6 Patterns > Fibrosis Pattern > Additional Features > w/ Variable Involvement > Other Variable Fibrosis Diseases > Sarcoidosis/Beryllosis

6 Patterns > Fibrosis Pattern > Additional Features > w/ Graunlomas > Sarcoidosis/Beryllosis

Sarcoidosis/Beryllosis

Sarcoidosis is histologiclly indistinguishable from Beryllosis. Sarcoid is characterized by the presence of multiple nonnecrotizing well formed grnaulomas of similar size that coalesce to form larger nodules. The lymphangitic distribution of the granulomas is classic and can be helpful in making a diagnosis. The granulomas are present in the bronchovascular bundles, interlobular septae, and in the pleura. In advanced cases there may be abundent hylaine sclerosis and fibrosis mimicking a fibrotic lung disease.

SEE BELOW FOR SAMPLE SIGNOUT

If you are considering a diagnosis of sarcoidosis, the biopsy should show the following features:

  • Non necrotizing granulomas

  • Hyaline sclerosis

  • Lymphangitic distribution

Lung fibrosis with multiple granulomas

Septal granulomas

Bronchovascular Granulomas

Pleural Granulomas

Extensive hyaline slcrosis

Biopsies with the following features should NOT be called Sarcoid:

  • Necrosis (consider infection - necrosis in sarcoid is very rare)

  • Abundant lymphoplasmacytic inflammation

  • Foreign material (consider aspiration)

  • Lack of pleural involvement

  • Poorly formed granulomas with intersitital inflammation

This degree of cellular interstitial inflammation is not seen in sarcoid (consider HP)

Poorly formed granulomas should not be seen in sarcoid (consider chronic HP)

Foreign material should not be seen in sarcoid (consider aspiration)

Necrosis should not be seen in sarcoid (consider infection)

Clinical Presentation

  • Sarcoidosis occurs most frequently in patients 20-40 years old and is more common in females and African Americans

  • Systemic disease that involves the lungs in 90% of cases

  • May have elevated VEG-F levels and ACE levels

  • Patients present with slowly worsening SOB and caugh

Radiology

  • Bilateral hilar lymphadenopathy

  • HRCT classically shows lymphangitic distribution of micronodules, fibrosis (reticulation), and hilar opacities

Sample Signout

If you are comfortable that the biopsy has all the features of sarcoidosis, consider the following approach to signing the case out:

Pulmonary sarcoidosis (see comment)

Comment:  The biopsy shows numerous non-necrotizing granulomas of similar size in a lymphangitic distribution. In areas the granulomas coalesce into larger nodules with hyaline sclerosis. These findings are typical for pulmonary sarcoidosis. Beryllosis may show identical features and cannot be distinguished histologically from sarcoidosis.