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The ultrastructural features of developing Kveim test granulomas.
E A Sheffield1, D N Mitchell, A Dewar
1National Heart and Lung Institute, Brompton Hospital, London, United Kingdom.
Sarcoidosis
|October 1, 1989
Summary
The Kveim test models granuloma development, revealing macrophage influx followed by mononuclear cell and mature epithelioid cell formation. This ultrastructural study clarifies epithelioid cell granuloma pathogenesis in sarcoidosis.
Area of Science:
- Immunology
- Pathology
- Cell Biology
Background:
- The Kveim test is a diagnostic tool for sarcoidosis.
- Granuloma formation is a key feature of sarcoidosis.
- Ultrastructural studies are crucial for understanding cellular processes.
Purpose of the Study:
- To investigate the ultrastructural development of epithelioid cell granulomas using the Kveim test.
- To characterize the cellular dynamics and morphology during granuloma formation in sarcoidosis patients.
Main Methods:
- A controlled prospective study involving 140 patients with suspected sarcoidosis.
- Two simultaneous Kveim tests per patient, with biopsies at varying intervals and at 28 days.
- Control groups included negative Kveim tests, biopsies from healthy subjects, and normal spleen injections.
Main Results:
- Initial macrophage influx observed within 3-5 days in all groups.
- Mononuclear cells with abundant rough endoplasmic reticulum appeared in positive tests from 8-10 days.
- Mature epithelioid cells with secretory activity developed by 12-14 days, coinciding with peak lymphocyte-histiocyte interactions.
Conclusions:
- The Kveim test effectively models epithelioid cell granuloma development ultrastructurally.
- Epithelioid cell development involves sequential cellular changes, including differentiation and secretory activity.
- Mast cells do not play a role in Kveim test-induced granuloma formation.