Skin nontumor
Dermal granulomatous and necrobiotic reaction patterns
Sarcoidosis
Last author update: 1 July 2011
Last staff update: 30 August 2022 (update in progress)
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PubMed Search: Sarcoidosis [title] skin
Table of Contents
Definition / general | Epidemiology | Clinical images | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Differential diagnosisCite this page: Hamodat M. Sarcoidosis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skinnontumorsarcoidosis.html. Accessed March 30th, 2023.
Definition / general
- Affects skin, lymph nodes and organs
- Diagnosis of exclusion
- Patients often have anergy to delayed hypersensitivity tests
Epidemiology
- 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
Images hosted on other servers:
39 year old man with systemic sarcoidosis
Cutaneous findings in systemic sarcoidosis
Microscopic (histologic) description
- 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, noncaseating 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 Langhans giant cells, and scattered lymphocytes
- Discrete, small central foci of fibrinoid necrosis are present; also transepidermal 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+ inclusions, may be large lysosomes containing hemolipofuscin)
- Note: foreign material in sarcoidal granulomata does not exclude the diagnosis of sarcoidosis
Microscopic (histologic) images
Contributed by Jijgee Munkhdelger, M.D., Ph.D., Andrey Bychkov, M.D., Ph.D. and Dr. Josehp Christopher Castillo Cuenca
Schaumann body
Schaumann bodies
Asteroid body
Low power
Non-caseating granulomas
Extension to subcutaneous fat tssue
Langhans giant cells
Various images
Images hosted on other servers:
Various images
Asteroid bodies
Hamazaki-Wesenberg bodies
Positive stains
- CD30 (focal, may involve atypical cells) (Am J Surg Pathol. 2003;27:912)
Differential diagnosis
- Must exclude these granulomatous diseases: tuberculosis, leprosy, berylliosis, fungal infection, Crohn's disease, foreign body granuloma
