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Sarcoidosis is a multisystem granulomatous disease of unknown etiology. It may occur at any age, but is most commonly seen in young to middle age adults. Sarcoidosis remains more common in women regardless of geographic or racial boundaries. Although the etiology remains unclear, the most common explanation is that sarcoidosis is a disease of immunologic dysregulation triggered by an as yet unidentified environmental or microbial antigen in genetically susceptible persons. We review a case of sarcoidosis with was initially diagnosed in a neck lymph node that was removed for evaluation of metastatic squamous cell carcinoma with a discussion on the clinical and histologic characteristic of the disease.

Background/Objectives: Myocarditis is an inflammatory disease of the myocardium and remains to this day a challenging diagnosis. A promising novel imaging method uses the expression of somatostatin receptors (SSTRs) on inflammatory cells to visualize myocardial inflammation. However, little is known about the histopathological correlate of SSTR imaging in different forms of myocarditis. Methods: In the present retrospective histopathological study, we systematically analysed the expression of SSTR subtype 2 (SSTR2) on inflammatory cells of 33 patients with biopsy- or explant-proven myocarditis (lymphocytic myocarditis (n = 5), giant-cell myocarditis (n = 11), and cardiac sarcoidosis (n = 17)), and in eight controls (multi-organ donors) without signs of myocardial inflammation and/or scars. Results: In all patients, immunohistochemical staining for SSTR2 was positive in areas with CD68-positive macrophages and multinucleated giant cells. Staining for SSTR2 was most prominent in the presence of multinucleated giant cells. The colocalization of both SSTR2 and CD68 on the same cell could be confirmed using immunofluorescence microscopy. Western blotting confirmed the upregulated expression of SSTR2 in cases of granulomatous inflammation (sarcoidosis) of the skeletal and heart muscle, in comparison with controls. Conclusions: In conclusion, our findings demonstrate the expression of SSTR2 on the protein level on CD68-positive macrophages and multinucleated giant cells in various forms of myocarditis, which provides a clear rationale for the diagnostic use of SSTR imaging in this patient group. [ABSTRACT FROM AUTHOR]

This article discusses two cases of severe hypercalcemia in lung transplant recipients, which were diagnosed as Pneumocystis jirovecii pneumonia (PJP). Both patients were successfully treated with trimethoprim-sulfamethoxazole (TMP-SMX) and showed improvement in symptoms and calcium levels. The article highlights the importance of considering PJP as a possible cause of hypercalcemia in immunocompromised patients and suggests further research on risk factors and prophylaxis strategies. [Extracted from the article]

The article discusses a rare condition known as Facial Afro-Caribbean Childhood Eruption (FACE) that primarily affects dark-skinned prepubescent children. The case study presented in the article describes successful treatment of FACE with topical erythromycin and tretinoin (TRT), suggesting a new potential therapy for this condition. The article emphasizes the importance of differentiating FACE from other dermatological conditions and highlights the need for further research to confirm the efficacy of TRT as a treatment for FACE. [Extracted from the article]

The article discusses a case of sarcoidal foreign body reaction to permanent makeup involving M2 macrophages in a 50-year-old Japanese woman. The patient experienced itching, pain, swelling, and raised yellowish lesions on her eyebrows after having permanent makeup applied nine years prior. Treatment with monthly steroid injections led to improvement in symptoms and aesthetic outcomes. The study highlights the role of M2 macrophages in the reaction and provides insights into the mechanisms underlying such reactions. [Extracted from the article]

This article discusses a case report of a patient with eosinophilic granulomatosis with polyangiitis (EGPA), a rare systemic antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. The patient presented with a choroidal granuloma near the optic disk, which was highlighted through multimodal imaging. The article describes the patient's medical history, examination findings, and treatment. The authors emphasize the importance of optical coherence tomography (OCT) in diagnosing and imaging retinal pseudo-tumors. This case report provides valuable insights into the ophthalmologic manifestations of EGPA and the utility of multimodal imaging in diagnosing and monitoring the condition. [Extracted from the article]

The article titled "Understanding the Term 'Necrobiosis'" explains the term "necrobiosis" in dermatopathology and its various interpretations. It discusses the confusion caused by different authors describing the term differently. The article suggests using simpler terminology like "altered collagen" or "altered dermal connective tissue" when describing histological sections or generating skin biopsy reports. Necrobiosis refers to histopathological changes in the dermal connective tissue, including the presence of flame figures and structural alterations in collagen fibers. It can be seen in conditions like granuloma annulare, lupus miliaris disseminatus faciei, and sarcoidosis, but using more specific descriptions may be more helpful. [Extracted from the article]

