We examined pathological changes of sarcoidosis in autopsy case in which clinical diagnosis was made.
Case: 64 year old woman, wife of a pesant.
Chief Complaint: Dyspnoea, cough, sputum, palpitation of heart, fever and eruptions of face and forearms.
Family History: Her grandmother died of pulmonary tuberculosis.
Past History: She had pain in the joints of elbows, arms, fingers, feet at the age of 20. She had first stridulous breathing at the age of 40.
Onset and Course of Present Illness: She had had the above chief complaints frequently since the age of 58. She was admitted to a certain hospital as having pulmonary tuberculosis, and the biopsy at the skin of her right fore arm was tried, and then her illness was considered sarcoidosis at the age of 60. She was admitted to the Department of Internal Medicine II, at the age of 61. She had the abve chief complaints off and on, and her conditions gradually deteriorated with corresponding changes in symptomes such as dyspnoea. She died severe dyspnoea at the age of 64 (1964).
X-ray Examination of the Chest: Chest films showed hilla enlargement which sharply demarcated, and showed irregular reticular and millialy infiltrative shadow throughout the lung fields. These findings of the chest were noticed from the age of 61.
Chief Laboratory Findings: Tuberculin reactions and Kveim tests were negative. Serum-globlin and serum calcium were almost normal.
Postmortem Examination; The main anatomical findings were small granulomas of epithelioid cells in both lungs, lymph-nodes, skin, heart and kidneys.
Lungs: Epithelioid cell granulomas were seen in the peribronchus, lobular septum, alveolar walls and pleura, and most of subpleural granulomas showed hyalin-like degeneration. Increase of collagenous fibers was seen in peribronchial lesions. The bronchial tree is filled with mucopurulent materials.
Lymph-nodes: The numerous lymph-nodes of mediastinum, trachea, bronchus, lung, neck, and pancreas-spleen showed various sizes: the small ones in the size of tip little finger and large ones in that tip of thumb. Sections through them reveal miliary, uniform granulomas including hyalin-like degeneration and Schaumann bodies.
Skin: Sarcoid granulomas were present over the fore arms and face, and were scattered in true skin.
Heart: Few granulomas were seen in the interstitial myocardium. The wall of right ventricle showed hypertrophy (light cor pulmonare).
Kidney: Few granulomas composed of giant cells and Schaumann bodies were present.
Discussion: Sarcoid granulomas show nearly uniform size and do not show necrosis, often with giant cells and hyaline-like degeneration and Schaumann bodies. Sarcoid granulomas in the skin and lungs are cured almost completely without remaining pathological changes, but relapses occur so frequently. Those lymph-nodes, however often change into hyalin-like degeneration. We consider that the initial lesion occurs within the lung, and then the lymphnodes of lung are infiltrated, and finally sarcoid granulomas appear in skin, heart, and kidney. Cause of death is relatively fresh pulmonary sarcoidosis.
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