulomas, but in 44{\%} of cases, there was an alternate diagnosis. We estimate that more than a quarter of the initial diagnoses will be changed based on biopsy results and clinical course.",
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N2 - Background: Sarcoidosis is an idiopathic granulomatous disease characterized by variable organ involvement and non-necrotizing granulomas. Objectives: To determine how often non-necrotizing granulomas are not secondary to sarcoidosis. Methods: A retrospective review was conducted to evaluate all biopsies performed at Mayo Clinic in Jacksonville, Florida from January 1, 1996, to December 31, 2013, showing non-necrotizing granulomas. Results: Three hundred and eight biopsies showing non-necrotizing granulomas met inclusion criteria. The average age was 58.2 years, 60.7% were female, and 85% were Caucasian. The most common symptoms were pulmonary (74.6% of cases), and the most common objective finding was lymphadenopathy (33.8%). The organs biopsied included lung parenchyma (65.3%), intrathoracic lymph nodes (25%), other lymph nodes (1.6%), liver (1.3%), airway (1.3%), skin (1.3%), kidney (0.7%), bone marrow (0.7%), gastrointestinal (0.7%), and one each from the brain, heart, bone, bladder, spleen, tendon, and eye. The suspected diagnosis was confirmed in 224 cases (72.7%). From the remaining 84 cases (27.3%), suspected sarcoidosis was refuted in 9, the initial diagnosis was changed to sarcoidosis in 37 (44%), and in 38, it was changed to a different diagnosis. Sarcoidosis was the final diagnosis in 173 (56%). Conclusion: Sarcoidosis was the leading cause of non-necrotizing granulomas, but in 44% of cases, there was an alternate diagnosis. We estimate that more than a quarter of the initial diagnoses will be changed based on biopsy results and clinical course.

AB - Background: Sarcoidosis is an idiopathic granulomatous disease characterized by variable organ involvement and non-necrotizing granulomas. Objectives: To determine how often non-necrotizing granulomas are not secondary to sarcoidosis. Methods: A retrospective review was conducted to evaluate all biopsies performed at Mayo Clinic in Jacksonville, Florida from January 1, 1996, to December 31, 2013, showing non-necrotizing granulomas. Results: Three hundred and eight biopsies showing non-necrotizing granulomas met inclusion criteria. The average age was 58.2 years, 60.7% were female, and 85% were Caucasian. The most common symptoms were pulmonary (74.6% of cases), and the most common objective finding was lymphadenopathy (33.8%). The organs biopsied included lung parenchyma (65.3%), intrathoracic lymph nodes (25%), other lymph nodes (1.6%), liver (1.3%), airway (1.3%), skin (1.3%), kidney (0.7%), bone marrow (0.7%), gastrointestinal (0.7%), and one each from the brain, heart, bone, bladder, spleen, tendon, and eye. The suspected diagnosis was confirmed in 224 cases (72.7%). From the remaining 84 cases (27.3%), suspected sarcoidosis was refuted in 9, the initial diagnosis was changed to sarcoidosis in 37 (44%), and in 38, it was changed to a different diagnosis. Sarcoidosis was the final diagnosis in 173 (56%). Conclusion: Sarcoidosis was the leading cause of non-necrotizing granulomas, but in 44% of cases, there was an alternate diagnosis. We estimate that more than a quarter of the initial diagnoses will be changed based on biopsy results and clinical course.

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