Presentation
Known case of neurofibromatosis.
Patient Data
Bilateral hilar fullness with lower and mid zones nodular opacities silhouetting heart border and diaphragm.
Expiratory phase CT demonstrates areas of air-trapping.
Large confluent bilateral hilar lymphadenopathy and bilateral mediastinal lymphadenopathy. The bronchi are encased and narrowed. The larger two lymph nodes seen in the paraoesophageal area measuring about 2.8 cm in short axis and the other seen in the right interlobar group measuring about 3.6 cm in short axis as well as average short axis of hilar lymph nodes measuring 2.8 cm. A few right axillary lymph nodes are noted as well, the largest measuring 1 x 1.1 cm.
Marked thickening of the peribronchovascular interstitium and bronchial wall thickening.
Multiple discrete clustered lung nodules in the left lung resembling galaxy sign.
Multiple bilateral lung nodules. Beaded left oblique fissure. The largest nodule in the anterior segment of the upper lobe of each lung measuring about 0.8 x 0.8 cm in the right side and about 1 x 1.2 cm in the left side.
Case Discussion
Findings were proved to be due to sarcoidosis.
Pathology report as follows:
Microscopic:
(1, 2, and 3) Sections of all lymph nodes, "levels 2, 4, and 7", reveal similar findings of lymph nodes with total effacement of nodal architecture, by many small, punched-out, non-caseating epithelioid granulomas, with scattered anthracotic-laden macrophages and few multinucleated giant cells.
No malignancy was seen in the levels examined.
(4) Sections reveal lung tissue showing multifocal, variably-sized interstitial and subpleural nodules, composed of non-caseating epithelioid granulomas, with scattered multinucleated giant cells, focal hyalinization and anthracotic pigment deposition.
Z.N stain for acid-fast bacilli is unrevealing.
No malignancy was seen in the levels examined.
Diagnosis:
Right side thoracic lymph node, level 2, excisional biopsy:
granulomatous lymphadenitis, suggestive of sarcoidosis
no malignancy seen in the levels examined
Right side thoracic lymph node, level 4, excisional biopsy:
granulomatous lymphadenitis, suggestive of sarcoidosis
no malignancy seen in the levels examined
Right side thoracic lymph node, level 7, excisional biopsy:
granulomatous lymphadenitis, suggestive of sarcoidosis
no malignancy seen in the levels examined
Right lung, middle lobe, wedge biopsy: involvement by granulomatous inflammation, with features suggestive of sarcoidosis.
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