Sarcoidosis: Difference between revisions

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      = Sarcoidosis (1) lymph node biopsy.jpg
| Image      = Sarcoidosis (1) lymph node biopsy.jpg  
| Width      =
| Width      =
| Caption    = Sarcoidosis-like granulomas in a lymph node. [[H&E stain]].
| Caption    = Sarcoidosis-like granulomas in a lymph node. [[H&E stain]].
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| IHC        =  
| IHC        =  
| EM        =
| EM        =
| Molecular  =  
| Molecular  = PCR for [[tuberculosis]] -ve
| IF        =
| IF        =
| Gross      =  
| Gross      =  
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*Carcinomatosis - interstitial pattern.<ref>URL: [http://www.radiologyassistant.nl/en/46b480a6e4bdc http://www.radiologyassistant.nl/en/46b480a6e4bdc]. Accessed on: 23 May 2010.</ref>
*Carcinomatosis - interstitial pattern.<ref>URL: [http://www.radiologyassistant.nl/en/46b480a6e4bdc http://www.radiologyassistant.nl/en/46b480a6e4bdc]. Accessed on: 23 May 2010.</ref>
*Lymphoma - bilateral lymphadenopathy +/- mediastinal lymphadenopathy.<ref name=pmid23207258>{{Cite journal  | last1 = Boujaoude | first1 = Z. | last2 = Dahdel | first2 = M. | last3 = Pratter | first3 = M. | last4 = Kass | first4 = J. | title = Endobronchial ultrasound with transbronchial needle aspiration in the diagnosis of bilateral hilar and mediastinal lymphadenopathy. | journal = J Bronchology Interv Pulmonol | volume = 19 | issue = 1 | pages = 19-23 | month = Jan | year = 2012 | doi = 10.1097/LBR.0b013e3182442b89 | PMID = 23207258 }}</ref>
*Lymphoma - bilateral lymphadenopathy +/- mediastinal lymphadenopathy.<ref name=pmid23207258>{{Cite journal  | last1 = Boujaoude | first1 = Z. | last2 = Dahdel | first2 = M. | last3 = Pratter | first3 = M. | last4 = Kass | first4 = J. | title = Endobronchial ultrasound with transbronchial needle aspiration in the diagnosis of bilateral hilar and mediastinal lymphadenopathy. | journal = J Bronchology Interv Pulmonol | volume = 19 | issue = 1 | pages = 19-23 | month = Jan | year = 2012 | doi = 10.1097/LBR.0b013e3182442b89 | PMID = 23207258 }}</ref>
<gallery>
File:Sarcoidosis - Bilateral hilar lymphadenoathy (6076995153).jpg | Markedly enlarged bilaterally hilar lymph nodes in stage 1 sarcoidosis (WC/Yale Rosen)
File:Sarcoidosis - Fibrosis (6076822244).jpg | Fibrosis (WC/Yale Rosen)
</gallery>


==Microscopic==
==Microscopic==
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**Negative for microorganisms with special stains.
**Negative for microorganisms with special stains.
*Usu. minimal (lymphoid) inflammation; sarcoid granulomas are known as "naked granulomas".<ref name=pmid18948765>{{Cite journal  | last1 = Brinster | first1 = NK. | title = Dermatopathology for the surgical pathologist: a pattern-based approach to the diagnosis of inflammatory skin disorders (part II). | journal = Adv Anat Pathol | volume = 15 | issue = 6 | pages = 350-69 | month = Nov | year = 2008 | doi = 10.1097/PAP.0b013e31818b1ac6 | PMID = 18948765 }}</ref><ref name=pmid24138972>{{Cite journal  | last1 = Noiles | first1 = K. | last2 = Beleznay | first2 = K. | last3 = Crawford | first3 = RI. | last4 = Au | first4 = S. | title = Sarcoidosis can present with necrotizing granulomas histologically: two cases of ulcerated sarcoidosis and review of the literature. | journal = J Cutan Med Surg | volume = 17 | issue = 6 | pages = 377-83 | month =  | year =  | doi =  | PMID = 24138972 }}</ref>
*Usu. minimal (lymphoid) inflammation; sarcoid granulomas are known as "naked granulomas".<ref name=pmid18948765>{{Cite journal  | last1 = Brinster | first1 = NK. | title = Dermatopathology for the surgical pathologist: a pattern-based approach to the diagnosis of inflammatory skin disorders (part II). | journal = Adv Anat Pathol | volume = 15 | issue = 6 | pages = 350-69 | month = Nov | year = 2008 | doi = 10.1097/PAP.0b013e31818b1ac6 | PMID = 18948765 }}</ref><ref name=pmid24138972>{{Cite journal  | last1 = Noiles | first1 = K. | last2 = Beleznay | first2 = K. | last3 = Crawford | first3 = RI. | last4 = Au | first4 = S. | title = Sarcoidosis can present with necrotizing granulomas histologically: two cases of ulcerated sarcoidosis and review of the literature. | journal = J Cutan Med Surg | volume = 17 | issue = 6 | pages = 377-83 | month =  | year =  | doi =  | PMID = 24138972 }}</ref>
*In lung: interstitial location.
*In lung:  
**Interstitial location +/- centrilobular.


