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Abdelghaffar M, Hwang E, Damsky W. Cutaneous Sarcoidosis. Clin Chest Med 2024; 45:71-89. [PMID: 38245372 DOI: 10.1016/j.ccm.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Sarcoidosis is a multisystem disease that most commonly affects the lungs, lymphatic system, eyes, and skin but any organ may be involved. Cutaneous sarcoidosis most commonly presents as pink-red to red-brown papules and plaques that commonly affect the head and neck. With the skin being readily accessible for evaluation and biopsy, when sarcoidosis is suspected, dermatologic evaluation may be helpful for establishing a definitive diagnosis. Treatment strategy depends on the severity and distribution of skin lesions and should incorporate patient preference and treatment considerations for other organs that may be involved.
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Affiliation(s)
- Mariam Abdelghaffar
- School of Medicine, Royal College of Surgeons in Ireland, Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Erica Hwang
- Department of Dermatology, Yale School of Medicine, 333 Cedar Street, LCI 501 PO Box 208059, New Haven, CT 06520, USA
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, 333 Cedar Street, LCI 501 PO Box 208059, New Haven, CT 06520, USA; Department of Pathology, Yale School of Medicine, 310 Cedar Street, LH 108, PO Box 208023, New Haven, CT 06520, USA.
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2
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Ibraheim MK, Desai M, Tawfik M, Elsensohn A, Furukawa B. Microblading-Induced Granulomatous Reaction: Case Report and Review of the Literature. Am J Dermatopathol 2023; 45:487-491. [PMID: 37130196 DOI: 10.1097/dad.0000000000002449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
ABSTRACT Microblading is a common cosmetic procedure that can modify the appearance of one's eyebrows. Although generally well-tolerated, the procedure can cause a number of dermatologic issues; on rare occasions, granulomatous reactions can manifest. We use this case to highlight a presentation of a nonsarcoidal granulomatous dermatitis and review the literature on granulomatous reactions secondary to microblading. Of the 21 cases included in our review, approximately half (10/21) were diagnosed with foreign-body granulomas and the other half with sarcoidosis (7 of 21 with systemic sarcoidosis and 4 of 21 with cutaneous sarcoidosis). Although microblading remains a commonplace cosmetic technique, it is not without risk. Much like other types of tattoos, microblading can cause granulomatous reactions for which we must be vigilant, and further workup for sarcoidosis might be considered in select patients.
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Affiliation(s)
| | - Mansee Desai
- Department of Dermatology, Loma Linda University, Loma Linda, CA
| | - Melanie Tawfik
- Department of Dermatology, Loma Linda University, Loma Linda, CA
| | - Ashley Elsensohn
- Department of Dermatology, Loma Linda University, Loma Linda, CA
- Department of Pathology, Loma Linda University, Loma Linda, CA; and
| | - Betsy Furukawa
- Department of Dermatology, Baylor Scott and White Medical Center, Temple, TX
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Nakamura T, Fujiwara M. Comparative Immunohistochemical Analysis of Macrophage Phenotypes in Cutaneous Sarcoid Granuloma, Suture Granuloma, and Lipogranuloma. Am J Dermatopathol 2023; 45:371-377. [PMID: 37130221 DOI: 10.1097/dad.0000000000002446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
ABSTRACT Granulomas are composed of a heterogeneous population of resident and recruited macrophages according to the type of lesion, extent of injury, and local tissue environment (eg, involved site and interaction with infiltrating lymphocytes). Although macrophage phenotypes in various types of granulomas have been previously described, the experimental conditions varied across studies, precluding a comparative and comprehensive understanding of granulomas. This study was conducted to comparatively analyze the expression of markers of the M1 and M2 phenotypes in macrophages that compose various types of granulomas, including epithelioid lesions, under strict conditions. Surgical specimens of cutaneous sarcoidosis (11 lesions), suture granuloma (10 lesions), and subcutaneous lipogranuloma (12 lesions) were immunohistochemically stained for CD11c, CD206, CD163, and CD10. The expression of these markers in macrophages composing each type of granuloma was scored and statistically analyzed. Granuloma macrophages were mostly immunoreactive for CD11c and CD206 in all the examined cases, although many intermingling CD206-negative cells were observed in 5 cases of lipogranuloma. CD163 and CD10 were diffusely expressed in macrophages composing suture granuloma and lipogranuloma, whereas they were not expressed in epithelioid cells in cutaneous sarcoidosis. Meanwhile, "interstitial" macrophages around epithelioid granulomas revealed moderate to marked CD163 expression in 7 lesions of cutaneous sarcoidosis. These results indicate significant differences of expression of CD163 and CD10 between cutaneous sarcoidosis and suture granuloma/lipogranuloma; CD163 and CD10 are downregulated after the epithelioid transformation of macrophages in cutaneous sarcoidosis.
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Sauvageau AP, Oulee A, Huang YY, Patel RM, Hamp L. Cutaneous sarcoidosis mimicking pigmented purpuric dermatosis. J Cutan Pathol 2023; 50:123-126. [PMID: 36070081 PMCID: PMC10087493 DOI: 10.1111/cup.14326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/22/2022] [Accepted: 09/04/2022] [Indexed: 01/24/2023]
Abstract
Sarcoidosis is a systemic inflammatory disorder characterized by the formation of non-caseating granulomas. Cutaneous involvement of sarcoidosis is common and has a wide variety of clinical presentations. Herein, we present a case of cutaneous sarcoidosis mimicking pigmented purpuric dermatosis (PPD) in a 26-year-old female treated with topical tofacitinib cream and a literature review of all other reported cases of cutaneous sarcoidosis with PPD-like features.