A 66‐year‐old male from Myanmar presented with 3 months of cough and constitutional symptoms. He was an ex‐tobacco user with no significant medical or exposure history. Chest x‐ray showed ill‐defined bilateral opacities and a left pleural effusion. Chest CT revealed two right lower lobe masses, and a moderate‐sized left pleural effusion. PET‐CT demonstrated hypermetabolic uptake in the thickened nodular pleura, pericardium, and hilar/mediastinal lymph nodes. EBUS‐TBNA of the right lower paratracheal node and TBLB of the right lower lobe mass yielded epithelioid granulomas comprising multinucleated giant cells, epithelioid histiocytes and lymphoplasmacytic cells. Thoracoscopy revealed hard, whitish mass‐like parietal pleural plaques, and pleural biopsy revealed identical histopathologic results. His symptoms resolved quickly after commencing prednisolone 25 mg daily. Chest CT at 6 months demonstrated near complete resolution of the parenchymal masses and pleural effusion. We highlight this unique case of pleuroparenchymal sarcoidosis mimicking metastatic lung cancer in a tuberculosis‐endemic region. [ABSTRACT FROM AUTHOR]

The article offers information on sarcoidosis, a multisystem disease characterized by granuloma formation and inflammation. Topics include the underlying pathology involving an abnormal immune response, the role of macrophages in granuloma formation, and the implications of aberrations in lipid metabolism in chronic sarcoidosis.

Mutations in nucleotide binding oligomerization domain containing 2 receptor (NOD2) are associated with Blau syndrome (also known as early-onset sarcoidosis)—a rare autosomal dominant, chronic granulomatous disease that typically presents before 5 years of age. Blau syndrome is characterized by the clinical triad of arthritis, granulomatous dermatitis, and recurrent uveitis. Here, we report a case of NOD2-mutation-associated early-onset sarcoidosis in which a combination of methotrexate and hydroxychloroquine was used to achieve improvement in arthritis, granulomatous dermatitis, and uveitis. A 13-month-old boy presented with a sudden-onset cutaneous eruption affecting the face, trunk, and extremities that initially mimicked papular atopic dermatitis but progressively worsened despite topical steroid therapy. The patient had no other known medical comorbidities or abnormalities except for heterochromia of the right eye. However, prior to presentation to dermatology, the patient began experiencing frequent falls, conjunctival injection, and apparent eye and joint pain. Skin biopsy from the right shoulder demonstrated rounded aggregates of epithelioid histiocytes and multinucleated giant cells without a significant lymphocytic component (“naked granulomas”), consistent with sarcoidal granulomatous dermatitis. Given the concern for Blau syndrome, the patient was sent for evaluation by ophthalmology and was found to have bilateral subconjunctival nodules. Our patient underwent genetic testing and was found to have a mutation in codon 1000 C > T (protein R334W) in the NOD2 gene. The patient responded to oral prednisolone 2 mg/kg/day for 8 weeks, but quickly relapsed, requiring a second 8-week course with taper upon starting methotrexate 7.5 mg subcutaneously weekly with 1 mg folic acid orally daily. After 8 weeks on methotrexate, due to persistent arthritis, conjunctival injection, and pruritus, and in consultation with rheumatology, the patient was started on hydroxychloroquine 75 mg orally daily along with continuation of 7.5 mg methotrexate subcutaneously weekly for 8 weeks, achieving significant reduction in arthritis, pruritus, and uveitis. After 8 weeks of this combination therapy, due to concerns of long-term macular toxicity, hydroxychloroquine was discontinued in favor of continuing methotrexate alone. The patient has remained free of significant side effects and stable with good disease control on 7.5 mg methotrexate weekly injected subcutaneously. [ABSTRACT FROM AUTHOR]

This article describes the case of a 49-year-old man who was hospitalized with acute heart failure and suspected acute myocarditis. The patient underwent an endomyocardial biopsy, which revealed a diagnosis of giant cell myocarditis (GCM). Despite treatment with immunosuppressive therapy, the patient's condition did not improve, and he ultimately received a heart transplant. The article provides a detailed description of the histological findings and discusses the rarity and pathogenesis of GCM. It also highlights the challenges in diagnosing GCM and the potential role of biopsy in guiding treatment decisions. [Extracted from the article]

The article focuses on a case study of a 34-year-old woman with pulmonary sarcoidosis, presenting a distinctive "bull's-eye" pattern on high-resolution computed tomography (HRCT). Topics include the radiological features of the bull's-eye sign in sarcoidosis, the patient's clinical course, and the longitudinal changes observed in HRCT over multiple presentations and discontinuation of treatment.

