Sarcoidosis

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Sarcoidosis
Sarcoidosis in a Lymph Node.
ICD-10	D86
ICD-9	135
OMIM	181000
DiseasesDB	11797
MedlinePlus	000076
MeSH	D012507

Sarcoidosis Microchapters
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Case #1
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Editor-in-Chief: Philip Marcus, M.D., M.P.H. [1], Division of Pulmonary Medicine St. Francis Hospital-The Heart Center, Roslyn, NY

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] and Hilary Womble, M. D.[[3]]

Image Examples

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  Osseous sarcoidosis

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  Osseous sarcoidosis

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  Complicated sarcoidosis

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  Complicated sarcoidosis

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  Complicated sarcoidosis

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Treatment

Corticosteroids, most commonly prednisone, have been the standard treatment for many years. In some patients, this treatment can slow or reverse the course of the disease, but other patients unfortunately do not respond to steroid therapy. The use of corticosteroids in mild disease is controversial because in many cases the disease remits spontaneously. Additionally, corticosteroids have many recognized dose- and duration-related side effects (which can be reduced through the use of alternate-day dosing for those on chronic prednisone therapy ), and their use is generally limited to severe, progressive, or organ-threatening disease. The influence of corticosteroids or other immunosuppressants on the natural history is unclear.

Severe symptoms are generally treated with steroids, and steroid-sparing agents such as azathioprine and methotrexate are often used. Rarely, cyclophosphamide has also been used. As the granulomas are caused by collections of immune system cells, particularly T cells, there has been some early indications of success using immunosuppressants, interleukin-2 inhibitors or anti-tumor necrosis factor-alpha treatment (such as infliximab). Unfortunately, none of these have provided reliable treatment and there can be significant side effects such as an increased risk of reactivating latent tuberculosis.

Avoidance of sunlight and Vitamin D foods may be helpful in patients who are susceptible to developing hypercalcemia.

Case Examples

Case #1

Clinical Summary

This 33-year-old white female was admitted for evaluation of abnormal findings on a chest x-ray. She was asymptomatic and a physical examination revealed no significant abnormalities. Laboratory results indicated hypercalcemia and elevated gamma globulin. Radiographic examination showed enlarged subcarinal, hilar, and right paratracheal lymph nodes. A right paratracheal lymph node was biopsied. Special stains for acid-fast bacilli and fungi were negative and a diagnosis of sarcoidosis was made.

Histopathological Findings

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

This is a low-power photomicrograph of a lymph node. Note the rather pale-pink color of the tissue with dark-staining cells found in only a few scattered areas. These darker cells represent the original lymphocytes of this lymphoid organ.

This photomicrograph of lymph node tissue illustrates a paucity of lymphocytes as well as numerous small, pale-staining nodules (arrows) throughout the tissue.

This is a photomicrograph of the small nodules (arrows) seen in the previous image. Close examination reveals that they are composed of large macrophages (epithelioid macrophages). These small granulomas form multiple series of reaction centers throughout the lymph node. Note the remaining lymphocytes surrounding the granulomas.

This photomicrograph of a single granuloma illustrates the individual macrophages (arrows) which make up the bulk of this tissue. There is an absence of necrosis in the center of the lesions in this case.

This is a photomicrograph of a multinucleated giant cell (1). In the center of this foreign body-containing giant cell there is a small asteroid body (2). There is no functional significance to this asteroid body.

This is a higher-power photomicrograph of an asteroid body (arrow) inside of a multinucleated giant cell.

See also

• Garland's triad
• Kveim test

External links

• The Foundation for Sarcoidosis Research
• Pathology Images of Sarcoidosis and Other Granulomatous Diseases
• Microscopy of granulomas in sarcoidosis
• Template:GPnotebook
• The Sarcoidosis Community is The Foundation for Sarcoidosis Research's online community
• Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease
• MedPix Pulmonary Sarcoid

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