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Affiliation(s)
- Andrew P Sauvageau
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Aislyn Oulee
- University of California Riverside School of Medicine, Riverside, California, USA
| | - Yuan Yu Huang
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rajiv M Patel
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Leela Hamp
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
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Wu Z, Li L, Qu H, Qi RQ, Niu J. Immunohistochemical Features of MMP-9 and pSTAT1 in Granuloma Annulare and Sarcoidosis: A Comparative Study of 62 Cases. J Immunol Res 2023; 2023:4098459. [PMID: 36959923 PMCID: PMC10030222 DOI: 10.1155/2023/4098459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/17/2023] Open
Abstract
Background Granuloma annulare (GA) and sarcoidosis are granulomatous inflammatory diseases that share similarities. Objective To identify the histological and immunohistochemical (IHC) features of GA and sarcoidosis. Methods A retrospective review of 36 patients with GA and 26 with sarcoidosis was performed. Results from hematoxylin and eosin (H&E) staining and IHC staining of MMP-9 and pSTAT1 within the skin lesions of GA and sarcoidosis were analyzed, and random forest was applied for developing a predictive model. Results Significantly greater expressions of MMP-9 (especially in elastic fibers, EFs, P < 0.0001) and pSTAT1 (P = 0.0003) were observed in lesion samples of GA versus sarcoidosis patients. In GA patients, MMP-9 was significantly upregulated in the interstitial type (P = 0.0222), while staining of pSTAT1 was positively correlated with the area of mucinous collagen in palisading GA (R = 0.5356, P = 0.0484). In sarcoidosis patients, MMP-9 (R = -0.7127, P = 0.0009) and pSTAT1 (R = -0.5604, P = 0.0067) were found to show stronger expressions in lesions with less lymphocyte infiltration. The predictive model demonstrated an AUC of 0.9675. Conclusion These results indicate that MMP-9 and pSTAT1 might exert roles in granulomatous inflammation in different modes, and the presence of more robust MMP-9 staining in EFs appears to be more suggestive of GA.
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Affiliation(s)
- Ze Wu
- 1Department of Dermatology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, 110016 Shenyang, China
| | - Linghui Li
- 1Department of Dermatology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, 110016 Shenyang, China
| | - Hui Qu
- 2College of Medicine and Biological Information Engineering, Northeastern University, No. 3-11, Wenhua Road, Heping District, 110819 Shenyang, China
| | - Rui-Qun Qi
- 3Department of Dermatology, The First Hospital of China Medical University, No. 155 Nanjing Bei Street, Heping District, 110001 Shenyang, China
- 4Key Laboratory of Immunodermatology, Ministry of Education and NHC, National Joint Engineering Research Center for Theranostics of Immunological Skin Diseases, No. 155 Nanjing Bei Street, Heping District, 110001 Shenyang, China
| | - Jun Niu
- 1Department of Dermatology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe District, 110016 Shenyang, China
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6
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Evenson CJ, Rosenbach M, Shields BE. Utility of angiotensin‐converting enzyme and serum calcium levels in cutaneous sarcoidosis. Int J Dermatol 2022. [DOI: 10.1111/ijd.16547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Collin J. Evenson
- Department of Dermatology University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Misha Rosenbach
- Penn Dermatology Perelman Perelman Center for Advanced Medicine Philadelphia PA USA
| | - Bridget E. Shields
- Department of Dermatology University of Wisconsin School of Medicine and Public Health Madison WI USA
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Wu S, Smith CJ, Miedema JR, Googe PB. Updates in Inflammatory Dermatopathology. Semin Diagn Pathol 2022; 39:288-297. [DOI: 10.1053/j.semdp.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/02/2022] [Accepted: 02/15/2022] [Indexed: 11/11/2022]
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Bae KN, Shin K, Kim HS, Ko HC, Kim B, Kim MB. Scar Sarcoidosis: A Retrospective Investigation into Its Peculiar Clinicopathologic Presentation. Ann Dermatol 2022; 34:28-33. [PMID: 35221592 PMCID: PMC8831309 DOI: 10.5021/ad.2022.34.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/24/2021] [Accepted: 07/25/2021] [Indexed: 11/08/2022] Open
Abstract
Background Scar sarcoidosis (SS), a rare form of cutaneous sarcoidosis, develops from pre-existing scars. Owing to its rarity, the clinicopathologic features and its significance in clinical prognosis have been obscure. Objective This study aimed to investigate clinical, laboratory and histopathologic findings and to clarify characteristics associated with the development of SS and systemic involvement. Methods We retrospectively assessed clinical, laboratory and histopathologic findings of SS. Clinical factors including demographics, anatomic area, number of lesion (single, multiple), presence of symptoms, latent period, injury types related to scar and the proportion of systemic involvement were investigated. Results Of the 21 patients with SS, skin lesions appeared predominantly in females (85.7%) and in the head and neck (57.1%). The mean latent period was 163.5 months and 13 patients (61.9%) had multiple lesions. Injury types were varied, with no specific type identified as associated with SS. Histologically, discrete sarcoidal granulomas surrounded by densely packed collagen bundles with a thickening of numerous fibers were observed. Ten patients (47.6%) had systemic involvement and showed significantly more of the multiple lesions, longer latent period and higher level of mean serum angiotensin-converting enzyme than those without systemic involvement. Conclusion Various causes of scar were related to SS, but no specific injury type was identified as leading to SS. Although the exact pathomechanism remains unclear, the possibility of systemic involvement could be considered when the patients have multiple lesions, longstanding scars, and elevated serum angiotensin-converting enzyme.