Silicone breast implants are frequently used for breast augmentation for cosmetic purposes, as well as for breast reconstruction after prophylactic or therapeutic mastectomy. Silicone lymphadenopathy is a well-known complication of silicone breast implants. Silicone droplets are present in the breast tissue through 'silicone bleeding' of the implant or because of implant rupture. These silicone particles can migrate from the breast to the regional lymph nodes. Silicone lymphadenopathy is caused by a substantial foreign body reaction against these silicone particles, and is frequently associated with asteroid body-containing multinucleated giant cells. Similar multinucleated giant cells are often observed in the capsule surrounding the silicone breast implant, and the number of associated asteroid bodies is highly variable. Here, we discuss a series of twelve women with breast implant-related asteroid bodies in their lymph nodes and/or breast tissue. This pictorial essay illustrates that the presence of asteroid bodies in a lymph node does not necessarily suggests a diagnosis of sarcoidosis. Clinical information about the patient having (or having had) silicone breast implants is often lacking. The encounter of asteroid body-containing giant cells in lymph node cytology, biopsies or resections should therefore lead to reflex clinical-pathological correlation, before establishing a final diagnosis. [ABSTRACT FROM AUTHOR]

Background: Neurosarcoidosis can have various neurological outcomes and presentations. It is an uncommon diagnosis, especially in young Caucasian males presenting with predominantly migraine headaches. Case presentation: A Caucasian male in his 20s with no medical history presented with 1 month of intractable migraine headaches associated with left sided blurry vision, nausea and vomiting. He has also been having intermittent paresthesia's in the left upper extremity. He reports lightheadedness when moving from sitting to standing and occasionally feels unsteady on his feet. He also endorses night sweats, generalized malaise, and fatigue. On admission, CT chest, abdomen, and pelvis showed diffuse lymphadenopathy above and below the diaphragm, as well as widespread pulmonary nodules. MR head and spine showed multiple and diffuse nodular leptomeningeal enhancements and enhancement foci along the cervical, thoracic, and lumbar spine. Lumbar puncture showed elevated total nucleated cells and protein. Surgical pathology from a right inguinal lymph node showed many scattered multinucleated giant cells and epithelioid histiocytes consistent with non-necrotizing granulomas seen in sarcoidosis. He was treated with high dose steroids with significant improvement in symptoms. Conclusions: The diagnosis of neurosarcoidosis may be challenging, and the differential may include other infectious, neoplastic, and inflammatory conditions. Neurosarcoidosis may present in a young Caucasian male with a constellation of nonspecific neurological symptoms such as cranial nerve palsies, gait imbalance, paresthesia's, and headaches, among other presentations. Neurosarcoidosis may present similarly to lymphoma with constitutional symptoms of night sweats, fatigue, as well as widespread lymphadenopathy. Histopathology may be useful in diagnosis. Neurosarcoidosis may initially respond well to steroid treatment. [ABSTRACT FROM AUTHOR]

A 75-year-old female with a history of stomach cancer and depression was referred to our hospital for left cervical lymphadenopathy. The biopsy of her left cervical lymph node revealed noncaseating granulomas with multinucleated giant cells. The positron emission tomography/computed tomography (PET/CT) indicated general lymphadenopathy (left supraclavicular left axillary, hepatic lymph nodes), except for the hilar lymph node. Both histology by transbronchial lung biopsy (TBLB) and analysis of broncho alveolar lavage fluid (BALF) were indicative of sarcoidosis. C-reactive protein (CRP) and soluble interleukin-2 receptor (sIL-2R) were increased in the sera. An alternative cause of granulomatous disease was ruled out, and on follow-up, she was diagnosed with sarcoidosis. Two years later, she was hospitalized for fever, anorexia, lymph node tenderness, and erythema nodosum with significant increases in CRP and sIL-2R. After admission, the repetitive axillary lymph biopsy showed the same histological findings as before, but the G-band staining showed clonal abnormalities. Bone marrow biopsy revealed abnormal lymphocytes with petal-like nuclei. Finally, she was diagnosed with malignant lymphoma infiltrating the bone marrow. After CHOP-based chemotherapy, her laboratory data, lymphadenopathy, and clinical findings improved, and she was discharged from the hospital on the 90th day. Careful medical treatment, including genetic analysis of the lymph node, is necessary in patients with sarcoidosis if lymphadenopathy is predominant. [ABSTRACT FROM AUTHOR]

Exam revealed four asymptomatic well-circumscribed waxy tan dermal nodules with central atrophy and prominent overlying superficial telangiectasias scattered along his scalp measuring between 0.9 and 2.6 cm (Figure 1). In summary, ANL should enter diagnostic consideration for patients presenting with dermal atrophic nodules or arcuate plaques of the scalp. An 85-year-old well-appearing Caucasian gentleman with high blood pressure and hypercholesterolemia presented to clinic for his routine annual skin check. [Extracted from the article]

(D') Magnification of D shows granuloma with multi-nucleated giant cells; (E) The left breast biopsies demonstrate inflammatory cell infiltration with multi-nucleated giant cells (HE staining). Granulomatous mastitis (GM) is a rare, benign, chronic inflammatory breast disease which could be successfully treated with immunosuppressive agents. [Extracted from the article]

This article presents a case study of a 68-year-old woman who presented with a large nasal mass and progressive dyspnea. The patient had a history of suspected sarcoidosis and was diagnosed with lupus pernio based on her skin biopsy findings. She was prescribed prednisone, methotrexate, and received intralesional steroid injections, which resulted in improvement of her skin lesion. Lupus pernio is a rare cutaneous manifestation of sarcoidosis, and systemic glucocorticoids and immunomodulatory drugs are commonly used for treatment. [Extracted from the article]

