Neslihan ÖZÇELİK, Atila TÜRKYILMAZ, Şafak ERSÖZ, Müge ERBAY, Yılmaz BÜLBÜL, Emine Sevil AYAYDIN MÜRTEZAOĞLU, Savaş ÖZSU

Mediastinal/hiler granülomatöz lenfadenit etyolojisi

Giriş: Granülom oluşumu çeşitli infeksiyöz ve infeksiyöz olmayan ajanlar tarafından başlatılan kronik bir inflamatuvar yanıtı temsiletmektedir. Özellikle infeksiyöz dışı nedenlere bağlı granülomatöz nedenler klinisyenleri oldukça zorlamaktadır.Materyal ve Metod: Bu çalışmada Eylül 2014 ile Aralık 2016 arasında EBUS ya da mediastinoskopiyle mediastinal/hiler lenfadenopatilerin (LAP) histopatolojik değerlendirmesinde granülomatöz lenfadenit tanısı alan hastaların dağılımı araştırılmıştır. Uyumlu histolojik, radyolojik ve klinik bulgularla birlikte kültür negatifliği olduğunda ‘güvenli’ sarkoidoz olarak tanımlandı. Dokuda mikroorganizmagörülmesi, kültür pozitifliği, tutarlı klinikopatolojik durumda pozitif seroloji veya pozitif antijen saptanması durumunda ‘güvenli’infeksiyöz olarak kaydedildi.Bulgular: Toplam 110 hastada granülomatöz LAP saptandı. Hastaların %70.9’u kadın cinsiyetindeydi ve ortalama yaş 53 (range44-61)’tü. Yetmiş dokuz (%71.8) hastada sarkoidoz, 7 (%6.4) hastada tümör ilişkili granülom, 4 (%3.6) hastada tüberküloz, 4(%3.6) hastada silikozis, 2 hastada (%1.8) ilaç ilişkili granülom, 1 (%0.9) hastada hipersensitivite pnömonisi, 1 (%0.9) hastadaChron hastalığı, 12 (%10.9) hastada nedeni bilinmeyen granülom saptandı. Tüberküloz tanısı 3 hastada kültür pozitifliğiyle konuldu.Sonuç: Bu çalışmada granülomatöz lenfadenitin en sık sebebinin sarkoidoz olduğu saptandı. Beklenenin aksine tüberküloz tanısı alanhasta sayısı oldukça düşüktü.

Causes of mediastinal/hilar granulomatous lymphadenitis

Introduction: Granulomatous lung disease (GLD) is caused by a wide range of conditions and it is challenge for pulmonologist. A detailed history of exposures is fundamental in GDL and has been found pivotal to reach a precise diagnosis. Materials and Methods: Between September 2014 and December 2016, the distribution of patients diagnosed with granulomatous lymphadenitis in the mediastinal/hilar lymph nodes by endobronchial ultrasound (EBUS) or mediastinoscopy was analyzed. To be listed as ‘confident’, a diagnosis of sarcoidosis required compatible histological, radiological and clinical findings in conjunction with negative cultures. Infectious entities listed as ‘confident’ had either microorganisms in tissue section, positive culture, positive serology or positive antigen detection in a consistent clinical pathological setting. Results: Granulomatous lymphadenitis was detected in 110 patients. The included 110 cases consisted of 70.9% women and median age of 53 (range 44-61) years. The final diagnosis of the patients was accepted to be sarcoidosis in 79 (71.8%), sarcoid like granulomas in 7 (6.4%), tuberculosis in 4 (3.6%), silicosis in 4 (3.6%), drug-associated granuloma in 2 (1.8%), hypersensitivity pneumonitis in 1 (0.9%), Chron disease in 1 (0.9%), unspecified in 12 (10.9%). Three patients were classified as tuberculosis based on culture. Conclusion: In this study, we found that the most common cause of granulomatous lymphadenitis was sarcoidosis. Contrary to expectations, the number of patients diagnosed with tuberculosis was very low.

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