1/80. Double cancers of the lung and esophagus associated with a sarcoid-like reaction in their regional lymph nodes: report of a case.A case of double cancers of the lung and esophagus associated with a sarcoid-like reaction in their regional lymph nodes is reported. A 73-year-old man with hemosputum was found to have a mass in his right lower lung field on a chest X-ray. Based on a diagnosis of lung cancer, a right middle and lower lobectomy with a dissection of the lymph nodes was performed. Microscopically, a well developed granulomatous reaction was seen in the dissected mediastinal and hilar lymph nodes. Three years after the pulmonary resection, he was admitted to our hospital because of dysphagia. A diagnosis of lower esophageal cancer was made. A lower esophagectomy with a total gastrectomy was performed. A sarcoid-like reaction comprising epithelioid cells and giant cells was seen in the regional lymph nodes. No clinical findings indicative of systemic sarcoidosis were observed. This rare condition may therefore help to improve our overall understanding of the relationship between malignant neoplasms and sarcoid-like reactions in the regional lymph nodes.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/80. Granulomatous mycosis fungoides: report of a case with some histopathologic features of granulomatous slack skin.We describe a case of granulomatous mycosis fungoides, tumor stage, mimicking sarcoidosis in an 82-year-old man with a 2-year history of skin disease. The final diagnosis was established after one of seven biopsy specimens showed a nongranulomatous histologic picture of patch-stage mycosis fungoides. Monoclonality was proven for the lymphocytic population by T-cell-receptor rearrangement studies. The unusually extensive granulomatous inflammation with huge giant cells surrounded by CD1a-positive cells in the other six biopsy specimens was suggestive of the histopathology of granulomatous slack skin, another rare granulomatous cutaneous T-cell lymphoma. Because both a clinical and histologic overlap between granulomatous mycosis fungoides and granulomatous slack skin have been reported in the literature, we conclude that they may belong to the spectrum of a single disease.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
3/80. Carcinoma in villous adenoma of ascending colon associated with sarcoid reaction in the regional lymph nodes.A 79-year-old woman was admitted to our hospital due to continuous anal bleeding. colonoscopy showed a huge villous tumor on the middle area of the ascending colon. A typical right colectomy and lymph node dissection were performed. The resected specimen showed a villous type tumor located on the ascending colon. The histopathologic investigation demonstrated a moderately differentiated adenocarcinoma arising in a tubulovillous adenoma and extending to the submucosa. Although there was no evidence of metastatic carcinoma in the dissected lymph nodes, epithelioid cell granulomas with multinucleated giant cells lacking in the central caseous necrosis suggested sarcoid reaction.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
4/80. sarcoidosis presenting as nail dystrophy.A 45-year-old woman was referred to the dermatology clinic for assessment of "refractory onychogryphosis." She had a 3-year history of lesions involving distal phalanges of the first and third of her left foot. Initially she described periungual erythema and swelling. Three weeks later she noted a whitish growth and thickening of her third toenail. X-ray films of the digit were reported as normal. Several months later the same changes occurred in her great toe. These lesions were asymptomatic. There was no history of trauma. Numerous fungal cultures were negative. No light microscopic examinations were undertaken. She had a trial of both topical and systemic terbinafine of 3-months duration with no clinical improvement. Several clinical opinions were obtained from two dermatologists, a surgeon, and a chiropodist. Past medical history of note was significant for tubal ligation, cervical cancer, and chronic sinusitis. The latter condition in retrospect was thought to be secondary to sarcoidosis. physical examination revealed periungual violaceous discolouration of the first and third toes of the left foot. There was evidence of significant nail changes including dystrophy, onycholysis, and hyperkeratosis (Fig. 1). The fingernails were normal. There were no other skin abnormalities. A punch biopsy of the tip of the third toe showed granulomatous inflammation. There was evidence of hyperkeratosis, exocytosis, and a dense infiltrate composed of collections of histiocytes and a few giant cells forming granulomas (Fig. 2). Repeat x-ray films of the foot showed soft tissue swelling of the first and third digits. There was bony resorption in the distal phalanges with a lacey trabecular pattern compatible with sarcoidosis (Fig. 3). Chest x-ray films revealed marked hilar adenopathy. The patient was sent to a respirologist who concurred with the diagnosis of sarcoidosis. Further investigations included a low serum calcium of 2.07 mmol/L, serum ACE of 70 U/L (upper limit of normal is 75), Wintrobe erythrocyte sedimentation rate (ESR) of 10 mm per hour, thyroid stimulating hormone concentration of 0.65 mU/L, and a urinary calcium excretion rate that was elevated at 7.3 mmol/day. Pulmonary function tests were unremarkable. The patient was initially treated with clobetasol under occlusion and intralesional triamcinolone with minimal improvement. She was subsequently started on prednisone, 15 mg per os daily because of the lung and bone involvement with significant improvement noted in the toe lesions with diminution of both the swelling and violaceous discolouration.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
5/80. Nodular sarcoid myositis of skeletal muscle diagnosed by fine needle aspiration biopsy. A case report.BACKGROUND: Symptomatic striated muscle involvement in sarcoidosis is rare. Muscle biopsy is usually required for the diagnosis. Fine needle aspiration biopsy (FNAB) has been successfully used in diagnosing soft tissue lesions. To the best of our knowledge, FNAB of sarcoid myositis has not been reported. CASE: A 31-year-old, black female with a history of sarcoidosis presented with an enlarging, painful, left calf mass. Infected thrombi were suspected. FNAB showed numerous loosely arranged epithelioid histiocytes, multinucleated giant cells and skeletal muscle cells. The overall cytologic picture was that of granulomatous myositis. The cytologic features coupled with the patient's history and magnetic resonance imaging findings suggested sarcoid myositis. Subsequent muscle biopsy showing noncaseating granulomata and negative stains for organisms confirmed the diagnosis of nodular sarcoid myositis. CONCLUSION: Nodular sarcoid myositis can be suggested by FNAB cytology in a patient with a past history of sarcoidosis.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