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Affiliation(s)
- Kyung-Nam Bae
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Kihyuk Shin
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Hoon-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
| | - Byungsoo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon-Bum Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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9
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Yoshida A, Sugita K, Yamamoto O. Infiltrative Erythemas and Nodules on a Unilateral Cheek Following Inappropriate Use of a Topical Steroid. Yonago Acta Med 2022; 65:88-89. [DOI: 10.33160/yam.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/25/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Ai Yoshida
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Kazunari Sugita
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Osamu Yamamoto
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
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Aróstegui Aguilar J, Diago A, Carrillo Gijón R, Fernández Figueras M, Fraga J, García Herrera A, Garrido M, Idoate Gastearena M, Christian Laga A, Llamas-Velasco M, Martínez Campayo N, Monteagudo C, Onrubia J, Pérez Muñoz N, Ríos-Martín J, Ríos-Viñuela E, Rodríguez Peralto J, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz A, Saus C, Suárez Peñaranda J, Velasco Benito V, Beato Merino M, Fernandez-Flores A. Granulomas in Dermatopathology: Principal Diagnoses — Part 2. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Mahabal GD, Peter DCV, George L, Thomas M, Pulimood SA. Cutaneous Sarcoidosis: A Retrospective Clinico-Pathological Study from the Indian Subcontinent in Patients Attending a Tertiary Health Care Centre. Indian Dermatol Online J 2021; 12:566-571. [PMID: 34430461 PMCID: PMC8354409 DOI: 10.4103/idoj.idoj_606_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/12/2020] [Accepted: 03/01/2021] [Indexed: 01/19/2023] Open
Abstract
Context: Sarcoidosis is a systemic disorder characterized histologically by noncaseating granulomas. There is paucity of Indian data on cutaneous sarcoidosis. Aims: To describe the clinical, histopathological findings, and extracutaneous involvement in cutaneous sarcoidosis. Materials and Methods: A retrospective study was done in patients of cutaneous sarcoidosis who had attended the dermatology clinic of a tertiary health care center in India from May 2009 to April 2015. The clinical details, histopathological findings, treatment, and response were reviewed. Results: There were 38 patients with cutaneous sarcoidosis. Mean age was 48 ± 13 years; 58% were female. Median duration of disease was 11 months (IQR 4–48 months). More than one morphology was seen in 28.9%, commonest being plaques (65.7%), and papules (50%). Erythema nodosum was rare. More than one site was involved in 55.3%, most commonly trunk (52.6%). Six patients had isolated cutaneous sarcoidosis. Commonest extracutaneous organs involved were lung (73.7%) and lymph nodes (68.4%). Histopathologically, classical naked sarcoidal granulomas were found in only 55.3%. Angiotensin converting enzyme (ACE) levels were elevated in 74.3% (26/35) with significant association with extracutaneous disease. Treatment included topical and/or systemic corticosteroids, hydroxychloroquine, and tacrolimus. Statistics: Pearson's Chi-square test was done to analyze associations between the skin lesions, ACE levels, and systemic involvement; P < 0.05 was considered significant. Conclusions: Cutaneous manifestations of sarcoidosis are varied, commonest being erythematous plaques. Even though most patients had systemic involvement, we found no significant association of the type and number of skin lesions with extracutaneous involvement or prognosis. Elevated ACE levels were significantly associated with systemic involvement.
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Affiliation(s)
- Gauri D Mahabal
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dincy C V Peter
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Leni George
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Meera Thomas
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Susanne A Pulimood
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
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12
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Morpheaform Plaques and an Infiltrated Scar: Answer. Am J Dermatopathol 2021; 43:595-596. [PMID: 34276028 DOI: 10.1097/dad.0000000000001810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Aróstegui Aguilar J, Diago A, Carrillo Gijón R, Fernández Figueras M, Fraga J, García Herrera A, Garrido M, Idoate Gastearena MA, Christian Laga A, Llamas-Velasco M, Martínez Campayo N, Monteagudo C, Onrubia J, Pérez Muñoz N, Ríos-Martín JJ, Ríos-Viñuela E, Rodríguez Peralto JL, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz A, Saus C, Suárez Peñaranda JM, Velasco Benito V, Beato Merino MJ, Fernandez-Flores A. Granulomas in Dermatopathology: Principal Diagnoses - Part 2. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00138-1. [PMID: 33891884 DOI: 10.1016/j.ad.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022] Open
Abstract
Part 2 of this series on granulomatous diseases focuses on skin biopsy findings. Whereas the first part treated noninfectious conditions (metabolic disorders and tumors, among other conditions), this part mainly deals with various types of infectious disease along with other conditions seen fairly often by clinical dermatologists.
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Affiliation(s)
- J Aróstegui Aguilar
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, España
| | - A Diago
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - R Carrillo Gijón
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M Fernández Figueras
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - J Fraga
- Servicio de Anatomía Patológica, Hospital Universitario de La Princesa, Madrid, España
| | - A García Herrera
- Servicio de Anatomía Patológica, Hospital Clínic, Barcelona, España
| | - M Garrido
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, España
| | - M A Idoate Gastearena
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Departamento de Citología, Histología y Anatomía Patológica, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - A Christian Laga
- Departamento de Patología, Brigham and Women's Hospital, Boston, Massachusetts, Estados Unidos
| | - M Llamas-Velasco
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España
| | - N Martínez Campayo
- Servicio de Dermatología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - C Monteagudo
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Facultad de Medicina, Universidad de Valencia, Valencia, España
| | - J Onrubia
- Servicio de Anatomía Patológica, Hospital Universitario San Juan de Alicante, Sant Joan d'Alacant, Alicante, España
| | - N Pérez Muñoz
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Quirón salud, Sant Cugat del Vallès, Barcelona, España
| | - J J Ríos-Martín
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - J L Rodríguez Peralto
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, España
| | - E Rozas Muñoz
- Departamento de Dermatología, Hospital de San Pablo, Coquimbo, Chile
| | - O Sanmartín
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Santonja
- Servicio de Anatomía Patológica, Fundación Jiménez Díaz, Madrid, España
| | - A Santos-Briz
- Servicio de Anatomía Patológica, Hospital Universitario de Salamanca, Salamanca, España
| | - C Saus
- Servicio de Anatomía Patológica. Hospital Universitario Son Espases, Palma de Mallorca, España
| | - J M Suárez Peñaranda
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, España
| | - V Velasco Benito
- Servicio de Anatomía Patológica, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| | - M J Beato Merino
- Servicio de Anatomía Patológica, Hospital Universitario La Paz, Madrid, España
| | - A Fernandez-Flores
- Servicio de Anatomía Patológica, Hospital Universitario El Bierzo, Ponferrada, León, España; Servicio de Anatomía Patológica, Hospital de la Reina, Ponferrada, León, España; Unidad de Investigación, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de A Coruña, A Coruña, España.
