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Tuesday, December 10, 2013
Sarcoidosis or lymphoma
Six years ago I was diagnosed with sacoid. I presented with swollen ankles and a dr did a chest X ray and it showed enlarged lymph glands. I had a biopsy done, they made an incision in my neck and removed a lymph gland. Fast forward to today... About six weeks ago my knee and both my ankles started swelling at first no one knew what it was from. A CT scan was done and it showed enlarged Lymph glands. Now they want to do another biopsy just like before to rule out lymphoma.. Is there a another less envasive way to make this diagnosis.
Unfortunately, there is not a reliable diagnostic blood or radiographic test available for sarcoidosis. Making the distinction between sarcoidosis and lymphoma is a common diagnostic dilemma.
In your case, you have an established diagnosis of sarcoidosis from a previous biopsy. Although it is possible that lymphoma developed in the years since the last biopsy was performed, it is most likely reactivation of your sarcoidosis. If you have any enlarged lymph nodes in the neck or perhaps skin manifestations (rash), it might be possible to confirm the diagnosis using less invasive methods. If a biopsy of the lymph nodes in your chest seems like the only option (based on advice from your doctors), it is possible to perform a procedure called "bronchoscopy" to get some material. This involves passing a "scope" into your lungs and is less invasive than the mediastinal surgery you previously had. However, bronchoscopy is good for diagnosing sarcoidosis but is not good for diagnosing lymphoma
Presumably, your doctors have considered all of these variables before recommending a repeat surgical biopsy.
Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University