Solitary subcutaneous sarcoidosis with massive chronic prepatellar bursal involvement

MR imaging features and a redefinition of the classification system for nodular fasciitis

To analyze magnetic resonance imaging features of nodular fasciitis and redefine the system for classifying this class of lesions.Twenty-seven patients with nodular fasciitis and 71 patients with other soft tissue lesions who underwent surgery or biopsy were retrospectively analysed. Demographic information, medical history, and magnetic resonance imaging features were collected. Classification of nodular fasciitis was performed based on a redefined system. Comparison between 2 groups was performed with Chi-square or Fisher exact test.For nodular fasciitis, the longest average lesion diameter was 1.87 cm (range, 0.52-5.46 cm), and 40.7% of lesions were located in the upper extremities, while 29.6% were located in the head and neck. Compared with skeletal muscle, most lesions exhibited isointensity on T1-weighted imaging and hyperintensity on T2-weighted imaging, and 45.5% of the lesions exhibited rim enhancement, 40.9% showed obvious homogenous enhancement, while 13.6% showed no enhancement or slight enhancement. The subcutaneous type accounted for 25.9% of cases, the fascial type 25.9%, the intramuscular type 29.6%, and the unclassified type 18.5%. The "fascia tail sign" was more frequently observed in nodular fasciitis than in other soft tissue lesions (P < .001). Nodular fasciitis was slightly more likely to present with the "inverted target sign" and "solar halo sign" than other soft tissue lesions (P > .05). The "cloud sign" only appeared in nodular fasciitis (P < .05).The "fascia tail sign" and "cloud sign" could help differentiate nodular fasciitis from other soft tissue lesions. A new classification may improve understanding about nodular fasciitis.

Subcutaneous sarcoidosis with thoracic involvement: A very rare presentation of the disease

Subcutaneous sarcoidosis is a very rare manifestation of sarcoidosis and its association with parenchymal lung involvement is rarer. We report the twentieth case in the literature published on PubMed. It is the case of a 61-year-old caucasian, non-smoker lady, who presented to a dermatology department with a 7-month history of asthenia, anorexia, weight loss, fever, exertion dyspnea, dry cough, arthralgia of the large joints and non-tender multiple subcutaneous tumefactions. Biopsy of the nodules established the diagnosis of subcutaneous sarcoidosis. Bronchioloalveolar lavage revealed alveolitis with lymphocyte predominance and the CD4/CD8 ratio was 8.5. Chest computed tomography scan revealed peribronchovascular thickening, micronodules of lymphatic distribution and mediastinal lymphadenopathies which were bilateral, asymmetric, and non-compressive. We therefore concluded the involvement of the lung and the mediastinal lymph nodes. The angiotensin-converting enzyme level was high. The patient was successfully treated with prednisone at the dose of 1mg/kg/day.

Subcutaneous sarcoidosis of the upper and lower extremities: A case report and review of the literature

BACKGROUND

Sarcoidosis is a granulomatous disease of unknown etiology that most often impacts the lungs. Cutaneous manifestations of sarcoidosis are seen among 9%-37% of patients. Subcutaneous sarcoidosis is a rare presentation of cutaneous sarcoidosis with estimates of frequency ranging from 1.4%-16%. To date, very few articles and case reports have been written about this subject. In this paper, we describe a case of subcutaneous sarcoidosis and perform a review of the literature to determine if there are commonalities among patients who present with subcutaneous sarcoidosis.

CASE SUMMARY

A 38-year-old female, with a past medical history of arthritis and recurrent nephrolithiasis, presents with an 8-mo history of 4 firm, asymptomatic, skin-colored nodules on her left and right upper extremities and neck. Needle biopsy and post-excisional pathology report both revealed well-formed, dense, non-caseating granulomas localized to the subcutaneous tissue. Chest computed tomography revealed mild mediastinal lymphadenopathy. A diagnosis of subcutaneous sarcoidosis was made, and the lesions were surgically removed.

CONCLUSION

Commonalities among patients presenting with subcutaneous sarcoidosis include: middle-aged female, lesions localizing to the upper or lower limbs, lymphadenopathy or pulmonary infiltration on chest imaging, elevated serum angiotensin-converting enzyme.