Sarcoidosis

Sarcoidosis
	Diagnosis in short
	; Sarcoidosis-like granulomas in a lymph node. H&E stain.
Site	hilar lymph nodes (lung), other sites
Prevalence	uncommon
Radiology	bilateral hilar lymphadenopathy

Sarcoidosis is non-necrotizing granulomatous disease of unknown etiology. It classically associated with (pulmonary) hilar lymphadenopathy. It may be found in almost any organ, e.g. heart, appendix.

General

Diagnosis of exclusion - infection must be excluded.
Rare.

Gross

Bilateral lymphadenopathy ~90% of cases.

Note:

Radiologic differential diagnosis includes carcinomatosis.^[1]

Microscopic

Features:

Granulomata, well-formed, non-necrotizing.
- Negative for microorganisms with special stains (PAS-D, GMS, AFB).
Usu. minimal (lymphoid) inflammation; sarcoid granulomas are known as "naked granulomas".^[2]
In lung: interstitial location.

DDx:

Reactive changes - may mimic sarcoidosis.
Drug reaction.
- Anti-TNF therapy.^[3]
- Ipilimumab.^[4]
Infections.
- Syphilis.^[5]
Common variable immunodeficiency.^[6]
Seminoma.^[7]

Images

Sarcoidosis - lung. (WC)
Granulomata in sarcoidosis with asteroid bodies. (WC)

www:

Stains

ZN -ve.
PASD -ve.
GMS -ve.

Note:

Done to r/o infection.

Sign out

Should be something like sarcoid-like granulomas and clinical correlation required.

References

↑ URL: http://www.radiologyassistant.nl/en/46b480a6e4bdc. Accessed on: 23 May 2010.
↑ Brinster, NK. (Nov 2008). "Dermatopathology for the surgical pathologist: a pattern-based approach to the diagnosis of inflammatory skin disorders (part II).". Adv Anat Pathol 15 (6): 350-69. doi:10.1097/PAP.0b013e31818b1ac6. PMID 18948765.
↑ Tong, D.; Manolios, N.; Howe, G.; Spencer, D. (Jan 2012). "New onset sarcoid-like granulomatosis developing during anti-TNF therapy: an under-recognised complication.". Intern Med J 42 (1): 89-94. PMID 22389903.
↑ Reule, RB.; North, JP. (Nov 2013). "Cutaneous and pulmonary sarcoidosis-like reaction associated with ipilimumab.". J Am Acad Dermatol 69 (5): e272-3. doi:10.1016/j.jaad.2013.07.028. PMID 24124863.
↑ Hervier, B.; Wastiaux, H.; Freour, T.; Masseau, A.; Corvec, S.; Armingeat, T.; Hamidou, M. (Sep 2009). "[Sarcoidosis-like granulomatosis revealing a tertiary syphilis].". Rev Med Interne 30 (9): 806-8. doi:10.1016/j.revmed.2009.01.003. PMID 19249139.
↑ Vultaggio, A.; Matucci, A.; Parronchi, P.; Rossi, O.; Filì, L.; Giudizi, MG.; Palandri, F.; Agostini, C. et al. (Sep 2007). "Association between sarcoidosis-like disease and common variable immunodeficiency (CVI): a new CVI variant showing an activation of the immune system.". Sarcoidosis Vasc Diffuse Lung Dis 24 (2): 127-33. PMID 18496983.
↑ Jankilevich, G.; Mendizabal, J.; Massa, MA.; Pedernera, A.; Galmes, M.; Spizzamiglio, N. (2006). "[Mediastinal sarcoidal reaction in follow up for seminoma].". Medicina (B Aires) 66 (6): 552-4. PMID 17240627.

[1] URL: http://www.radiologyassistant.nl/en/46b480a6e4bdc. Accessed on: 23 May 2010.

[pmid18948765-2] Brinster, NK. (Nov 2008). "Dermatopathology for the surgical pathologist: a pattern-based approach to the diagnosis of inflammatory skin disorders (part II).". Adv Anat Pathol 15 (6): 350-69. doi:10.1097/PAP.0b013e31818b1ac6. PMID 18948765.

[pmid22389903-3] Tong, D.; Manolios, N.; Howe, G.; Spencer, D. (Jan 2012). "New onset sarcoid-like granulomatosis developing during anti-TNF therapy: an under-recognised complication.". Intern Med J 42 (1): 89-94. PMID 22389903.

[pmid24124863-4] Reule, RB.; North, JP. (Nov 2013). "Cutaneous and pulmonary sarcoidosis-like reaction associated with ipilimumab.". J Am Acad Dermatol 69 (5): e272-3. doi:10.1016/j.jaad.2013.07.028. PMID 24124863.

[pmid19249139-5] Hervier, B.; Wastiaux, H.; Freour, T.; Masseau, A.; Corvec, S.; Armingeat, T.; Hamidou, M. (Sep 2009). "[Sarcoidosis-like granulomatosis revealing a tertiary syphilis].". Rev Med Interne 30 (9): 806-8. doi:10.1016/j.revmed.2009.01.003. PMID 19249139.

[pmid18496983-6] Vultaggio, A.; Matucci, A.; Parronchi, P.; Rossi, O.; Filì, L.; Giudizi, MG.; Palandri, F.; Agostini, C. et al. (Sep 2007). "Association between sarcoidosis-like disease and common variable immunodeficiency (CVI): a new CVI variant showing an activation of the immune system.". Sarcoidosis Vasc Diffuse Lung Dis 24 (2): 127-33. PMID 18496983.

[pmid17240627-7] Jankilevich, G.; Mendizabal, J.; Massa, MA.; Pedernera, A.; Galmes, M.; Spizzamiglio, N. (2006). "[Mediastinal sarcoidal reaction in follow up for seminoma].". Medicina (B Aires) 66 (6): 552-4. PMID 17240627.

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Sarcoidosis

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