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Archives of Pathology & Laboratory... Jan 2022Because granulomas are represented in almost every disease category, the number of clinically and pathologically important granulomatous pulmonary diseases is large.... (Review)
Review
CONTEXT.—
Because granulomas are represented in almost every disease category, the number of clinically and pathologically important granulomatous pulmonary diseases is large. Their diagnosis by pathologists is particularly challenging because of their nonspecificity. A specific diagnosis can be achieved only when a granuloma-inciting agent(s) (eg, acid-fast bacilli, fungi, foreign bodies, etc) are identified microscopically or by culture; this does not occur in most cases. Furthermore, a specific diagnosis cannot be reached in a high percentage of cases. Although sarcoidosis and infectious diseases account for approximately half of pulmonary granulomatous diseases worldwide, there is significant geographic variation in their prevalence.
OBJECTIVES.—
To present updated information to serve as a guide to pathologic diagnosis of pulmonary granulomatous diseases, to address some commonly held misconceptions and to stress the importance of multidisciplinary coordination. Presentation of basic aspects of granulomas is followed by discussion of specific disease entities, such as tuberculous and nontuberculous Mycobacterial infections, fungal, bacterial, and parasitic infections, sarcoidosis, necrotizing sarcoid granulomatosis, berylliosis, hypersensitivity pneumonitis, hot tub lung, rheumatoid nodule, bronchocentric granulomatosis, aspirated, inhaled, and embolized foreign bodies, drug-induced granulomas, chronic granulomatous disease, common variable immunodeficiency, and granulomatous lesions associated with various types of cancer.
DATA SOURCES.—
Review of pertinent medical literature using the PubMed search engine and the author's practical experience.
CONCLUSIONS.—
Although the diagnosis of granulomatous lung diseases continues to present significant challenges to pathologists, the information presented in this review can be helpful in overcoming them. The importance of multidisciplinary coordination in cases where morphologic diagnosis is not possible cannot be overstated.
Topics: Alveolitis, Extrinsic Allergic; Granuloma; Humans; Lung; Lung Diseases; Sarcoidosis
PubMed: 33905479
DOI: 10.5858/arpa.2020-0543-RA -
CMAJ : Canadian Medical Association... Feb 2024
Topics: Humans; Middle Aged; Berylliosis; Metal Workers
PubMed: 38346777
DOI: 10.1503/cmaj.221680-f -
Annals of the American Thoracic Society Apr 2018Metal-induced hypersensitivity is driven by T-cell sensitization to metal ions. Although numerous metals are associated with the development of diffuse parenchymal lung... (Review)
Review
Metal-induced hypersensitivity is driven by T-cell sensitization to metal ions. Although numerous metals are associated with the development of diffuse parenchymal lung disease, beryllium-induced hypersensitivity is the best-studied to date. This review focuses on the interaction between innate and adaptive immunity that leads to the development of chronic beryllium disease. After beryllium exposure, activation of the innate immune system occurs through the engagement of pattern-recognition receptors. This activation leads to cell death, release of alarmins, and activation and migration of dendritic cells to lung-draining lymph nodes. These events culminate in the development of an adaptive immune response that is characterized by beryllium-specific, T-helper type 1-polarized, CD4 T-cells and granuloma formation in the lung. The unique ability of beryllium to bind to human leukocyte antigen-DP molecules that express a glutamic acid at position 69 of the β-chain alters the charge and conformation of the human leukocyte antigen-DP-peptide complex. These changes induce post-translational modifications that are recognized as non-self. In essence, the ability of beryllium to create neoantigens underlies the genesis of chronic beryllium disease, and demonstrates the similarity between beryllium-induced hypersensitivity and autoimmunity.