Notes:
Notes:
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DDx:
DDx:
*Infections.
**Fungal.
**Mycobacterial, e.g. [[tuberculosis]].
**Tertiary [[syphilis]].<ref name=pmid19249139>{{Cite journal  | last1 = Hervier | first1 = B. | last2 = Wastiaux | first2 = H. | last3 = Freour | first3 = T. | last4 = Masseau | first4 = A. | last5 = Corvec | first5 = S. | last6 = Armingeat | first6 = T. | last7 = Hamidou | first7 = M. | title = [Sarcoidosis-like granulomatosis revealing a tertiary syphilis]. | journal = Rev Med Interne | volume = 30 | issue = 9 | pages = 806-8 | month = Sep | year = 2009 | doi = 10.1016/j.revmed.2009.01.003 | PMID = 19249139 }}</ref>
*[[Hypersensitivity pneumonitis]] - usually poorly-formed granulomas, centrilobular, not paraseptal.{{fact}}
*Reaction to treatment/drug.
*Reaction to treatment/drug.
**Anti-TNF therapy.<ref name=pmid22389903>{{Cite journal  | last1 = Tong | first1 = D. | last2 = Manolios | first2 = N. | last3 = Howe | first3 = G. | last4 = Spencer | first4 = D. | title = New onset sarcoid-like granulomatosis developing during anti-TNF therapy: an under-recognised complication. | journal = Intern Med J | volume = 42 | issue = 1 | pages = 89-94 | month = Jan | year = 2012 | doi =  | PMID = 22389903 }}</ref>
**Anti-TNF therapy.<ref name=pmid22389903>{{Cite journal  | last1 = Tong | first1 = D. | last2 = Manolios | first2 = N. | last3 = Howe | first3 = G. | last4 = Spencer | first4 = D. | title = New onset sarcoid-like granulomatosis developing during anti-TNF therapy: an under-recognised complication. | journal = Intern Med J | volume = 42 | issue = 1 | pages = 89-94 | month = Jan | year = 2012 | doi =  | PMID = 22389903 }}</ref>
**Ipilimumab.<ref name=pmid24124863>{{Cite journal  | last1 = Reule | first1 = RB. | last2 = North | first2 = JP. | title = Cutaneous and pulmonary sarcoidosis-like reaction associated with ipilimumab. | journal = J Am Acad Dermatol | volume = 69 | issue = 5 | pages = e272-3 | month = Nov | year = 2013 | doi = 10.1016/j.jaad.2013.07.028 | PMID = 24124863 }}</ref>
**Ipilimumab.<ref name=pmid24124863>{{Cite journal  | last1 = Reule | first1 = RB. | last2 = North | first2 = JP. | title = Cutaneous and pulmonary sarcoidosis-like reaction associated with ipilimumab. | journal = J Am Acad Dermatol | volume = 69 | issue = 5 | pages = e272-3 | month = Nov | year = 2013 | doi = 10.1016/j.jaad.2013.07.028 | PMID = 24124863 }}</ref>
*Infections.
*[[Common variable immunodeficiency]].<ref name=pmid18496983>{{Cite journal  | last1 = Vultaggio | first1 = A. | last2 = Matucci | first2 = A. | last3 = Parronchi | first3 = P. | last4 = Rossi | first4 = O. | last5 = Filì | first5 = L. | last6 = Giudizi | first6 = MG. | last7 = Palandri | first7 = F. | last8 = Agostini | first8 = C. | last9 = Semenzato | first9 = G. | title = Association between sarcoidosis-like disease and common variable immunodeficiency (CVI): a new CVI variant showing an activation of the immune system. | journal = Sarcoidosis Vasc Diffuse Lung Dis | volume = 24 | issue = 2 | pages = 127-33 | month = Sep | year = 2007 | doi =  | PMID = 18496983 }}</ref>