Interferon-gamma (IFN- ) expressing T-helper lymphocytes have been hypothesized to play a central role in idiopathic granuloma annulare (GA) pathogenesis, leading to constitutive Janus kinase-Signal transducer and activator of transcription (JAK-STAT) pathway activation.[1] Here, we report three cases of immunotherapy-associated GA that exhibit JAK-STAT activation on immunohistochemistry, suggesting a potential shared mechanism with sporadic GA. Granulomatous/sarcoid-like lesions associated with checkpoint inhibitors: a marker of therapy response in a subset of melanoma patients. While patient 3 developed GA prior to treatment with pembrolizumab, it is interesting to note that she had a significant worsening of GA during treatment with pembrolizumab. [Extracted from the article]

A 22-year-old male with human immunodeficiency virus (HIV) infection presented to the outpatient clinic in March 2021 with an 8-month history of multiple nodular lesions on the upper and lower limbs. Granulomatous secondary syphilis may resemble all these differential diagnoses, as they can have a similar clinical presentation with red-purple macules, papules, plaques, tumors, and nodules. The classic cutaneous presentation of secondary syphilis is a symmetrical non-tender macular rash, erythematous or copper-colored, on the trunk, extremities, palms, and soles.[1] Nevertheless, secondary syphilis has a highly versatile cutaneous presentation; a more aggressive or atypical presentation has been reported among patients with HIV infection.[2] Granulomatous infiltration is a rare finding in secondary syphilis, with few cases reported in the literature. [Extracted from the article]

Granulomatous inflammation (GI) diseases are a group of chronic inflammation disorders characterized by focal collections of multinucleated giant cells, epithelioid cells and macrophages, with or without necrosis. GI diseases are closely related to microbes, especially virulent intracellular bacterial infections are important factors in the progression of these diseases. They employ a range of strategies to survive the stresses imposed upon them and persist in host cells, becoming the initiator of the fighting. Microbe-host communication is essential to maintain functions of a healthy host, so defense capacity of hosts is another influence factor, which is thought to combine to determine the result of the fighting. With the development of gene research technology, many human genetic loci were identified to be involved in GI diseases susceptibility, providing more insights into and knowledge about GI diseases. The current review aims to provide an update on the most recent progress in the identification and characterization of bacteria in GI diseases in a variety of organ systems and clinical conditions, and examine the invasion and escape mechanisms of pathogens that have been demonstrated in previous studies, we also review the existing data on the predictive factors of the host, mainly on genetic findings. These strategies may improve our understanding of the mechanisms underlying GI diseases, and open new avenues for the study of the associated conditions in the future. [ABSTRACT FROM AUTHOR]

The article focuses on a case of a man presented with annular plaques on his neck, who has a medical history of type 2 diabetes mellitus, nephrolithiasis, hypovitaminosis D, and hypercholesterolemia. It mentions that with a diagnosis of annular elastolytic giant cell granuloma (AEGCG), a rare chronic inflammatory disorder of the skin, he was identified through a histologic examination of two shave biopsies. It also mentions treatments, such as intralesional steroids, topical pimecrolimus, etc.

While most forms of sarcoidosis of the skin do not require treatment, 40% of patients initially diagnosed with cutaneous sarcoidosis are found to have an asymptomatic disease involving other organ systems. It is the involvement of the lungs, heart, eyes, and nervous system which most often contributes to morbidity/mortality. An early and accurate diagnosis of sarcoidosis is difficult because patients may be asymptomatic, initial presentations may vary, and there is no single reliable diagnostic test except biopsy. We present a case of scar sarcoidosis which led to the diagnosis of stage II pulmonary sarcoidosis in a woman in her 50s. Her scar sarcoidosis presented as well-circumscribed, reddish-brown macules surrounding an atrophic scar from a prior skin graft on the right leg. Biopsy revealed scattered, well-formed, non-necrotizing granulomas of the dermis composed of epithelioid histiocytes and multinucleated giant cells, surrounded by a sparse infiltrate of lymphocytes and histiocytes. A CT chest demonstrated extensive hilar lymphadenopathy, leading to a diagnosis of stage II pulmonary sarcoidosis with cutaneous involvement. This case illustrates the interesting presentation of scar sarcoidosis and underscores the importance of a broad differential including sarcoidosis for skin changes around scars and underscores the need for early biopsy. Prompt cutaneous diagnosis leads to earlier systemic evaluation, therapeutics, and better outcomes. [ABSTRACT FROM AUTHOR]

The article focuses on two cases of drug-induced granulomatous panniculitis, presenting patients with unique medical histories and clinical manifestations, emphasizing the importance of immunohistochemical findings in the diagnosis, with a detailed description of histopathological results and treatment outcomes.

