The clinical spectrum of the sarcoid peripheral lymph node

Background: The finding of sarcoid-type granulomas in a peripheral lymph no de (PLN) without clinical evidence of changes suggestive of sarcoidosis els ewhere poses a diagnostic problem. The long term follow-up of these patient s has never been described in adults. Aims of the work: 1. To describe in t he above population whether and when a definite diagnosis of sarcoidosis wa s eventually made, and the time required to make the diagnosis. 2. To study the percentage of peripheral lymph node presentation in sarcoidosis. Patie nts: A peripheral lymph node presentation, with lymph node biopsy demonstra ting sarcoid granulomas, was seen in 127 patients over the last 20 years. D etailed investigation permitted the early diagnosis of sarcoidosis in 76, a nd of sarcoid reaction in 8 patients. The other 43 patients with granulomat ous lymph node and no clinical evidence of changes outside the lymphatic sy stem at the onset are the subject of the present study. Methods: Periodic e xamination at our Sarcoid Clinic every 2 to 4 months, in a long term median follow-up of 36 months (range 1 to 203) and workup according to clinical n eed, including chest X ray and Computed Axial Tomography (CAT), pulmonary f unction tests, total body Ga-67 scan, Broncho Alveolar Lavage (BAL) studies , blood cell counts, 24 h calciuria and urine analysis, serological tests f or liver function, calcaemia, Angiotensin Converting Enzyme (ACE). Results: The diagnosis of sarcoidosis (chronic in all) could be made in 33 patients (25 pulmonary, 8 extrapulmonary), after a median time from presentation of 5 years (range 3-288 months). In the other 10, in spite of a median durati on of the illness of 62 months (range 20-487), our diagnosis has been idiop athic granulomatous disease of peripheral lymph nodes. Thus, we observed 10 9 patients in 20 years presenting with lymph nodes that were surgically rem oved and provided the diagnosis of sarcoidosis sooner (76 patients) or late r (33 patients). Conclusions: 1. In patients presenting only sarcoid granul omas in peripheral lymph nodes, sarcoidosis may be diagnosed months or year s later, but a subpopulation of them still exists where granulomatous lesio ns remain unexplained. 2. In our series of patients, peripheral lymph node presentation occurred in 11.7% of cases of sarcoidosis.