**Tertiary [[syphilis]].<ref name=pmid19249139>{{Cite journal  | last1 = Hervier | first1 = B. | last2 = Wastiaux | first2 = H. | last3 = Freour | first3 = T. | last4 = Masseau | first4 = A. | last5 = Corvec | first5 = S. | last6 = Armingeat | first6 = T. | last7 = Hamidou | first7 = M. | title = [Sarcoidosis-like granulomatosis revealing a tertiary syphilis]. | journal = Rev Med Interne | volume = 30 | issue = 9 | pages = 806-8 | month = Sep | year = 2009 | doi = 10.1016/j.revmed.2009.01.003 | PMID = 19249139 }}</ref>
*[[Common variable immunodeficiency]].<ref name=pmid18496983>{{Cite journal  | last1 = Vultaggio | first1 = A. | last2 = Matucci | first2 = A. | last3 = Parronchi | first3 = P. | last4 = Rossi | first4 = O. | last5 = Filì | first5 = L. | last6 = Giudizi | first6 = MG. | last7 = Palandri | first7 = F. | last8 = Agostini | first8 = C. | last9 = Semenzato | first9 = G. | title = Association between sarcoidosis-like disease and common variable immunodeficiency (CVI): a new CVI variant showing an activation of the immune system. | journal = Sarcoidosis Vasc Diffuse Lung Dis | volume = 24 | issue = 2 | pages = 127-33 | month = Sep | year = 2007 | doi =  | PMID = 18496983 }}
</ref>
*Reactive changes associated with tumours:
*Reactive changes associated with tumours:
**All testicular tumours<ref name=pmid18496978>{{Cite journal  | last1 = Paparel | first1 = P. | last2 = Devonec | first2 = M. | last3 = Perrin | first3 = P. | last4 = Ruffion | first4 = A. | last5 = Decaussin-Petrucci | first5 = M. | last6 = Akin | first6 = O. | last7 = Sheinfeld | first7 = J. | last8 = Guillonneau | first8 = B. | title = Association between sarcoidosis and testicular carcinoma: a diagnostic pitfall. | journal = Sarcoidosis Vasc Diffuse Lung Dis | volume = 24 | issue = 2 | pages = 95-101 | month = Sep | year = 2007 | doi =  | PMID = 18496978 }}</ref> - esp. [[seminoma]].<ref name=pmid17240627>{{Cite journal  | last1 = Jankilevich | first1 = G. | last2 = Mendizabal | first2 = J. | last3 = Massa | first3 = MA. | last4 = Pedernera | first4 = A. | last5 = Galmes | first5 = M. | last6 = Spizzamiglio | first6 = N. | title = [Mediastinal sarcoidal reaction in follow up for seminoma]. | journal = Medicina (B Aires) | volume = 66 | issue = 6 | pages = 552-4 | month =  | year = 2006 | doi =  | PMID = 17240627 }}</ref>
**All testicular tumours<ref name=pmid18496978>{{Cite journal  | last1 = Paparel | first1 = P. | last2 = Devonec | first2 = M. | last3 = Perrin | first3 = P. | last4 = Ruffion | first4 = A. | last5 = Decaussin-Petrucci | first5 = M. | last6 = Akin | first6 = O. | last7 = Sheinfeld | first7 = J. | last8 = Guillonneau | first8 = B. | title = Association between sarcoidosis and testicular carcinoma: a diagnostic pitfall. | journal = Sarcoidosis Vasc Diffuse Lung Dis | volume = 24 | issue = 2 | pages = 95-101 | month = Sep | year = 2007 | doi =  | PMID = 18496978 }}</ref> - esp. [[seminoma]].