We present the unusual case of a 62-year-old male with profound asthenia and dyspnea for the last two months. Blood exams showed a severe hypercalcemia. Suspecting an underlying malignancy, we performed a 18F-FDG PET-CT, revealing widespread metabolic uptakes in muscles, consistent with an inflammatory process. The muscular biopsy showed a non-necrotising granuloma with multinucleated giant cells, pathognomonic for the diagnosis of acute isolated muscular sarcoidosis. A high-dose steroid therapy was started with clinical improvement and serum calcium normalization. [ABSTRACT FROM AUTHOR]

A characteristic feature of sarcoidosis is a dysregulated immune response to persistent stimuli, often leading to the formation of non-necrotizing granulomas in various organs. Although genetic susceptibility is an essential factor in disease development, the etiology of sarcoidosis is not fully understood. Specifically, whether autoimmunity contributes to the initiation or progression of the disease is uncertain. In this study, we investigated systemic autoimmunity to vimentin in sarcoidosis. IgG antibodies to human vimentin were measured in sera from sarcoidosis patients and healthy controls. Mice immunized with recombinant murine vimentin were challenged intravenously with vimentin-coated beads to mimic pulmonary sarcoidosis. Lungs from treated mice were studied for cellular infiltration, granuloma formation, and gene expression. Immune cells in the bronchoalveolar lavage fluid were evaluated by flow cytometry. Compared to healthy controls, sarcoidosis patients had a higher frequency and levels of circulating anti-vimentin IgG. Vimentin-immunized mice developed lung granulomas following intravenous challenge with vimentin-coated beads. These sarcoidosis-like granulomas showed the presence of Langhans and foreign body multinucleated giant cells, CD4 T cells, and a heterogeneous collection of MHC II positive and arginase 1-expressing macrophages. The lungs showed upregulated pro-inflammatory gene expression, including Ifng, Il17, and Tnfa, reflecting TH1/TH17 responses typical of sarcoidosis. In addition, genes in the TH2 canonical pathway were also upregulated, congruent with increased numbers of ILC2 in the bronchoalveolar lavage. Overall, these results further validate vimentin as an autoantigen in sarcoidosis and provide evidence for an anti-vimentin immune response in disease pathogenesis. Our study also highlights the possible role of ILC2-driven TH2-like responses in the formation of lung granulomas in sarcoidosis.

Sea urchin granuloma is a chronic complication that can occur as a result of sea urchin spine injuries. This case study describes a 35-year-old female who had been handling sea urchins for two years and developed multiple skin nodules and lesions on her hands. Surgical resection of the nodules revealed granulomas with foreign-body reaction and sarcoid granulomas. Sea urchin granulomas can present as firm nodules and papular lesions and may require surgical intervention or other treatment options to prevent chronic complications. The exact cause of sea urchin granuloma is still unknown, but further research is needed to understand its pathogenesis. [Extracted from the article]

Mycobacteriosis, mostly resulting from Mycobacterium tuberculosis (MTb), nontuberculous mycobacteria (NTM), and Mycobacterium leprae (M. leprae), is the long-standing granulomatous disease that ravages several organs including skin, lung, and peripheral nerves, and it has a spectrum of clinical-pathologic features based on the interaction of bacilli and host immune response. Histiocytes in infectious granulomas mainly consist of infected and uninfected macrophages (Mφs), multinucleated giant cells (MGCs), epithelioid cells (ECs), and foam cells (FCs), which are commonly discovered in lesions in patients with mycobacteriosis. Granuloma Mφ polarization or reprogramming is the crucial appearance of the host immune response to pathogen aggression, which gets a command of endocellular microbe persistence. Herein, we recapitulate the current gaps and challenges during Mφ polarization and the different subpopulations of mycobacteriosis. [ABSTRACT FROM AUTHOR]

Mycobacterium chimaera is a non-tuberculous mycobacterium, member of the Mycobacterium avium complex (MAC), which has become a global public health concern due to infection following cardiac surgery performed with contaminated heater-cooler units. M. chimaera infection is characterized by a long latency, non-specific signs and symptoms and high mortality rates. Thus, the diagnosis is still challenging both for forensic pathologists and for clinicians. Clinical manifestations of M. chimaera infection include endocarditis, hepatitis, nephritis, encephalitis and chorioretinitis. A constant histopathologic finding is the presence of non-caseating granulomas, with multinucleated giant cells and histiocytes. Hereby, we present two cases of fatal disseminated M. chimaera infection following aortic valve surgery reporting clinical history and post-mortem findings. Further, we provide a brief overview of the literature with a special focus on histopathological characteristics of M. chimaera infection. The aim of this article is to provide a complete synopsis of histopathological characteristics useful for forensic pathologists. [ABSTRACT FROM AUTHOR]

