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Thread: sarcoidosis

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    pathologyguy is offline Junior Member
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    sarcoidosis

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    A 49-year-old African-American female with shortness of breath is found to have hilar lymphadenopathy on chest x-ray. Biopsy of one of the lymph nodes reveals granulomas, and is highly suggestive of sarcoidosis. Which of the following histological findings must have been present in the biopsy material to support the diagnosis of granulomatous inflammation? A. Asteroid bodies
    B. Caseous necrosis
    C. Epithelioid histiocytes
    D. Fibroblast proliferation
    E. Multinucleated giant cells

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    Asclepius1 is offline Ultimate Member 537 points
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    My guess is B. Caseous necrosis .

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    Re: sarcoidosis

    Multinucleated giant cells

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    I got two questions like this on the board regarding the type of necrosis tissue.

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    pathologyguy is offline Junior Member
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    Re: sarcoidosis

    Quote Originally Posted by pathologyguy
    A 49-year-old African-American female with shortness of breath is found to have hilar lymphadenopathy on chest x-ray. Biopsy of one of the lymph nodes reveals granulomas, and is highly suggestive of sarcoidosis. Which of the following histological findings must have been present in the biopsy material to support the diagnosis of granulomatous inflammation? A. Asteroid bodies
    B. Caseous necrosis
    C. Epithelioid histiocytes
    D. Fibroblast proliferation
    E. Multinucleated giant cells
    The correct answer is C. A granuloma is defined as a focus of chronic inflammatory reaction in which the predominant cell type is the epithelioid macrophage or histiocyte. Epithelioid histiocytes are recognized on standard H&E preparation by their pale pink cytoplasm and indistinct cell boundaries. Granulomas are generally surrounded by a ring of lymphocytes and infrequent plasma cells. None of the other features are required for the diagnosis of granulomas, although they may be present.
    The granulomas of sarcoidosis usually contain many multinucleated giant cells, and frequently these giant cells contain stellate inclusions called asteroid bodies. Neither asteroid bodies (choice A) nor giant cells (choice E) are required to make the diagnosis of sarcoidosis, nor does their absence preclude the diagnosis.

    Caseous necrosis (choice B) describes the gross appearance of cheesy, necrotic debris filling a nodule of active tuberculosis, but also has come to describe its characteristic amorphous and eosinophilic appearance on H&E sections. Caseous necrosis is suggestive of tuberculosis, not sarcoidosis.

    Over time, fibroblasts proliferate (choice D) within the core of old, inactive granulomas, eradicating the histiocytes and stereotypical appearance and producing a dense collagenous scar. This feature is not required for the diagnosis of granulomas.

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    C. Epithelioid histiocytes ?

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