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Skin-nontumor

Granulomatous but non-infectious disorders

Sarcoidosis


Reviewer: Mowafak Hamodat MB.CH.B, MSc., FRCPC (see Reviewers page)
Revised: 25 August 2011, last major update July 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Definition
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● Affects skin, lymph nodes and organs
● Diagnosis of exclusion
● Patients often have anergy to delayed hypersensitivity tests

Epidemiology
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● May present with acute, self-limiting disease, as a chronic form exclusively affecting the skin or with a serious systemic variant with widespread lesions
● Etiology is unknown

Clinical images
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39 year old otherwise healthy man with systemic sarcoidosis

   
Various images

Micro description
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● Inflammatory and granulomatous reactions with dense superficial and deep lymphocytes, eosinophils and plasma cells
● Variable parakeratosis, spongiosis, acanthosis and epidermal erosion
● May have lymphoid germinal centers resembling lymphoma with destruction of adnexae and atypia
● Dense, non-caseating granulomatous infiltrate in the dermis extends into subcutaneous fat; granulomas are discrete and uniform in size and shape; composed of epitheloid histiocytes with abundant eosinophilic cytoplasm and oval nuclei containing a small central nucleolus
● Variable Langerhans giant cells, and scattered lymphocytes
● Discrete, small central foci of fibrinoid necrosis are present; also trans-epidermal elimination
● Also Schaumann bodies (calcium and protein inclusions inside of Langhans giant cells as part of a granuloma; basophilic laminated rounded conchoidal structures), asteroid bodies (small, intracytoplasmic, eosinophilic star shaped structure also present in tuberculoid leprosy, berylliosis and atypical facial necrobiotic xanthogranuloma), Hamazaki–Wesenberg bodies (peculiar PAS-positive inclusions, may be large lysosomes containing hemolipofuscin)
● Note: foreign material in sarcoidal granulomata does not exclude the diagnosis of sarcoidosis

Micro images
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Various images


Asteroid bodies


Schaumann bodies


Hamazaki–Wesenberg bodies

Positive stains
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● CD30 (focal, may involve atypical cells, Am J Surg Pathol. 2003;27:912)

Differential diagnosis
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● Must exclude these granulomatous diseases: tuberculosis, leprosy, berylliosis, fungal infection, Crohn’s disease, foreign body granuloma

End of Skin-nontumor > Granulomatous but non-infectious disorders > Sarcoidosis


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