Introduction: The histopathological examination (HPE) findings of caseating granulomas from the transrectal ultrasound (TRUS) of prostate biopsy are rare. A high index of suspicion is necessary to diagnose a tuberculosis infection. Here, we present the clinical outcomes of patients and the practical management steps when encounter these findings. Methods: We conducted a retrospective analysis of three cases in a tertiary care centre and reviewed the available literature on the topic. Results: All patients were aged less than 55 years and were considered young adults. One patient presented with neurogenic systemic symptoms, and two patients presented with lower urinary tract symptoms. All patients had abnormal digital rectal examination findings that warranted a TRUS biopsy of the prostate. All biopsies reported caseating granuloma with multinucleated giant cells. Additional investigations led to the diagnosis of tuberculosis infections in two patients, and one patient was diagnosed as having non-specific granulomatous prostatitis. All patients were treated according to their specific diagnosis and recovered fully. Conclusion: The detection of caseating granuloma on prostate biopsy may lead to diagnoses of several conditions, either infective or non-infective in origin. Further investigation is mandatory to provide appropriate treatment. [ABSTRACT FROM AUTHOR]

Background: Sarcoid-like reaction (SLR) is a histological pattern of granulomatous inflammation that is clinically differentiated from sarcoidosis. Since SLR is known to occur in several neoplasias and occasionally causes lymphadenopathy and mimics metastatic malignancy, it needs to be considered whether lymphadenopathy is due to metastasis or SLR for the choice of cancer treatment. Few cases of hepatocellular carcinoma (HCC) with SLR have been reported. Here, a case of HCC with lymphadenopathy diagnosed as SLR without metastasis is presented. Case presentation: A 69-year-old woman was admitted to our hospital because of upper abdominal pain. She tested positive for hepatitis C virus ribonucleic acid. Imaging modalities showed an 81 × 65-mm-sized tumor with multiple nodules in segment 3 and a 17 × 12-mm-sized tumor in segment 5 with a common HCC enhancement pattern. In addition, a lymph node in the hepatoduodenal ligament was enlarged at 13 mm in size, suggesting the metastasis of HCC. Hepatectomy of the lateral segment and segment 5 and lymph node dissection in the hepatoduodenal ligament were performed. Both tumors in segments 3 and 5 were pathologically diagnosed as HCC without vessel invasion. The tumors contained necrotic cells and epithelioid cell granulomas with multinucleated giant cells, which is typically observed in sarcoidosis. The dissected lymph nodes also contained epithelioid cell granulomas, as well as giant cells with asteroid bodies. There was no malignancy in the lymph nodes. The pathological findings suggested the coexistence of malignancy and sarcoidosis. However, since the patient did not show any typical findings of pulmonary or cardiac sarcoidosis, the case was diagnosed as HCC with SLR in the primary lesion and regional lymph nodes. Conclusions: SLR needs to be considered in the differential diagnosis when a cancer patient develops lymphadenopathy. However, lymphadenopathy due to SLR is indistinguishable from that due to metastasis even when using multiple imaging modalities. Pathological examinations may be helpful for the diagnosis. [ABSTRACT FROM AUTHOR]

Childhood sarcoidosis is a chronic multisystemic, non-caseating granulomatous disease of unknown etiology. Early-onset disease classically presents with a triad of skin rash, uveitis, and arthritis, but bone marrow involvement is rare. We report a 9-1/2- year old Indian female child who presented with bleeding manifestation, skin rash, uveitis, and arthritis. Bone marrow biopsy showed multiple non-necrotizing granulomas comprising epithelioid cells, mature lymphocytes, and multinucleated giant cells with few eosinophils in the background, with negative staining for acid-fast bacilli or fungi. She was treated successfully with oral prednisolone. This is the first report of an early-onset childhood sarcoidosis with bone marrow involvement from India. [ABSTRACT FROM AUTHOR]

Sarcoidosis is an inflammatory disease that affects one or multiple organs, most commonly the lungs and lymph nodes. This disease can present in a variety of ways which often makes diagnosis difficult. A 54-year-old postmenopausal African American female with a history of omental carcinomatosis of unknown origin was referred to the gynecology-oncology service at a local community hospital following a laparoscopic incarcerated hernia repair where multiple abdominal lesions suspicious of ovarian carcinomatosis were visualized. She was brought to the operating room for a diagnostic laparoscopy at which point the intra-abdominal survey revealed white tubercle-like lesions that were consistent with peritoneal tuberculosis. The lesions were excised and sent to pathology. The omentum biopsy was originally reported as adipose tissue showing focal fibrosis, focal mild acute inflammation, few cyst formation, and multiple granulomatous chronic inflammation, with multinucleated giant cells. Periodic acid-Schiff stain and acid fast bacilli stain were negative, and a diagnosis of peritoneal tuberculosis was made. The patient was started on an antituberculosis treatment regimen; however, she was not improving. The pathology slides were reexamined and revealed nonnecrotizing granulomatous inflammation consistent with sarcoidosis. The patient was immediately referred to the department of pulmonology and rheumatology, at which point she was started on corticosteroids and had an improvement in her condition. [ABSTRACT FROM AUTHOR]

