For the definitive diagnosis of sarcoidosis, pathological examination is mandatory. Transbronchial lung biopsy has been performed for the diagnosis of sarcoidosis, and the ultrastructure of sarcoid granuloma and other architectures including capillary vessels were examined.
TBLB was performed in right S8b and S3a in 17 cases of sarcoidosis ranging from 22 years old to 53 years old. Preparations for light microscopy and electron microscopy examination were made. The latter was performed after fixation of the specimen in 2.5% glutaraldehyde.
Anterior scalene node biopsy was performed in 12 cases. Positive TALB identified by the presence of sarcoid granuloma was obtained in 3/8 cases (38%) in stage I, in 6/7 cases (86%) in stage II and 2/2 cases (100%) in stage III according to X-ray staging. The overall TBLB pathological diagnosis was 11/17 cases (65%) of sarcoidosis, and increased to 82% by including the results of scalene node biopsy. Electron microscopy examination was performed in 7 cases. In the sarcoid granuloma, lysosomal epitheloid cells and vesicular epitheloid cells were observed. A number of blebs caused by the breakdown of endothelium was also observed. Alveolar ulcer of the epithelium was noted. Derangement of the pulmonary architecture which is not indicated by chest X-ray is present in the lungs of cases sarcoidosis. Electron microscopic examination of TBLB specimens can afford useful acknowlegement in various kinds of pulmonary disease.