6/80. adenolymphoma (Warthin's tumor) with multiple sarcoid-like granulomas.Five cases of adenolymphoma (Warthin's tumor) (AL) with numerous sarcoid-like granulomas within the lymphoid stroma are described. All patients were males, aged from 44 to 71 years (mean 57.3 years); all tumors were localized in the parotid gland. Fine needle aspiration cytology was performed in two cases 7.5 and 2 weeks before operation, respectively. Microscopic examination demonstrated the typical structure of AL. In addition, dispersed throughout the lymphoid stroma there were numerous granulomas formed by both epithelioid and multinucleated giant cells of Langhans type, strongly resembling sarcoidosis. The pathogenesis of the granulomatous change remains speculative. It could be caused by a toxic effect of the cysts' contents but probably not by its direct action; the spread of the fluid via sinuses into the lymphatic tissue seems to be more probable. We presume that the previous FNA may have some triggering effect. Granulomatous transformation of the lymphoid stroma resembling sarcoidosis is rare, but should be included in the spectrum of secondary changes in AL. It is not limited to metaplastic AL; it can be seen in an otherwise typical AL without any additional histologic changes. knowledge of a previous FNA and awareness of the possibility of this peculiar histologic change are necessary to avoid incorrect diagnosis.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
7/80. Sarcoid reaction in primary neuroblastoma: case report.We present a unique case of a 9-month-old infant with a left adrenal neuroblastoma with sarcoid reaction, detected by mass screening. There was no clinical evidence indicating systemic sarcoidosis or pulmonary mycobacterial infection. Histological examination of the resected adrenal tumor revealed many noncaseating epithelioid granulomas with lymphocytic infiltrate, composed of epithelioid cells and few giant cells, arising in tumor parenchyma and fibrovascular stroma. Most of the lymphocytes in the granulomas were CD3- or CD45RO-positive T cells, with fewer being CD20-positive B cells. The lymphocytes in the epithelioid granulomas expressed CD4 or CD8, but not CD56 and CD57. CD4-positive cells were observed more within the granulomas (internal area) than in the surrounding area (external area) of the same granulomas, while most of the CD8-positive cells were seen consistently at the outer margin of the granulomas (marginal zone). CD45RA-positive T cells were observed predominantly in the external area. The results of immunostaining demonstrated that lymphocytes in granulomas of this case showed the same distribution pattern as that seen in systemic sarcoidosis. Although the sarcoid reaction is a phenomenon known to be associated with the region of cancer, granuloma within the primary neuroblastoma is extremely rare. The sarcoid reaction in the present case of neuroblastoma may be associated with a delayed-type hypersensitivity reaction, and its significance and relevance still remain obscure.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
8/80. Sudden death caused by myocardial tuberculosis: case report and review of the literature.A 25-year-old fit man died suddenly while playing social soccer. autopsy revealed an infiltrative lesion involving the left ventricle with overlying pericarditis. No other significant pathologic changes were observed. Histologic examination showed necrotizing granulomatous inflammation. No acid-fast bacilli were demonstrated in the pericardial fluid or on histologic examination. The presence of mycobacterium tuberculosis dna complex was confirmed by use of the ligase chain reaction technique. The differential diagnosis of myocardial tuberculosis includes sarcoidosis, rheumatic fever, rheumatoid arthritis, giant-cell-containing tumors, idiopathic (giant-cell) myocarditis, and bacterial infections such as tularemia and brucellosis. This case illustrates the protean manifestations of tuberculosis and highlights the use of molecular biologic techniques in arriving at a definitive diagnosis in cases of suspected tuberculosis.- - - - - - - - - - ranking = 2keywords = giant (Clic here for more details about this article) |
9/80. sarcoidosis and giant midesophageal diverticulum.traction diverticula of the midesophagus result from granulomatous inflammation of mediastinal lymph nodes. Tuberculosis and histoplasmosis are known etiologies of this condition. To the best of our knowledge, this is the first report of a traction diverticulum caused by sarcoidosis.- - - - - - - - - - ranking = 4keywords = giant (Clic here for more details about this article) |
10/80. Resolution of sarcoidosis after allogeneic bone marrow transplantation with donor lymphocyte infusions.Abnormalities of immune surveillance may contribute to the development of myeloid malignancy as well as immune-mediated diseases. In leukaemia, allogeneic haemopoietic stem cell transplantation (alloHSCT) has been used to induce disease remission, in part by restoring mechanisms of immune regulation. Although, by the same principle, allogeneic stem cell transplantation is an attractive option for the treatment of immunological disorders, it is unclear whether remission after transplantation is due to pre-transplant conditioning, or modulation of auto-reactive lymphocytes by cells in the allograft. We report the case of a patient with chronic myeloid leukaemia (CML) who received an allogeneic bone marrow transplant (alloBMT) from his brother. He subsequently suffered a cytogenetic and molecular relapse of CML. At the same time, sarcoidosis involving the marrow was diagnosed. He was treated with donor lymphocyte infusions (DLI) and attained remission from CML; in addition, no giant cell granulomas were detected in the marrow, indicating resolution of sarcoidosis. This case illustrates the need for further studies on the role of T cell-based therapies in the management of immune-mediated disorders.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
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