Table of Contents
Definition / general | Case reports | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Virtual slides | Cytology description | Differential diagnosis | Additional referencesCite this page: DePond W. Sarcoidosis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lymphnodessarcoidosis.html. Accessed January 17th, 2021.
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
- 50 year old African American HIV+ woman with Hamazaki-Wesenberg bodies (Arch Pathol Lab Med 2003;127:111)
Gross images
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
Cytology description
- Epithelioid granulomas (Chest 2000;118:928)
Differential diagnosis