This 33-year-old white female was admitted for evaluation of abnormal findings on a chest x-ray. She was asymptomatic and a physical examination revealed no significant abnormalities. Laboratory results indicated hypercalcemia and elevated gamma globulin. Radiographic examination showed enlarged subcarinal, hilar, and right paratracheal lymph nodes. A right paratracheal lymph node was biopsied. Special stains for acid-fast bacilli and fungi were negative and a diagnosis of sarcoidosis was made.
This is a photomicrograph of the small nodules (arrows) seen in the previous image. Close examination reveals that they are composed of large macrophages (epithelioid macrophages). These small granulomas form multiple series of reaction centers throughout the lymph node. Note the remaining lymphocytes surrounding the granulomas.
Lymph Node: Sarcoidosis
The exact cause of sarcoidosis is unknown. Sarcoidosis is characterized by non-caseating granulomas in many tissues and organs.
The typical characteristic of a sarcoid granuloma is a non-caseating granuloma which consists of an aggregate of tightly-clustered epitheliod cells, often with Langhans’ or multinucleated giant cells. Occasionally, asteroid bodies may be seen.
Asteroid bodies are stellate inclusions within giant cells. They are not pathognomonic for sarcoid; they can be seen in other granulomatous disease processes (e.g., berylliosis).
- eMedicine Medical Library: Acute Complications of Sarcoidosis
- eMedicine Medical Library: Sarcoidosis
- eMedicine Medical Library: Dermatologic Manifestations of Sarcoidosis
- eMedicine Medical Library: Neurosarcoidosis
- Merck Manual: Sarcoidosis
- English JC, Patel PJ, Greer KE. Sarcoidosis. J Am Acad Dermatol 2001;44:725-43
- Johns CJ, Michele TM. The clinical management of sarcoidosis. A 50-year experience at the Johns Hopkins Hospital. Medicine (Baltimore) 1999 Mar;78(2):65-111.
Related IPLab Cases
Hypercalcemia is the state of having increased levels of calcium in the blood.