Sarcoidosis + honeycomb lung

Question 1

what is sarcoidosis

Answer 1

Systematic disease of unknown etiology characterized by the presence of non-caseating granulomas in many organs.

Question 2

The sarcoidosis is seen commonly in females of which age

Answer 2

20-40 years

Question 3

The sarcoidosis is associated with which antigen

Answer 3

HLA-A1
HLA-B8

Question 4

list 4 immunological abnormalities associated with sarcoidosis

Answer 4

• Intra-alveolar and interstitial accumulation of CD4 + T cells resulting in CD4 :CD8 T cell ratio ranging from 5:1 to 15:1.
• Increased levels of IL-2 and IFN-g causing T-cell expansion and macrophage activation
  respectively.
• Polyclonal hypergammaglobulinemia.
• Anergy to skin antigens like purified protein derivative (PPD)Q.

Question 5

Explain histologically appearance of sarcoidosis

Answer 5

Histologically, there is characteristically presence of non-caseating granuloma composed of aggregates of epithelioid cells and giant cells. There is also presence of Schaumann bodies (laminated concretions of calcium and protein) and asteroid bodies (stellate or star shaped inclusions in giant cells).

Question 6

Explain the sarcoidosis in the lungs

Answer 6

Most common site of organ involvement
There is presence of non-caseating granuloma in the bronchial submucosa
Bronchoalveolar lavage shows CD4,CD9,T lymphocytes ration of>2.5 is seen

Question 7

explain the sarcoidosis in lymph nodes

Answer 7

Involvement of hilar and mediastinal nodes is seen in almost all the cases

Question 8

explain the sarcoidosis in the liver and spleen

Answer 8

splenomegaly may be seen with sparing of capsule. Scattered granulomas are seen more in portal triad as compared to globular paranchyma

Question 9

explain the sarcoidosis in the bone marrow

Answer 9

favoured site of localization having tendency to involve phalangeal bones of hands and feet showing small areas of bone resorption, bony shaft widening and new bone formation

Question 10

explain the sarcoidosis in the skin

Answer 10

lesion inclide erythema nodosum, subcutaneous nodules, erythematous plaque and lupus perniq

Question 11

explain the sarcoidosis in eye, lacrimal and salivary glands

Answer 11

Unilateral or bilateral oculr involvement resulting in iritis, glaucoma or corneal opacity may occur.
Causes lacrimal gland inflammation (causing dry eyes) and salivary gland involvement (dry mouth)

Question 12

Organizing diffuse alveolar damage is known as what?

Answer 12

Honeycomb lung

Question 13

explain the honeycomb lung gross appearance

Answer 13

Honeycomb change, gross
Appearance of the irregular residual small dilated airspaces between bands of dense fibrous interstitial connective tissue.
The lung compliance is markedly diminished so that patients receiving mechanical ventilation require increasing positive end-expiratory pressure (PEEP), predisposing them to airway rupture and development of interstitial emphysema.