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Sarcoidosis

Case contributed by Henry Knipe
Diagnosis certain

Presentation

Cough for six months. No fevers.

Patient Data

Age: 45 years
Gender: Male
x-ray

Right hilar mass and multiple bilateral lung nodules are identified. Cardiac silhouette is not enlarged.

High resolution

ct

Bilateral pulmonary nodules without cavitation or calcification. Scattered randomly throughout both lungs. Enlarged pretracheal lymph and right hilar nodes. No evidence of interstitial disease. 

After a negative EBUS the patient proceeded to a CT guided pulmonary nodule biopsy. 

HISTOPATHOLOGY

MICROSCOPIC DESCRIPTION: Sections show non-necrotizing granulomatous inflammation in a background of dense fibrous tissue. No normal lung parenchyma is identified. The adjacent bronchial epithelium appears intact. ZN, Fite, PAS and Grocott stains are negative. There is no evidence of dysplasia or malignancy.

DIAGNOSIS:

Lung core biopsy: Non-necrotizing granulomatous inflammation. Features favoring sarcoidosis.

Case Discussion

The differential diagnosis for random pulmonary nodules includes:

  • nodular pulmonary metastases
  • infection, e.g. tuberculosis
  • sarcoidosis
  • silicosis

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