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Abed Dickson M, Hernández BA, Marciano S, Mazzuoccolo LD. Prevalence and characteristics of cutaneous sarcoidosis in Argentina. Int J Womens Dermatol 2021; 7:280-284. [PMID: 34222584 PMCID: PMC8243117 DOI: 10.1016/j.ijwd.2021.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/29/2020] [Accepted: 01/06/2021] [Indexed: 01/19/2023] Open
Abstract
Background Sarcoidosis is a multisystem granulomatous disease of unknown etiology. The incidence is higher in women than in men, according to some studies. Studies regarding prevalence and characteristics of cutaneous sarcoidosis in our region are scarce. Objective This study aimed to describe the characteristics of patients with cutaneous sarcoidosis and to estimate its prevalence. Methods A cross-sectional study was conducted of patients with cutaneous sarcoidosis between January 1, 2004 and April 30, 2019 at the Hospital Italiano de Buenos Aires in Argentina. We included all patients age >17 years with biopsy-proven cutaneous sarcoidosis. Isolated cutaneous sarcoidosis was defined as the presence of epithelioid noncaseating granulomas on a skin biopsy without further evidence of systemic involvement. To estimate period prevalence, we only considered the subgroup of patients affiliated with our private health system. Results A total of 38 patients with cutaneous sarcoidosis were included. The median age at the time of diagnosis was 55.5 years. There was a striking female predominance in our series (73.7%). Overall, 15 patients (39.5%) had isolated cutaneous sarcoidosis and 23 (60.5%) had systemic sarcoidosis with cutaneous involvement. The median follow-up of the study population from histological diagnosis was 50 months (interquartile range, 24–10 months). Regarding skin involvement, 28 patients (73.7%) presented with only sarcoidosis-specific lesions, 6 (15.8%) presented with erythema nodosum, and 4 (10.5%) presented with both sarcoidosis-specific lesions and erythema nodosum. Treatment was given to 29 patients (73.6%), with systemic and topical corticosteroids being the most frequent. The crude prevalence of cutaneous sarcoidosis was 16.9 (95% confidence interval, 10.6–25.5) per 100,000 persons. Conclusion One of the major findings of our study was that 40% of patients had isolated cutaneous sarcoidosis.
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Singh P, Jain E, Dhingra H, Mohan H, Thami GP. Clinico-pathological spectrum of cutaneous sarcoidosis: an experience from a government institute in North India. Med Pharm Rep 2020; 93:241-245. [PMID: 32832888 PMCID: PMC7418838 DOI: 10.15386/mpr-1384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/05/2019] [Accepted: 01/12/2020] [Indexed: 12/02/2022] Open
Abstract
Background and aims Sarcoidosis is a multisystem granulomatous disease of unknown etiology and cutaneous involvement is the second most frequent manifestation in systemic sarcoidosis. The aim of the present study is to evaluate the clinical and pathological spectrum of cutaneous sarcoidosis and compare the same with literature available. Methods The present retrospective study was conducted from January 2010–March 2015 and fifteen cases diagnosed as cutaneous sarcoidosis on biopsy were reviewed. The histological spectrum of cutaneous sarcoidosis was evaluated. Results The mean age at diagnosis was 46 years. Nine (60%) cases out of 15 were females. Most common cutaneous lesions were nodules (46.6%) followed by papules (40%). Classically, lymphocyte-poor, non-caseating epithelioid cell granulomas, was the most common histologic finding. Inclusion bodies were seen in 20% cases with occasional presence of fibrinoid necrosis (13.3%). Peri-adnexal granuloma, seen in one case, raised the possibility of tuberculoid leprosy. Foreign body was seen in one case supporting the opinion that sarcoidosis and granulomatous foreign body reaction are not mutually exclusive. Epidermal changes including atrophy, loss of rete pegs, acanthosis, papillomatosis, hyperkeratosis, parakeratosis and basal cell vacuolation were seen in 46.6% cases. Reticulin was positive in all the cases while special stains for acid fast bacilli and fungi were negative. Conclusion The clinical presentation of cutaneous sarcoidosis may be variable. Presence of naked, reticulin-rich granulomas is the most characteristic histopathological finding. Correlation of clinical history with histologic examination is essential to exclude other granulomatous diseases including leprosy, syphilis, other infectious granulomatous diseases and foreign body reaction.
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Affiliation(s)
- Priyanka Singh
- Department of Pathology, Lady Hardinge Medical College, New Delhi, India
| | | | - Harshi Dhingra
- Department of Pathology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Harsh Mohan
- Department of Pathology, Government Medical College and Hospital, Sector 32-A, Chandigarh, India
| | - G P Thami
- Department of Pathology, Government Medical College and Hospital, Sector 32-A, Chandigarh, India
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Abstract
Sarcoidosis is a chronic, multisystem, inflammatory disorder of unknown etiology that is characterized by noncaseating granulomas that impair normal organ functioning. Sarcoidosis predominantly affects the lungs, but the skin is often cited as the second most frequently involved organ. Cutaneous manifestations of sarcoidosis are highly variable and ongoing research seeks to better understand the relationship between clinical morphology and disease prognosis. Skin findings in patients with sarcoidosis can be "specific," in which sarcoidal granulomas infiltrate the skin, or they can represent a "nonspecific" reactive inflammatory process, as is seen in calcinosis cutis and erythema nodosum. Cutaneous sarcoidosis can be the initial presenting sign or develop later in the course of the disease. In some patients, the skin will be the most involved and impactful organ system and will drive therapy. In other cases, the skin will be an incidental or minor finding, but may be easily accessible for biopsy to confirm the diagnosis. There are many potential therapies for sarcoidosis, though no one therapy is universally effective.
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Affiliation(s)
- Avrom Caplan
- Ronald O. Perelman Department of Dermatology, NYU School of Medicine, New York, New York
| | - Misha Rosenbach
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sotonye Imadojemu
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Zhu X, Sun J. A case of facial atrophic sarcoidosis in an adolescent, successfully treated with the combination of prednisone and hydroxychloroquine. An Bras Dermatol 2020; 95:340-342. [PMID: 32299736 PMCID: PMC7253884 DOI: 10.1016/j.abd.2019.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 08/04/2019] [Indexed: 11/30/2022] Open
Abstract
Sarcoidosis is a multisystem granulomatous disorder of unknown aetiology. Cutaneous involvement occurs in up to 30% of patients and skin findings are often the initial presenting symptom. The facial atrophic form of sarcoidosis without associated ulceration in adolescents has rarely been described in the literature. We report a case of 13-year-old male patient with a facial atrophic sarcoidosis who was successfully treated with the combination of prednisone and hydroxychloroquine.
