PURPOSE: Traditionally, the presence of polarizable foreign body in epithelioid granulomas was thought to exclude the diagnosis of sarcoidosis1. More recently it has been recognized that the presence of these bodies is compatible with a diagnosis of sarcoidosis. Polarizable foreign bodies have been reported in 22% to 24% of skin biopsies from patients with cutaneous sarcoidosis. This study aims to establish the incidence of such bodies in lung biopsy samples from patients with pulmonary sarcoidosis.
METHODS: Patients diagnosed to have pulmonary sarcoidosis at a single institution were identified. Only those patients who had bronchoscopic or open lung biopsies were included in the study. The biopsy slides were re-examined to establish the presence or absence of polarizable foreign bodies.
RESULTS: Twenty-nine patients with sarcoidosis were identified to have a lung biopsy between the years 1997 to 2005. However, the pathology specimens of only 16 of these patients were immediately available for review. Nine of these 16 patients had transbronchial, three had endobronchial, three had endobronchial and transbronchial, and one had open lung biopsy. Polarizing bodies were found in nine (56%) of these patients. An additional four patients were found to have non-polarizable foreign body material in the granulomas. Thus, foreign bodies were identified in a total of 13 (81%) of these patients.
CONCLUSION: Rather than an occasional association, polarizable and non-polarizable foreign bodies appear to be present in lung granulomas of most patients with pulmonary sarcoidosis.
CLINICAL IMPLICATIONS: While a cause and effect association cannot be made from this study, the high incidence of foreign body material in these patients does raise the question whether exposure to environmental particulates may be the nidus for the sarcoid granulomatous reaction.
DISCLOSURE: Vinay Sharma, None.