Background: Hypophysitis is primary or idiopathic or secondary to another disease process. The histologic subtypes of hypophysitis are lymphocytic, granulomatous, xanthomatous, xanthogranulomatous, or IgG4-related. Granulomatous hypophysitis is the second most common form and is characterized by multinucleated giant cells with granulomas and histiocytes. It can be idiopathic or secondary to another process such as infection, sarcoidosis, vasculitis, dendritic cell disorders, Crohn's disease (CD) or a reaction to rupture of a Rathke's cyst or pituitary adenoma. We present a case of granulomatous hypophysitis in a patient with CD who had resistance to corticosteroids but a dramatic response to immunosuppressive therapy with anti-tumor necrosis factor (TNF)-α therapy. Case description: A 43-year-old woman with a 9-year history of ileal and colonic CD presented to the Pituitary Center with headaches, visual disturbance, fatigue, nausea, and secondary amenorrhea. She was not on active therapy for her CD at the time of presentation and had no gastrointestinal symptoms. Hormonal evaluation revealed hyperprolactinemia, secondary hypothyroidism and adrenal insufficiency. MRI revealed a 12 × 12 × 19 mm sellar lesion abutting the optic chiasm, reported as a macroadenoma. The patient underwent endoscopic transsphenoidal biopsy of the pituitary mass. Pathology revealed granulomatous hypophysitis. Evaluation for secondary causes of hypophysitis, apart from CD, was negative. Despite a course of high dose prednisone, her symptoms and MRI findings worsened and she developed symptoms consistent with diabetes insipidus. Using a personalized medicine approach, she was started on anti-(TNF)-α therapy with infliximab combined with azathioprine, which are indicated for treatment of CD. Her headaches and polyuria resolved and her menstrual cycles resumed. MRI at 3 months and more than 1.5 years after initiation of anti-TNF-α therapy revealed durable resolution of the pituitary mass. Conclusion: To our knowledge, this is the first report of successful use of anti-TNF-α therapy for a patient with granulomatous hypophysitis, in this case associated with a previous diagnosis of CD. Although glucocorticoids are used frequently as first-line therapy for primary hypophysitis, granulomatous hypophysitis can be corticosteroid resistant and other immunosuppressive approaches may need to be considered within the context of the patient. [ABSTRACT FROM AUTHOR]

Sarcoidosis is an enigmatic multisystem disease characterized by the development and accumulation of granulomas: a compact collection of macrophages that have differentiated into epithelioid cells and which are associated with T helper (Th)1 and Th17 cells. Although no single causative factor has been shown to underlie sarcoidosis in humans, its etiology has been related to microbial, environmental, and genetic factors. We examine how these factors play a role in sarcoidosis pathogenesis. Specifically, we propose that dysfunction of mTOR, Rac1, and autophagy-related pathways not only hampers pathogen or nonorganic particle clearance but also participates in T cell and macrophage dysfunction, driving granuloma formation. This concept opens new avenues for potentially treating sarcoidosis and may serve as a blueprint for other granulomatous disorders. Sarcoidosis is a granulomatous disease triggered by genetic, microbial, and environmental factors. Familial sarcoidosis cases allow the identification of pathways involved in genetic predisposition to the disease. Macrophage and T cell dysfunction contributes to the development and progression of sarcoidosis. We propose that defects in autophagy and mTOR-related pathways decrease the clearance of infectious as well as nonorganic particles and promote granuloma formation and Th17 differentiation in sarcoidosis. Drugs used in sarcoidosis management, such as methotrexate, azathioprine, leflunomide, and chloroquine, interfere with autophagy. Functional studies using mutated forms of genes involved in the mTOR, Rac1, and autophagy pathways are warranted to identify cell types and underlying mechanisms contributing to disease development. [ABSTRACT FROM AUTHOR]

Indeed, a skin biopsy is mandatory to make an accurate diagnosis and to exclude differential diagnoses showing an inflammatory infiltrate composed of non-caseating granulomas involving fat lobules. Subcutaneous sarcoidosis, also known as Darier-Roussy sarcoidosis, is a rare presentation of cutaneous sarcoidosis. Sarcoidosis is a multisystemic granulomatous disease of unknown cause ([1]). [Extracted from the article]

The article presents a case study of a 79-year-old woman presented with pruritic papules and plaques on the chest, back, arms, hands, legs, and feet of 1 year's duration. She reported a history of hypothyroidism, arthritis, and vitiligo but denied a history of cancer. Histopathologic examination revealed a dense infiltrate of epithelioid histiocytes with amphophilic ground-glass cytoplasm in a nodular configuration.

