Radiology Quiz 17921 | Radiopaedia.org

Images
Questions
Findings

What proportion of patients with systemic sarcoidosis also have CNS involvement?

Histologically, central nervous system involvement is seen in 14-27% of patients with systemic sarcoidosis, although only 3-15% are symptomatic.

Question 2

What is the most common form of intracranial involvement?

Show Answer

Parenchymal involvement is the most common finding and can be in a number of forms: A) extension of enhancing leptomeningeal disease up perivascular spaces; B) periventricular high T2 white matter lesions; C) enhancing masses / nodules.

This patient went on to have a supraclavicular lymph node core biopsy.

Histology

MICROSCOPIC DESCRIPTION: The sections show cores of lymphoid parenchyma which are replaced by well formed non-necrotizing granulomas. The granulomas are composed of epithelioid histiocytes and scattered giant cells. Focal calcification is also noted. There is no evidence of a primary lymphoid neoplasm, malignancy, or organisms (including on ZN or FITE staining).

CONCLUSION: Non-necrotizing granulomatous lymphadenitis. These findings are consistent with sarcoidosis.