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Affiliation(s)
- Xiaomei Zhu
- Department of Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, China.
| | - Jianfang Sun
- Department of Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, China.
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Poline J, Fogel O, Pajot C, Miceli‐Richard C, Rybojad M, Galeotti C, Grouteau E, Hachulla E, Brissaud P, Cantagrel A, Mazereeuw Hautier J, Melki I, Petit A, Piram M, Sarrabay G, Wouters C, Vignon‐Pennamen M, Bourrat E, Meinzer U. Early‐onset granulomatous arthritis, uveitis and skin rash: characterization of skin involvement in Blau syndrome. J Eur Acad Dermatol Venereol 2019; 34:340-348. [DOI: 10.1111/jdv.15963] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/26/2019] [Indexed: 01/21/2023]
Affiliation(s)
- J. Poline
- Department of General Pediatrics Paediatric Internal Medicine, Rheumatology and Infectious Diseases National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Auto‐immune diseases RAISE Robert Debré University Hospital Assistance Publique‐Hôpitaux de Paris Paris France
- INSERM UMR1149 Université Paris Diderot‐Sorbonne Paris‐Cité Paris France
| | - O. Fogel
- Department of Rheumatology Cochin University Hospital Assistance Publique‐Hôpitaux de Paris ParisFrance
| | - C. Pajot
- Department of Paediatric Nephrology and Internal Medicine Purpan University Hospital Toulouse France
| | - C. Miceli‐Richard
- Department of Rheumatology Cochin University Hospital Assistance Publique‐Hôpitaux de Paris ParisFrance
| | - M. Rybojad
- Department of Dermatology Saint Louis University Hospital Assistance Publique‐Hôpitaux de Paris Paris France
| | - C. Galeotti
- Department of Paediatric Rheumatology National Reference Centre for Auto‐inflammatory Diseases CEREMAIA Kremlin Bicêtre University Hospital Assistance Publique‐Hôpitaux de Paris Kremlin Bicêtre France
| | - E. Grouteau
- Department of Paediatric Emergencies Purpan University Hospital Toulouse France
| | - E. Hachulla
- Department of Internal Medicine and Clinical Immunology Referral Centre for Rare Systemic and Auto‐immunes Diseases C. Huriez University Hospital Lille France
| | - P. Brissaud
- Department of Rheumatology Bichat‐Claude Bernard University Hospital Assistance Publique‐Hôpitaux de Paris Paris France
| | - A. Cantagrel
- Department of Rheumatology Purpan University Hospital Toulouse France
| | - J. Mazereeuw Hautier
- Department of Dermatology Larrey Hospital Paul Sabatier University Toulouse France
| | - I. Melki
- Department of General Pediatrics Paediatric Internal Medicine, Rheumatology and Infectious Diseases National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Auto‐immune diseases RAISE Robert Debré University Hospital Assistance Publique‐Hôpitaux de Paris Paris France
| | - A. Petit
- Department of Pediatric Hematology and Oncology Assistance Publique‐Hôpitaux de Paris GH HUEP Armand Trousseau Hospital Paris France
- UMRS_938 CDR Saint‐Antoine Sorbonne Université Paris France
| | - M. Piram
- Department of Paediatric Rheumatology National Reference Centre for Auto‐inflammatory Diseases CEREMAIA Kremlin Bicêtre University Hospital Assistance Publique‐Hôpitaux de Paris Kremlin Bicêtre France
| | - G. Sarrabay
- Department of Medical Genetics Rare diseases and Personalized medicine Rare and Autoinflammatory diseases unit Montpellier University Hospital University of Montpellier Montpellier France
| | - C. Wouters
- Department of Paediatric Rheumatology Leuven University Hospital Leuven Belgium
| | - M.D. Vignon‐Pennamen
- Department of Anatomopathology Saint Louis University Hospital Assistance Publique‐Hôpitaux de Paris Paris France
| | - E. Bourrat
- Department of General Pediatrics Paediatric Internal Medicine, Rheumatology and Infectious Diseases National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Auto‐immune diseases RAISE Robert Debré University Hospital Assistance Publique‐Hôpitaux de Paris Paris France
- Department of Dermatology Saint Louis University Hospital Assistance Publique‐Hôpitaux de Paris Paris France
| | - U. Meinzer
- Department of General Pediatrics Paediatric Internal Medicine, Rheumatology and Infectious Diseases National Reference Centre for Rare Paediatric Inflammatory Rheumatisms and Systemic Auto‐immune diseases RAISE Robert Debré University Hospital Assistance Publique‐Hôpitaux de Paris Paris France
- INSERM UMR1149 Université Paris Diderot‐Sorbonne Paris‐Cité Paris France
- Biology and Genetics of Bacterial Cell Wall Unit Pasteur Institute Paris France
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García-Colmenero L, Sánchez-Schmidt JM, Barranco C, Pujol RM. The natural history of cutaneous sarcoidosis. Clinical spectrum and histological analysis of 40 cases. Int J Dermatol 2018; 58:178-184. [PMID: 30306543 DOI: 10.1111/ijd.14218] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/27/2018] [Accepted: 08/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cutaneous lesions of sarcoidosis can allow physicians to establish the diagnosis of a systemic disease, but the need of monitoring patients presenting skin limited sarcoidosis in order to detect further extracutaneous involvement has rarely been evaluated. OBJECTIVES To review clinical and histological features of patients with cutaneous sarcoidosis and the risk of progression to systemic disease. To characterize the phenotype of patients with isolated cutaneous sarcoidosis and to assess the temporal relationship between cutaneous and systemic disease. METHODS Retrospective review of a series of patients with cutaneous sarcoidosis. Clinical, histopathological, and evolutive features were reviewed. RESULTS Forty patients were included in the study. Systemic disease was present in 82.5% of patients. Previous or concurrent cutaneous involvement occurred in 81.8% of them. Seven out of 14 patients with cutaneous lesions evolved to a systemic sarcoidosis in a mean time of 6 years, with a range between 4 and 9 years. No clinical or histological differences were found between patients with systemic sarcoidosis and those who showed persistent isolated cutaneous lesions. CONCLUSIONS Sarcoidosis may be manifested as an isolated cutaneous disorder. No clinical or histopathological features seem to be helpful to discriminate cases of a persistent isolated cutaneous disease from those that will develop systemic involvement. Since the development of systemic involvement in cases of isolated cutaneous sarcoidosis can occur many years afterward, careful monitoring seems advisable, and a long follow-up is recommended.
