Diagnosis Of Sarcoidosis With Salivary Gland Biopsy

As with Sjogren's syndrome diagnoses with salivary gland biopsies, early stage disease is perhaps more readily diagnosed with a parotid biopsy rather than a minor salivary gland biopsy. It has been pointed out that cases of sarcoidosis that do not clinically produce parotid enlargement nonetheless show involvement at the microscopic level (Marx 1995). In this review, the labial biopsy was positive in 38% of cases while 88% of parotid biopsies were positive for sarcoidosis. The lesions of sarcoidosis in labial salivary gland biopsies tend to be sparse such that multiple labial glands require excision for microscopic analysis. Another report investigated the yield of minor salivary gland biopsy in the diagnosis of sarcoidosis (Nessan and Jacoway 1979). In this study of 75 patients, non-caseating granulomas were present in minor salivary gland biopsies in 44 patients (58%). There was no correlation with minor salivary gland biopsy yield and stage of the disease. The highest yield for diagnosis of sarcoidosis was found in transbronchial lung biopsies (93%). Nonetheless, the diagnosis of sarcoidosis is one of exclusion, owing to an absence of a diagnostic gold standard. As such, a compatible clinical picture is established based on the patient's symptoms, physical, and radiographic findings. The biopsy of salivary gland tissue or other tissue identifies the presence of non-caseating granulomas such that a provisional diagnosis of sarcoidosis is made. It then becomes necessary to exclude other sources of granulomatous inflammation, such as Crohn's

Natural Medicine For Sarcoidosis
Figure 6.13. Histopathology of sarcoidosis. (Image courtesy of Dr. Joseph A. Regezi.)

disease, deep fungal infections, and others. It is important to point out that there are no pathogno-monic diagnostic tests for sarcoidosis. Rather, the salivary biopsy must be considered with an elevated angiotensin converting enzyme (ACE) and lysozyme result, and an altered ratio of CD4/CD8 cells, among others, so as to offer a diagnosis of sarcoidosis (Kasamatsu et al. 2007).

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