<ref name=pmid17240627>{{Cite journal  | last1 = Jankilevich | first1 = G. | last2 = Mendizabal | first2 = J. | last3 = Massa | first3 = MA. | last4 = Pedernera | first4 = A. | last5 = Galmes | first5 = M. | last6 = Spizzamiglio | first6 = N. | title = [Mediastinal sarcoidal reaction in follow up for seminoma]. | journal = Medicina (B Aires) | volume = 66 | issue = 6 | pages = 552-4 | month =  | year = 2006 | doi =  | PMID = 17240627 }}</ref>
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<gallery>
<gallery>
Image:Asteroid_body_intermed_mag.jpg | Sarcoidosis - lung. (WC)
Image:Asteroid_body_intermed_mag.jpg | Sarcoidosis - lung. (WC)
Image:Asteroid_body_very_high_mag.jpg | Granulomata in sarcoidosis with asteroid bodies. (WC)
Image:Asteroid_body_very_high_mag.jpg | Granulomata in sarcoidosis with [[asteroid bodies]]. (WC)
File:Sarcoidosis - Schaumann body (6151514639).jpg | [[Schaumann body]] in sarcoidosis. (WC/Yale Rosen)
File:Sarcoidosis - Fibrosis of granulomas (6148634442).jpg | Fibrosis in sarcoid granulomas. (WC/Yale Rosen)
File:Sarkoidosis muscle.jpg | Muscle involvement in sarcoidosis. (WC/jensflorian)
File:Sarcoidosis_histology_skin_involvement.jpg | Skin involvement in sarcoidosis. (WC/jensflorian)
</gallery>
====Case====
<gallery>
Image: Sarcoidosis - lung FNA -- very low mag.jpg | Sarcoidosis lung - very low mag. (WC)
Image: Sarcoidosis - lung FNA -- low mag.jpg | Sarcoidosis lung - low mag. (WC)
Image: Sarcoidosis - lung FNA -- intermed mag.jpg | Sarcoidosis lung - intermed. mag. (WC)
Image: Sarcoidosis - lung FNA -- high mag.jpg | Sarcoidosis lung - high mag. (WC)
Image: Sarcoidosis - lung FNA -- very high mag.jpg | Sarcoidosis lung - very high mag. (WC)
</gallery>
</gallery>
www:
====www====
*[http://path.upmc.edu/cases/case412.html Sarcoidosis - several images (upmc.edu)].
*[http://path.upmc.edu/cases/case412.html Sarcoidosis - several images (upmc.edu)].
*[http://path.upmc.edu/cases/case517.html Neurosarcoidosis - several images (upmc.edu)].
*[http://path.upmc.edu/cases/case517.html Neurosarcoidosis - several images (upmc.edu)].
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Note:
Note:
*Done to r/o infection.
*Must be done to exclude infection.
 
==Molecular==
*PCR for Tuberculosis -ve.


==Sign out==
==Sign out==
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Sarcoidosis is favoured based on the morphology of the granulomas and the  
Sarcoidosis is favoured based on the morphology of the granulomas and the  
lack of microorganisms with special stains (ZN, PASF, GMS).
lack of microorganisms with special stains (ZN, PASF, GMS).
A serum ACE level should be considered, if not already done.


Clinical and radiologic correlation is required.
Clinical and radiologic correlation is required.
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*[[Medical lung diseases]].
*[[Medical lung diseases]].
*[[Cardiac sarcoidosis]].
*[[Cardiac sarcoidosis]].
*[[Melkersson-Rosenthal syndrome]].


==References==
==References==
Retrieved from "https://librepathology.org/wiki/Sarcoidosis"