Injection of soft tissue fillers for esthetic purposes is considered a relatively simple, minimally invasive procedure. Although rare, significant complications exist and may occur in the setting of both non-medical grade and medical-grade silicone fillers, administered by untrained or trained providers. We report a case of a 61 y/o male with an unusual case of foreign body granulomas arising on his forehead and periorbital region for the past 3 years. He had no drug allergies or history of trauma. He only recalled administration of "Botox" near the affected area 20 years ago, although he acknowledged being unsure of the nature of the substance. Examination showed bilateral, periorbital, edematous plaques, with subcutaneous nodules on the forehead. Punch biopsy showed multiple vacuoles surrounded by collagen bundles in the dermis, a histiocytic infiltrate, and multinucleated giant cells. Based on clinicopathological correlation, a diagnosis of foreign body granuloma related to silicone filler injections was made. He was treated with intralesional steroids and doxycycline 100 mg twice daily with complete resolution. Physicians should acknowledge this potential complication of silicone fillers and should inquire about their use with close-ended questions. We also review the diagnostic and therapeutic challenges faced by physicians when encountering this diagnosis. [ABSTRACT FROM AUTHOR]

Although GA is usually localized and has spontaneous resolution, it can be generalized and refractory to systemic treatments.[4],[5] Here, we highlight rapid improvement in two patients with recalcitrant GA on treatment with the JAK inhibitor baricitinib. In summary, these patients' cases highlight that baricitinib could be a plausible treatment option as a new molecular-targeted therapy for refractory generalized GA. Https://doi.org/10.1093/ced/llac110 Dear Editor, Granuloma annulare (GA) is a granulomatous inflammatory skin disease and the pathogenesis is challenging. [Extracted from the article]

Background: The full-blown lesion of granuloma annulare (GA) is characterized by necrobiotic granulomas with palisading of histiocytes and stromal mucin deposition. Cases in which the granulomatous features are not fully developed have been described as the "interstitial" variant; however, there is no good definition regarding their criteria for diagnosis. Methods: We conducted a retrospective study of 97 cases of GA. Results: Cases of interstitial GA (69) were paucicellular with scant to no mucin, with only a few scattered mononuclear cells but lacking well-formed granulomas with multinucleated giant cells. Immunohistochemical study showed that the cells in conventional cases of GA stained strongly positive for CD68 and CD163, whereas the small mononuclear cells in interstitial GA were strongly positive only for CD163. Conclusions: Interstitial GA differs from the classical GA in several respects, including morphology and immunophenotype. Use of antibodies to CD163 may be helpful for distinguishing the interstitial variant from other conditions. Recognition of the interstitial variant is of importance to explain the presence of lesions that clinically are suspicious for GA but histologically do not resemble the conventional form of the disease. [ABSTRACT FROM AUTHOR]

The article focuses on a 74-year-old Caucasian woman admitted with symptoms suggestive of COVID-19, including fever, cough, and respiratory distress, along with a history of hypertension and previous hysterectomy for endometrial cancer, who later developed cutaneous lesions on her hands.

A case study of a 50-year-old White woman with PsA presented with painful subcutaneous nodules on the face and arms in the last 5 months; these nodules were associated with anorexia, fatigue, and weight loss. Topics include multisystem chronic inflammatory disorder of unknown etiology characterized by noncaseating granulomas; and cases of sarcoidosis combined with psoriasis and psoriatic arthritis (PsA), in patients treated with anti–tumor necrosis factor inhibitors.

Dear Editor, A 57-year-old woman was diagnosed with sarcoidosis based on iritis, increased serum levels of angiotensin converting enzyme (ACE) and lysozyme, and bilateral hilar lymphadenopathy on chest x-ray and computed tomography scan 1 year and 3 months previously, and was under follow-up at the Respiratory Medicine and Ophthalmology Departments. Although she had been diagnosed with sarcoidosis, no skin lesions suggestive of sarcoidosis were observed. [Extracted from the article]

Dermal fillers may induce late-onset adverse skin reactions in patients under BRAF inhibitors Histiocytoses are disorders characterized by inflammation and the accumulation of cells derived from the monocyte and macrophage lineages, which results in tissue damage. Although the development of sarcoidosis-like lesions seems to be a paradoxical adverse event of BRAF/MEK inhibitors, recent data confirm their immunomodulatory effect.5 Three reported cases of sarcoidosis occurring during BRAF-inhibitor treatment for ECD have demonstrated an original intracellular mechanism of granuloma formation linked to paradoxical ERK expression.2 Contrary to Amoura I et al i .,2 median duration of BRAF inhibition treatment before occurrence of sarcoidosis-like lesions was 8 months. [Extracted from the article]

A 54-year-old Caucasian woman had been undergoing regular follow-up at our Melanoma service for a previous nodular melanoma of the dorsum (Breslow thickness 3.6 mm with ulceration). Cutaneous sarcoid-like reaction in a patient treated with target therapy for metastatic melanoma: the hue is the clue Dynamics of chemokine, cytokine, and growth factor serum levels in BRAF-mutant melanoma patients during BRAF inhibitor treatment. [Extracted from the article]