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20
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An unusual swelling of the supraorbital region. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:98-101. [PMID: 29373259 DOI: 10.1016/j.oooo.2017.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 10/29/2017] [Accepted: 11/06/2017] [Indexed: 11/20/2022]
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Munday WR, McNiff J, Watsky K, DiCapua D, Galan A. Perineural granulomas in cutaneous sarcoidosis may be associated with sarcoidosis small-fiber neuropathy. J Cutan Pathol 2015; 42:465-70. [PMID: 25757612 DOI: 10.1111/cup.12484] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 11/27/2022]
Abstract
Perineural granulomas in cutaneous sarcoidosis have been rarely reported and their clinical significance has yet to be evaluated. Recently, a 27-year-old male presented with multiple pink papules on the flank and lower back, accompanied by a painful, burning sensation. Biopsies revealed well-defined granulomas, consistent with sarcoidosis, in the dermis and involving small cutaneous nerves. We hypothesized that perineural granulomas may be an under-recognized feature of cutaneous sarcoidosis and may be responsible for sensory disturbances. We reviewed cases from 29 consecutive patients with cutaneous sarcoidosis. Perineural granulomas were identified in 18/29 (62%) patients and in 22/40 (55%) biopsies. Perineural granulomas were identified in 7/9 biopsies from the proximal upper extremity, 1/3 from the distal upper extremity, 7/12 from the head and the neck, including 4/4 from the nose, 5/9 from the back, 1/2 from the flank and 1/1 from the proximal lower extremity and 0/4 from the distal lower extremity. The anatomical distribution is similar to sarcoidosis small-fiber neuropathy (SSFN), in which sarcoidosis patients without evident skin lesions experience sensory disturbances of unknown etiology involving the face, the proximal extremities and the trunk. Our results indicate perineural granulomas in cutaneous sarcoidosis are more common than previously appreciated, primarily involve the head, the proximal upper extremities and the back, and may be responsible for neurological manifestations.
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Affiliation(s)
- William R Munday
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Jennifer McNiff
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA.,Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Kalman Watsky
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Daniel DiCapua
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Anjela Galan
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA.,Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
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23
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Ultrasound findings in cutaneous sarcoidosis. Postepy Dermatol Alergol 2015; 32:51-5. [PMID: 25821428 PMCID: PMC4360006 DOI: 10.5114/pdia.2014.40955] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 09/29/2013] [Accepted: 11/25/2013] [Indexed: 11/29/2022] Open
Abstract
The diagnosis of cutaneous sarcoidosis relies mainly on the patient's history, presence of characteristic skin lesions and histological examination that shows a granulomatous, non-necrotizing dermal infiltration. The aim of the study was to assess the ultrasonographic features of cutaneous lesions of sarcoidosis before and after treatment. A 38-year-old woman with systemic sarcoidosis and specific cutaneous lesions was treated with systemic steroids followed by hydroxychloroquine. Ultrasonographic examination of the cutaneous sarcoidosis lesions was performed with a Philips iU 22 and Siemens Acuson S 2000 device, with the use of linear 15 MHz and 17 MHz transducers. Histological examination of skin lesions showed characteristic, naked, non-necrotizing granulomas in the upper dermis. Ultrasound examination revealed well-demarcated, hypoechogenic changes. Power-Doppler scan revealed increased vascularity within the lesions and the surrounding tissue. Clinical improvement of the skin lesions was confirmed by ultrasound examination, which showed a decrease in their size and normalization of dermal echogenicity and vascularity. Ultrasound examination can show cutaneous sarcoidosis lesions and their regression after appropriate treatment.
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Tchernev G, Cardoso JC, Chokoeva AA, Verma SB, Tana C, Ananiev J, Gulubova M, Philipov S, Kanazawa N, Nenoff P, Lotti T, Wollina U. The "mystery" of cutaneous sarcoidosis: facts and controversies. Int J Immunopathol Pharmacol 2014; 27:321-30. [PMID: 25280023 DOI: 10.1177/039463201402700302] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The reason why the cutaneous form of sarcoidosis is well known in the literature is because of its spectrum of manifestations granting it the fame of a Great Imitator. The mystery shrouding the pathogenesis of this rare cutaneous disease is still there (in spite of the fundamental progress of the various diagnostic methods in current day medicine). The production of the morphological substrate - the epithelioid cell granuloma - which is considered to be characteristic of skin sarcoidosis, could, however, also be the end result of a reaction to i) various specific infectious agents such as Leishmaniasis cutis, coccidioidomycosis, etc., ii) certain residual bacterial or other mycobacterial antigens which, at the moment of setting the diagnosis are - by definition - non-infectious but still immunogenic, as well as iii) different tumor antigens in lesional tissue or other location. Often, differentiating between sarcodiosis and a sarcoid-like reaction, based on the updated criteria for cutaneous sarcoidosis, is problematic to downright impossible. A future characterization of the genetic signature of the two conditions, as well as the implementation of additional mandatory panels for i) the identification of certain infectious or ii) non-infectious but immunogenic and iii) tumor antigens in the epithelioid cell granuloma (or in another location in the organism), could be a considerable contribution to the process of differentiating between the two above-mentioned conditions. This will create conditions for greater accuracy when setting the subsequent therapeutic approaches.
