Lymph nodes - not lymphoma
Inflammatory disorders (noninfectious)
Sarcoidosis

Author: William D. DePond, M.D. (see Authors page)

Revised: 27 June 2018, last major update June 2006

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Sarcoidosis[TI] lymph node[TIAB] free full text[sb]

Cite this page: DePond, W.D. Sarcoidosis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/lymphnodessarcoidosis.html. Accessed August 20th, 2018.
Definition / general
  • Multisystemic granulomatous disease that is a diagnosis of exclusion
  • Occurs worldwide, with increased incidence in Scandinavian countries
  • Etiology is unclear, although reaction to mycobacteria is suspected
  • In U.S., 10 - 15x more common in blacks vs. whites
  • Usually lung (hilar nodes), other lymph nodes, eyes, skin and liver but may affect any organ
  • Often preceded by erythema nodosum
  • Associated with hypoparathyroidism, due to PTH related protein secreted by granulomatous cells
  • Kveim test:
    • 60 - 85% sensitive and fairly specific
    • Biopsy of area 4 - 6 weeks after intradermal inoculation of human spleen extract shows sarcoid-like granuloma
    • Not commonly used due to lack of extract
Case reports
Gross images

Images hosted on PathOut server:

Contributed by Dr. Mark R. Wick:
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Mediastinum, lymph node



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Bilateral hilar adenopathy

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Lymph node

Microscopic (histologic) description
  • Nodal effacement by small granulomas composed of epithelioid cells with scattered Langhans giant cells and lymphocytes
  • Giant cells are smaller and have fewer nuclei than tuberculosis
  • Necrosis is absent / limited
  • Variable Schaumann bodies, asteroid bodies and calcium oxalate crystals within giant cell cytoplasm
  • No / rare follicular centers
  • Asteroid bodies: have star-like cytoplasmic pattern, composed of radiating filamentous arms covered by myelin-like membranes; contain calcium, phosphorous, silica, aluminum; not specific for sarcoidosis
  • Hamazaki-Wesenberg inclusions: PAS+, yellow-brown, ovoid; may represent large lysosomes with hemosiderin or lipofuscin; present in up to 68% of cases but not specific for sarcoidosis; may resemble yeast (Arch Pathol Lab Med 1987;111:555)
  • Schaumann bodies: round, with concentric laminations, contain iron and calcium; not specific for sarcoidosis
Microscopic (histologic) images

Images hosted on PathOut server:

Contributed by Dr. Mark R. Wick:
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Sarcoid lymph node asteroid body

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Sarcoid lymph node

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Sarcoid mediastinum lymph node



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Classic sarcoid granuloma

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Various images

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Various images, with necrosis

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Numerous granulomas

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Hamazaki-Wesenberg inclusions, GMS, Fontana-Masson



Contributed by Dr. Weijie Li:
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Various images

Virtual slides

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Lymph node sarcoidosis

Cytology description