The patient undergoes ultrasound-guided biopsy of an enlarged level III neck node. What are the expected histological findings, and are they specific for the condition in the above question?
Non-caseating granulomas are found in the specimen, and this is the expected finding in sarcoidosis. However, they are not specific for sarcoid as non-caseating granulomas also seen in foreign body reaction eg talc and aspiration pneumonia, histoplasmosis, cryptococcosis, leprosy and Crohn's disease.
On soft tissue windows, marked mediastinal and hilar lymphadenopathy can be seen. On lung windows, multiple randomly distributed bilateral nodules are seen, with conglomerate subpleural plaques. No abnormality was found below the diaphragm (images not shown). The appearances favour stage II sarcoidosis, rather than lymphoma.