Abstract
Purpose. To introduce a minimally invasive procedure, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), to obtain a pathologic evidence of a definite ocular sarcoidosis in a patient who initially presented with presumed ocular sarcoidosis with pulmonary involvement. Methods. An EBUS-TBNA procedure was performed at perihilar lymph nodes, subcarina, and right paratrachea of the patient and specimen obtained was sent for histocytopathological studies. Result. Histocytopathological findings revealed aggregates of epithelioid histiocytes forming a noncaseous granuloma, a hallmark of sarcoidosis. Conclusion. EBUS-TBNA should be considered an alternative procedure to provide cytohistopathology proven diagnosis of definite ocular sarcoidosis.
Highlights
The diagnosis of sarcoidosis can be reliably established when there is a compatible clinical/radiological picture together with the hallmark histologic findings of noncaseating epithelioid cell granulomas
Real-time EBUS-TBNA, a minimally invasive technique which used a curved linear array ultrasonic bronchoscope that provides high resolution imaging of the mediastinum using high frequency ultrasound probes attached to the tip of a flexible endoscope, allowed aspiration biopsy to obtain a definite diagnosis for malignant and benign lung lesions more safely with high diagnostic values and sensitivities compared to conventional methods which relied on a “blind” needle puncture guided by static computed tomography scans [3,4,5]
Though recent study reported a high CD4/CD8 ratio of lymphocytes obtained from diagnostic vitrectomy using flow cytometric analysis which delivered a high diagnostic value; such evidence provided the diagnosis of presumed ocular sarcoidosis [7]
Summary
The diagnosis of sarcoidosis can be reliably established when there is a compatible clinical/radiological picture together with the hallmark histologic findings of noncaseating epithelioid cell granulomas. The most predominant finding is peribronchial thickening or bilateral lower lung involvement, especially hilar adenopathy, which occurs in patients with pulmonary sarcoidosis [1]. Ocular involvement in sarcoidosis is present in approximately 25– 60% of patients with systematic sarcoidosis and may be the initial manifestation of the disease [1, 2]. A systematic review and meta-analysis of EBUS-TBNA in sarcoidosis between 2004 and 2011 which included 553 patients from 15 studies revealed a diagnostic yield ranging from 54 to 93% with the pooled diagnostic accuracy being 79% (95% CI, 71–86%) and only 5 minor complications were reported [6]. The first report to demonstrate the role of EBUS-TBNA in labeling a diagnosis of definite ocular sarcoidosis in a patient who had bilateral hilar lymphadenopathy and peribronchial thickening but initially presented with presumed ocular sarcoidosis
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