Liver Biopsy in Sarcoidosis

No agreement has been reached about the aetiology of the syndrome known as sarcoidosis, Besnier-Boeck-Schaumann disease, lymphogranu-lomatosis benigna, or non-caseating tuberculosis; and even those who hold decided opinions on this subject admit their inability to demonstrate the agent which they consider responsible. Hence any satisfactory definition of the group of cases to be included under this heading includes a description of the characteristic histological changes, and the most secure basis for a diagnosis of sarcoidosis in the individual case is the demonstration of these changes in affected tissues. If superficial lymph-nodes are enlarged, they provide suitable biopsy material; but in some of the more obscure cases, where diagnosis is often of practical importance, these nodes are not involved. In 1943 van Beek and Haex first drew attention to the possible value of aspiration liver biopsy in providing favourable material for the histologi-cal diagnosis of sarcoidosis. They reported that in two out of four cases presenting features of this syndrome they had been able to find characteristic changes in the material obtained by aspiration liver biopsy, although in neither of them had there been clinical evidence of hepatic involvement. Subse-quently van Buchem (1946) published a further series of fourteen cases in which liver biopsy was performed, with positive results in all. In view of the controversy about the relation between sarcoi-dosis and tuberculosis van Buchem also carried out liver biopsy in nine cases of active pulmonary tuberculosis. In none were specific changes found in the material examined. The present paper reports three cases presenting clinical manifestations of sarcoidosis, in which characteristic changes were found in liver tissue obtained by aspiration biopsy, and a fourth in which similar changes were an incidental finding in a liver biopsy from a patient showing no other evidence of this syndrome.