Sarcoidosis

Lymph nodes - not lymphoma
Inflammatory disorders (noninfectious)
Sarcoidosis

Topic Completed: 1 June 2006

Revised: 5 February 2019, last major update June 2006

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

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

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Cite this page: DePond W. Sarcoidosis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lymphnodessarcoidosis.html. Accessed May 29th, 2020.

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

Images hosted on PathOut server:

Contributed by Dr. Mark R. Wick:

Mediastinum, lymph node

Images hosted on other servers:

Bilateral hilar adenopathy

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: