上咽頭の検索が診断に有用であったサルコイドーシスの二症例 1) 1) 1) 1) 1) 2) 2) 2) 2) 3) 要旨 2 1 68 TBLB BDP 10 2 23 BHL TBLB 10 2 キーワード : Diagnostic usefulness of epipharyngeal examination in sarcoidosis: Report of two cases Tetsuo Yamaguchi 1), Yoshihito Yamada 1), Chiyoko Kono 1), Sakuo Hoshi 1), Hiroko Amano 1), Hiroko Watanabe 2), Takeshi Watanabe 2), Natsuhiko Mitomi 2), Makoto Hara 2), Tamiko Takemura 3) ABSTRACT We report diagnostic usefulness of epipharyngeal examinations in sarcoidosis. Case 1: A 68-year-old woman had sarcoidosis-suspected diffuse lung abnormalities, uveitis and thrombocytopenia but declined to undergo transbronchial lung biopsy. Then, we referred her to an ear-nose-throat (ENT) specialist who incidentally discovered a mass in her upper respiratory tract. The biopsy specimen of the lesion contained non-caseating epithelioid cell granulomas. After she was treated by beclomethasone inhalation for 10 months for her asthmatic symptoms, the epipharyngeal mass showed marked shrinkage. Case 2: A 23-year-old man with BHL was referred to our hospital and underwent transbronchial biopsy resulting in negative findings. An ENT specialist found rough surface in part in his epipharyngeal mucosa, and a biopsy of the portion disclosed sarcoid granulomas. He was followed up without treatment and the surface looked almost normal 10 months later,. These two patients had no significant symptoms suggesting any topical involvements in the epipharynx. Epipharyngeal examination is not so invasive that this procedure should be made more positively to bring about diagnostic benefit for the patients of suspected sarcoidosis. keywords ; Sarcoidosis, Upper respiratory tract involvement, Epipharyngeal involvement, Mass formation 1) JR 東京総合病院呼吸器内科, 2) JR 東京総合病院耳鼻咽喉科, 3) 日赤医療センター病理著者連絡先 : 山口哲生 JR 東京総合病院呼吸器内科 151-8528 渋谷区代々木 2-1-3 TEL: 03-3320-2200 FAX: 03-3370-8501 1) Dept. of Respiratory Medicine, JR Tokyo General Hospital 2) Dept. of Otolaryngology, JR Tokyo General Hospital 3) Dept. of Pathology, Japan Red Cross Medical Center 45
日サ会誌 2002,22(1) はじめに 3 01 12 症例呈示 症例 1:68 歳女性. 主婦. 既往歴 家族歴 生活歴 主訴 現病歴 臨床経過 95 BHL 00 BHL 1.7 /mm 3 00 12 70kg 49kg ACE 31.9IU/L/37 Table.1 VC 2.25L 99.6 FEV1.0 65.5 5.0 /mm 3 01 2 Figure 1 Figure 2 BDP 100 g/ Figure 1. Laryngoscopic appearance of an epipharyngeal mass in case one. Figure 2. Many non - caseating epithelioid cell granulomas below epithelium in a biopsy specimen of the epipharyngeal mass in case one. 症例 2:23 歳男性. コンピュータ関係. 既往歴 家族歴 生活歴 18 3 4 主訴 BHL 現病歴 臨床経過 99 5 BHL 98 BHL Ga 46
ACE Table.1 Table 1. Laboratory data on the first visits Figure 3. Laryngoscopic apparance of epipharyngeal mucosa, a part of which seemed rough in case two. 99 6 BALF 6.0 10 4 / l BALF 39 CD4/CD8 4.8 TBLB 01 3 BHL 1 Figure 3 Figure 4 02 1 考察 Figure 4. Non - caseating epithelioid cell granuloma below epithelium in a biopsy specimen of the epipharyngeal mucosa in case two. 1967 Scadding upper respiratory tract 1965 2 1) James 1982 sarcoidosis of the upper respiratory tract SURT 2) 1994 James 3) Sharma 1984 SURT 4) 47
日サ会誌 2002,22(1) Wilson 5) Brompton750 URT 18 9 27 5 2 URT Boeck 1905 1 6) SURT Lindsay 7) SURT 9 3 1 2 Larsson 8) 10 8 3 Weiss 9) 11 1 10) 1 28/418 11) 2 1 2 1 1 BDP100 g/ 2 2 Wilson 12) 2 1 2 2 結論 2 2 48
引用文献 1) Scadding JG and Mitcchell: The upper respiratory tract. Sarcoidosis. 2nd Ed. Chapman and Hall Medical London 1985; 290-301. 2) James DG, Barter S, Jash D, et al: Sarcoidosis of the upper respiratory tract (SURT). J Laryngol Otol. 1982; 96: 711-718. 3) James DG: Upper respiratory tract. Sarcoidosis and other granulomatous disorders. James DG Ed. Marcel Dekker Inc. New York 1994; 417-420. 4) Sharma Om P: Upper respiratory tract.sarcoidosis: Clinical management. Butterworths. London. 1984; 125-128. 5) Wilson R, Lund V, Sweatman M, et al: Upper respiratory tract involvement in sarcoidosis and its management. Eur Resp J 1988; 1: 269-272. 6) Boeck C: Fortgesetzte Untersuchungen uber das multiple benigne Sarkoid. Arch Dermatol Syph. 1905; 73: 71-86, 301-332. 7) Lindsay JR, Perlman HB: Sarcoidosis of the upper respiratory tract. Ann. Otol. 1951; 60: 549-566. 8) Larsson LG: Nasopharyngeal lesions in sarcoidosis. Acta Radiol. 1951, 36: 361-373. 9) Weiss JA: Sarcoidosis in otolaryngology. Report of eleven cases. Evaluation of blind biopsy as a diagnostic aid. Laryngoscope 1960; 70: 1351-1398. 10) 平島直子, 中島格, 北川晋二 : 上気道のサルコイドーシス 1 例. 耳喉 1975; 47: 33-37. 11) 植竹健司, 高橋直喜, 鈴木俊雄, 他 : 鼻粘膜病変による高度の鼻閉を初発としたサルコイドーシスの 1 例. 日胸疾会誌 1983; 21: 672-678. 12) Wilson R, Sweatman M, Mackay I, et al: Adenoidal tissue as an aid to the diagnosis of sarcoidosis in childhood. Thorax 1986; 41: 66-67. 49