顎下リンパ節腫脹が診断の契機となったサルコイドーシスの1例

• Published in: 日本口腔外科学会雑誌 Vol. 55; no. 9; pp. 448 - 452
• Main Authors: 君塚, 幸子, 大村, 進, 岡本, 喜之, 青木, 伸二郎
• Format: Journal Article
• Language: Japanese
• Published: 社団法人 日本口腔外科学会 20.09.2009
• Subjects: サルコイドーシス; リンパ節腫脹; 耳下腺腫脹; 顎下リンパ節
• ISSN: 0021-5163; 2186-1579
• DOI: 10.5794/jjoms.55.448

Sarcoidosis is a systemic disease of unknown etiology characterized pathologically by noncaseatingepithelioid cell granulomas affecting any organ. It is often associated with bilateral hilar lymphadenopathy, pulmonaryinfiltration, and skin or eye lesions. We report a case of sarcoidosis with submandibular lymphadenopathy. The patient was a 28-year-old woman who presented with a left submandibular painless nodule. Magnetic resonanceimaging（MRI）revealed a submandibular mass with low intensity on T-1 weighted images and high intensityon T-2 weighted images. Under general anesthesia, resection of the lesion was performed. Histologically thespecimen consisted of numerous noncaseating epithelioid cell granulomas. The histological diagnosis was sarcoidosis,and additional examinations were conducted. Ga-67 scintigraphy bilaterally showed increased uptake inthe lacrimal glands, parotid glands, and hilar lymp nodes. Bilateral hilar lymphadenopathy was confirmed on thoracicCT scanning, and bilateral swelling of the parotid gland was confirmed on MRI. The results of the tuberculinskin test were negative, and the serum levels of angiotensin-converting enzymes and γ-globulin were increased.These findings supported the histological diagnosis. Because the patient was asymptomatic, only careful follow-upwas continued, without treatment. During 24 months of follow-up, bilateral swelling of the parotid gland graduallydecreased, and abnormal uptake of Ga-67 disappeared in all lesions.