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Affiliation(s)
- G Tchernev
- Policlinic for Dermatology and Venerology, Saint Kliment Ohridski University, Medical Faculty, University Hospital Lozenetz, Sofia, Bulgaria
| | - J C Cardoso
- Dermatology Department University Hospital of Coimbra, Pinto, Coimbra, Portugal
| | - A A Chokoeva
- Department of Dermatology and Venereology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - C Tana
- Department of Medicine and Science of Aging "G. d'Annunzio" University, Chieti, Italy
| | - J Ananiev
- Department of General and Clinical Pathology, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
| | - M Gulubova
- Department of General and Clinical Pathology, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
| | - S Philipov
- Department of General and Clinical Pathology, Medical Faculty, "Saint Kliment Ohridski University", Sofia, Bulgaria
| | - N Kanazawa
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - P Nenoff
- Laboratory for Medical Microbiology, Mölbis, Germany
| | - T Lotti
- Dermatology Department, University of Rome "G. Marconi" Rome, Italy
| | - U Wollina
- Department of Dermatology and Allergology, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
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Ishak R, Kurban M, Kibbi AG, Abbas O. Cutaneous sarcoidosis: clinicopathologic study of 76 patients from Lebanon. Int J Dermatol 2014; 54:33-41. [PMID: 25265873 DOI: 10.1111/ijd.12248] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sarcoidosis is a multi-system granulomatous disease of unknown etiology. The skin is involved in 25% of cases. Studies on cutaneous sarcoidosis from our region are lacking. OBJECTIVES This study was conducted to describe clinical and histopathologic findings in all patients diagnosed with cutaneous sarcoidosis at the American University of Beirut Medical Center between 1992 and 2010 and to compare findings with those published in the literature. METHODS Clinical charts of patients with cutaneous sarcoidosis were retrospectively reviewed. Extracutaneous lesions were classified by organ involvement. Treatment was documented. Pathology specimens were reviewed. RESULTS Cutaneous sarcoidosis was diagnosed in 76 Lebanese patients, 79% of whom were women. Mean age at diagnosis was 48 years. A total of 29% of patients had systemic disease that was commonly associated with lupus pernio lesions and subcutaneous sarcoidosis. The most common cutaneous lesions were sarcoidal plaques. The histopathologic features in our series did not differ from those described in the literature, except for the documented presence of a grenz zone. Interestingly, 23% of biopsy specimens contained perineural granulomas, raising the possibility of tuberculoid or borderline tuberculoid leprosy. Foreign bodies were detected in 10% of cases (all had systemic involvement), supporting the opinion that sarcoidosis and granulomatous foreign body reaction are not mutually exclusive. CONCLUSIONS The clinical and histopathologic features of cutaneous sarcoidosis patients in the present series are generally comparable with those published in the literature, with minor differences. Clinically, the most commonly seen lesion was plaque. Microscopically, cutaneous sarcoidosis may exhibit a grenz zone and may show perineural inflammation and foreign bodies.
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Affiliation(s)
- Rim Ishak
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
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Noiles K, Beleznay K, Crawford RI, Au S. Sarcoidosis Can Present with Necrotizing Granulomas Histologically: Two Cases of Ulcerated Sarcoidosis and Review of the Literature. J Cutan Med Surg 2013; 17:377-83. [DOI: 10.2310/7750.2013.13035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Sarcoidosis is a systemic inflammatory disorder with cutaneous involvement present in 25% of cases. The presence of naked granulomas histologically is the hallmark of sarcoidosis. The presence of necrotizing granulomas is highly suggestive of other granulomatous conditions and leads the clinician to pursue other diagnoses, such as infectious causes. Objectives: We describe two cases of sarcoidosis in which necrotizing granulomas were present on biopsy. Both patients had ulcerated cutaneous lesions of sarcoidosis. In one case, the presence of these atypical histologic features led to a delay in diagnosis of almost 10 years. We review the various histopathologic findings associated with cutaneous sarcoidosis and discuss a potential connection between ulcerated sarcoidosis and atypical histologic findings. Conclusion: When atypical histopathologic features are present, the differential diagnosis of sarcoidosis should not be excluded.
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Affiliation(s)
- Kristin Noiles
- From the Department sof Dermatology and Skin Science and Pathology and Laboratory Medicine, University of British Columbia, and Division of Dermatology, Department of Medicine, St. Paul's Hospital, Providence Health Care, Vancouver, BC
| | - Katie Beleznay
- From the Department sof Dermatology and Skin Science and Pathology and Laboratory Medicine, University of British Columbia, and Division of Dermatology, Department of Medicine, St. Paul's Hospital, Providence Health Care, Vancouver, BC
| | - Richard I. Crawford
- From the Department sof Dermatology and Skin Science and Pathology and Laboratory Medicine, University of British Columbia, and Division of Dermatology, Department of Medicine, St. Paul's Hospital, Providence Health Care, Vancouver, BC
| | - Sheila Au
- From the Department sof Dermatology and Skin Science and Pathology and Laboratory Medicine, University of British Columbia, and Division of Dermatology, Department of Medicine, St. Paul's Hospital, Providence Health Care, Vancouver, BC
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Kosjerina Z, Zaric B, Vuckovic D, Lalosevic D, Djenadic G, Murer B. The sarcoid granuloma: 'epithelioid' or 'lymphocytic-epithelioid' granuloma? Multidiscip Respir Med 2012; 7:11. [PMID: 22958359 PMCID: PMC3436643 DOI: 10.1186/2049-6958-7-11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 06/20/2012] [Indexed: 11/16/2022] Open
Abstract
Background This study aims to analyze the structure and quantities of cellular elements in sarcoid granulomas. Methods We investigated 34 transbronchial lung biopsy samples obtained from 34 sarcoid patients. The quantity and composition of the cellular elements inside a granuloma were determined by the quantitative stereometry method, employing the numerical density as a stereological method. Results A total of 102 sarcoid granulomas were analyzed. The central part of all granulomas was occupied by epithelioid cells. Besides these, giant cells, lymphocytes, macrophages and plasma cells were also seen. The mean numerical density of all the cells in the central part of a sarcoid granuloma was 111,751 mm-3. Lymphocytes prevailed in number, exceeding the total count of all other cells. With a mean numerical density of 74,321 mm-3, lymphocytes were twice as numerous as both epithelioid cells and macrophages with a mean numerical density of 37,193 mm-3. Conclusions Lymphocytes are the predominant cell type in the central part of a sarcoid granuloma, significantly exceeding both epithelioid cells and macrophages in number, raising the question if the term “epithelioid granuloma”, routinely used to designate sarcoid granulomas, is correct, or if it would be more logical to call them “lymphocytic-epithelioid granulomas” instead. Trial registration This study was supported by the Serbian Ministry of Science and Environmental Protection Grant Number 175006/2011.
