Buğra KERGET, Elif YILMAZEL UÇAR, Metin AKGÜN, Yener AYDIN, Ömer ARAZ, Aslı ARAZ, Fatma AKDEMİR, Elif DEMİRCİ

Sarkoidoz ve tüberküloz lenfadenit ayrımında doku element analizi kullanılabilir mi?

Giriş: Sarkoidoz ve tüberküloz lenfadenit, granülomatöz inflamasyon oluşturan hastalıklardır. Bu iki hastalığın lenf bezi tutulumunun ayrımı bazı durumlarda güç olmaktadır. Bu çalışma, histopatolojik ve klinik olarak ayırıcı tanısında güçlük yaşayabildiğimiz bu hastalıklarda alınan doku örneklerinde çalışılan elementlerin hastalıkların ayrımına katkıda bulunup bulunmayacağını tespit etmek amacıyla yapılmıştır. Materyal ve Metod: Çalışmaya 152 olgu alındı. Olguların 57’si kazeifiye granülomatöz inflamasyon, 58’i non-kazeifiye granülomatöz inflamasyon, 37’si ise reaktif lenf bezi doku örneklerinden oluşmaktaydı. Dokularda “inductively coupled plasma-optical emission spectroscopy (ICP-OES)” yöntemiyle kalsiyum, magnezyum, demir, bakır, çinko, krom, molibden, nikel ve selenyum elementlerinin analizi yapıldı. Bulgular: Üç grup elde edilen elementlerin miktarları karşılaştırıldığında; kazeifiye granülomatöz inflamasyon ile non-kazeifiye granü- lomatöz inflamasyon karşılaştırıldığında kazeifiye granülomatöz inflamasyonda kalsiyum yüksek (662.6 ± 4.6 ppm, p< 0.001) ve demir miktarı düşük (48.7 ± 83 ppm, p< 0.001) idi. Kazeifiye granülomatöz inflamasyon ile reaktif lenf dokusu karşılaştırıldığında kalsiyum yüksek, demir ve magnezyum düşük idi, non-kazeifiye granülomatöz inflamasyon ile reaktif lenf dokusu karşılaştırıldığında demir miktarı yüksek, magnezyum miktarı düşük idi ancak her iki karşılaştırmada istatistiksel olarak anlamlı fark yoktu. Kazeifiye granülomatöz inflamasyon da kalsiyumun 207 ppm “cutt-of” değeri için özgüllüğü %85, duyarlılığı %63 idi. Yine demir elementinin 51 ppm “cutt-of” değeri için özgüllüğü %74, duyarlılığı %58 idi. Sonuç: Lenf bezi dokusunda kalsiyum yüksekliği ve demir düşüklüğü kazeifiye granülomatöz inflamasyon, tüberküloz, lehine yorumlanabilir. Sarkoidoz ve tüberküloz lenf bezi tutulumunun ayrımında güçlük çekilen durumlarda, doku element analizinin yapılması hastalık ayrımında ek destekleyici bulgu verebilir.

Can tissue elemental analysis be used to differentiate sarcoidosis and tuberculous lymphadenitis?

Introduction: Sarcoidosis and tuberculous lymphadenitis are granulomatousinflammatory diseases. Differentiating lymph node involvement in these twodiseases can be challenging. This study evaluated whether elemental analysisof tissue samples could facilitate the differentiation of these histopathologically and clinically similar diseases.Materials and Methods: A total of 152 tissue samples were included: 57 caseating granulomatous inflammation, 58 non-caseating granulomatous inflammation, and 37 reactive lymph node specimens. The tissue samples wereanalyzed for calcium, magnesium, iron, copper, zinc, chrome, molybdenum,nickel and selenium with inductively coupled plasma-optical emission spectroscopy (ICP-OES).Results: Comparison of element levels in the three groups revealed that caseating granulomatous inflammation had higher calcium content (662.6 ± 4.6ppm, p< 0.001) and lower iron content (48.7 ± 83 ppm, p< 0.001) comparedto non-caseating granulomatous inflammation. Compared to reactive lymph tissue, caseating granulomatous inflammation had higher calcium and lower iron and magnesium content while non-caseating granulomatous inflammation had higher levels of iron and lower magnesium; however, these differences were not statistically significant.In caseating granulomatous inflammation, a calcium cut-off value of 207 ppm yielded 85% specificity and 63% sensitivity. For iron,a cut-off value of 51 ppm had 74% specificity and 58% sensitivity.Conclusion: High calcium and low iron levels in lymph tissue may be suggestive of caseating granulomatous inflammation and tuberculosis. In cases where differentiating between sarcoidosis and tuberculous lymphadenitis is difficult, performing tissue elementalanalysis may provide additional supportive evidence for differential diagnosis.

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