Topics: Adaptive Immunity; Autoimmunity; Berylliosis; Beryllium; CD4-Positive T-Lymphocytes; Genetic Predisposition to Disease; HLA-DP beta-Chains; Humans; Hypersensitivity; Lung
PubMed: 29676647
DOI: 10.1513/AnnalsATS.201707-573MG -
The Western Journal of Medicine Aug 1987Sarcoidosis is a multisystem granulomatous disease of unknown etiology. The organs that are involved by sarcoidosis include the lungs in which the granuloma is seen in... (Review)
Review
Sarcoidosis is a multisystem granulomatous disease of unknown etiology. The organs that are involved by sarcoidosis include the lungs in which the granuloma is seen in more than 90% of patients to the pituitary, which is only rarely affected. There are many hypotheses as to the cause of sarcoidosis. Some of them rely on the similarities seen between sarcoidosis and the other granuloma-forming diseases such as tuberculosis, berylliosis, pine pollen inhalation and acute and chronic bacterial and viral infections, while others find similarities between sarcoidosis and immune reactions observed in autoimmune disorders. Still other explanations implicate a genetic predisposition or a still-unknown agent as the underlying cause of the granuloma formation.
Topics: Granuloma; Humans; Sarcoidosis
PubMed: 3310401
DOI: No ID Found -
Postgraduate Medical Journal Jul 1988The increasing use of beryllium in a variety of industries continues to be a hazard. New cases are still being reported to the UK Beryllium Case Registry, now numbering... (Review)
Review
The increasing use of beryllium in a variety of industries continues to be a hazard. New cases are still being reported to the UK Beryllium Case Registry, now numbering 60 in the period 1945-1988. The majority of cases follow inhalation which results in acute beryllium disease (chemical pneumonitis) or more commonly chronic beryllium disease--a granulomatous pneumonitis. Granulomatous skin nodules also occur following local implantation. The clinical and radiological features are briefly described with the emphasis on pathology and immunology. Laser microprobe mass spectrometry analysis of tissue sections is a major advance in diagnosis. Detection of beryllium distinguishes the granulomas of chronic beryllium disease from other diseases, in particular sarcoidosis. The role of beryllium lymphocyte transformation tests is discussed. Chronic beryllium disease is steroid dependent and local excision of skin lesions appears to be curative. There is no evidence that beryllium is carcinogenic.
Topics: Berylliosis; Humans; Skin Diseases
PubMed: 3074283
DOI: 10.1136/pgmj.64.753.511 -
Journal of Immunology (Baltimore, Md. :... Apr 2022Sarcoidosis and chronic beryllium disease are noninfectious lung diseases that are characterized by the presence of noncaseating granulomatous inflammation. Chronic... (Review)
Review
Sarcoidosis and chronic beryllium disease are noninfectious lung diseases that are characterized by the presence of noncaseating granulomatous inflammation. Chronic beryllium disease is caused by occupational exposure to beryllium containing particles, whereas the etiology of sarcoidosis is not known. Genetic susceptibility for both diseases is associated with particular MHC class II alleles, and CD4 T cells are implicated in their pathogenesis. The innate immune system plays a critical role in the initiation of pathogenic CD4 T cell responses as well as the transition to active lung disease and disease progression. In this review, we highlight recent insights into Ag recognition in chronic beryllium disease and sarcoidosis. In addition, we discuss the current understanding of the dynamic interactions between the innate and adaptive immune systems and their impact on disease pathogenesis.
Topics: Adaptive Immunity; Berylliosis; Beryllium; Chronic Disease; Granuloma; Humans; Lung Diseases; Sarcoidosis
PubMed: 35418504
DOI: 10.4049/jimmunol.2101159 -
Clinics in Chest Medicine Dec 1997Since sarcoidosis was first recognized as a distinct clinical entity, investigators have speculated that a transmissible agent may cause sarcoidosis. Recent attempts at... (Review)
Review
Since sarcoidosis was first recognized as a distinct clinical entity, investigators have speculated that a transmissible agent may cause sarcoidosis. Recent attempts at directly isolating infectious organisms or indirectly detecting microbial DNA or RNA from sarcoid tissue have led to inconclusive results. Studies on the immunopathogenic origins of sarcoidosis have provided evidence of persistent antigenic stimulation at sites of inflammation that are associated with dysregulated cytokine production. To date, however, the challenge of defining the cause of sarcoidosis remains unmet.
Topics: Autoimmune Diseases; Berylliosis; Environmental Exposure; Humans; Infections; Sarcoidosis
PubMed: 9413653
DOI: 10.1016/s0272-5231(05)70413-5