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Affiliation(s)
- Zdravko Kosjerina
- Pathology Department, Institute for Lung Diseases of Vojvodina, 21234, Sremska Kamenica, Serbia.
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Tchernev G, Ananiev J, Cardoso JC, Wollina U, Verma SB, Patterson JW, Dourmishev LA, Tronnier M, Okamoto H, Mizuno K, Kanazawa N, Gulubova M, Manolova I, Salaro C. Sarcoidosis and molecular mimicry--important etiopathogenetic aspects: current state and future directions. Wien Klin Wochenschr 2012; 124:227-38. [PMID: 22527817 DOI: 10.1007/s00508-012-0154-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 01/21/2012] [Indexed: 01/19/2023]
Abstract
Sarcoidosis is a disease of uncertainty in terms of its cause, presentation, and clinical course. The disease has a worldwide distribution and affects all ages, races, and both sex. Sarcoidosis of the skin may have an extremely heterogeneous clinical presentation, so that the definitions of 'great imitator' and 'clinical chameleon' have long been used. The factors that influence clinical picture and severity of the disease are probably linked to the etiopathogenesis of sarcoidosis, which continues to be shrouded in mystery. The current state of the art on the pathogenesis of sarcoidosis is that it is an immunological response in a genetically susceptible individual to an as-yet undefined antigenic stimulus. How exposure occurs in genetically predisposed patients is not completely clear, but the most likely explanation is that these agents or antigens are either inhaled into the lungs or enter through contact with the skin, as these are the common target organs that are constantly in contact with the environment. An autoimmune etiology of sarcoidosis could possibly occur through a process of molecular mimicry of infectious or other environmental antigens to host antigens. This could lead to a cross-mediated immune response and induction of autoimmune disease. This molecular mimicry may probably be responsible for the heterogeneous clinical presentations of the disease. Several investigations and studies have provided valuable evidence on the etiopathogenesis of sarcoidosis, which may lead to the future development of targeted and innovative treatment strategies. Nevertheless, we are still a long way from unravelling the underlying cause of this mysterious disease.
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Affiliation(s)
- Georgi Tchernev
- Policlinic for Dermatology and Venereology, University Hospital Lozenetz, Academic Educational Hospital of The Saint Kliment Ohridski University, Koziak street 1, 1407, Sofia, Bulgaria.
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Wu MC, Lee JYY. Cutaneous sarcoidosis in southern Taiwan: clinicopathologic study of a series with high proportions of lesions confined to the face and angiolupoid variant. J Eur Acad Dermatol Venereol 2012; 27:499-505. [PMID: 22340140 DOI: 10.1111/j.1468-3083.2012.04473.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Sarcoidosis is a multisystem granulomatous disorder of unknown aetiology. Our clinical experience suggests that facial involvement and the angiolupoid variant appear more common in our patients compared with series reported from the western countries. OBJECTIVE To characterize the clinicopathologic features of cutaneous sarcoidosis diagnosed in our department and to compare our data with those in the literature. METHODS We conducted a clinicopathologic review of biopsy-proved cases of cutaneous sarcoidosis diagnosed during January 2002-December 2010. RESULTS Our study consisted of 37 patients, ages 26-84 years (mean 54.3 years), of whom 84% were females. Systemic involvement was detected in 73%, affecting the lung in 57%, lymph nodes in 65% and eyes in 43%. Most skin lesions were the papulonodular type (70%) and confined to the face (54%). The angiolupoid variant, while rare in Europe and America, was the most common variant (38%) in our series and often associated with eye involvement. The histology was characterized by infiltration of naked sarcoidal granulomas, mostly (86%) mixed with variable amounts of tuberculoid granulomas in the dermis and/or the subcutis. Other findings included fibrinoid necrosis (23%), foreign bodies (16%), osteoclast-like cells (14%) and granuloma annulare-like and necrobiosis lipoidica-like features. CONCLUSION The present series of cutaneous sarcoidosis was characterized by a marked female predominance and by high proportions of facial involvement and the angiolupoid variant. Angiolupoid sarcoidosis was often associated with eye involvement. A complete dermatologic examination and biopsy of suspicious skin lesions should be routinely performed to facilitate early diagnosis of sarcoidosis.
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Affiliation(s)
- M C Wu
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Abstract
The histological discrimination of granulomatous cutaneous T-cell lymphomas (CTCLs) from reactive granulomatous disorders such as sarcoidosis and granuloma annulare (GA) may be difficult due to overlapping histological features. We analyzed the T-cell receptor gene rearrangement in sarcoidosis and GA to investigate the value of the detection of clonal T cells as an adjunctive diagnostic marker in the differentiation between sarcoidosis and GA versus granulomatous CTCLs. Rearrangement of T-cell receptor γ genes was examined by the use of automated high-resolution polymerase chain reaction fragment analysis in 35 cases of sarcoidosis and 15 cases of GA and compared with a series of 19 cases of granulomatous CTCLs. A monoclonal T-cell population was found in none of the cases of sarcoidosis and in 2 of 15 cases of GA (13%). In granulomatous CTCLs, a neoplastic T-cell clone was detected in 94%. Presence of clonal T cells argues in favour of a granulomatous CTCL, while a polyclonal T-cell population makes the presence of a sarcoidosis or a GA more likely. The analysis of T-cell clonality is a useful diagnostic adjunct in the differentiation between sarcoidosis and GA from granulomatous CTCLs.
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Aliağaoğlu C, Güvenç SC, Yanik ME, Kavak A, Yildirim U. 'Sausage finger' without bone involvement. Clin Exp Dermatol 2010; 35:677-8. [PMID: 20642800 DOI: 10.1111/j.1365-2230.2010.03780.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C Aliağaoğlu
- Departments of Dermatology, Faculty of Medicine, Düzce University, Düzce, Turkey
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