Tuberc Respir Dis.  2013 Sep;75(3):116-119.

Isolated Cervical Lymph Node Sarcoidosis Presenting in an Asymptomatic Neck Mass: A Case Report

• Kwon YS
• Jung HI
• Kim HJ
• Lee JW
• Choi WI
• Kim JY
• Rho BH
• Lee HW
• Kwon KY

Abstract

Sarcoidosis, a systemic granulomatous disease of unknown etiology. The presentation of sarcoidal granuloma in neck nodes without typical manifestations of systemic sarcoidosis is difficult to diagnose. We describe the case of a 37-year-old woman with an increasing mass on the right side of neck. The excisional biopsy from the neck mass showed noncaseating epithelioid cell granuloma of the lymph nodes. No evidence of mycobacterial or fungal infection was noted. Thoracic evaluations did not show enlargement of mediastinal lymph nodes or parenchymal abnormalities. Immunohistochemistry showed abundant expression of tumor necrosis factor-alpha in the granuloma. However, transforming growth factor-beta was not expressed, although interleukin-1beta was focally expressed. These immunohistochemical findings supported characterization of the granuloma and the diagnosis of sarcoidosis. Sarcoidosis can present with cervical lymph node enlargement without mediastinal or lung abnormality. Immunohistochemistry may support the diagnosis of sarcoidosis and characterization of granuloma.

Keyword

Sarcoidosis; Lymphatic Diseases; Neck; Immunohistochemistry

MeSH Terms

Adult
Biopsy
Epithelioid Cells
Female
Granuloma
Humans
Immunohistochemistry
Interleukin-1beta
Lung
Lymph Nodes
Lymphatic Diseases
Neck
Sarcoidosis
Tumor Necrosis Factor-alpha
Interleukin-1beta
Tumor Necrosis Factor-alpha

Figure

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  Figure 1 Sagittal (A) and axial (B) images of enhanced neck computed tomography (CT). (A) Sagittal images of enhanced neck CT show multiple enlarged lymph nodes at levels II, III, IV, and V. (B) Axial images of enhanced neck CT show multiple enlarged lymph nodes at levels II, III, IV, and V. The short diameter of the largest lymph node is approximately 3 cm (arrow).

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  Figure 2 Microscopic findings of the case. (A) An epithelioid granulomatous lesion with central necrosis and multinucleated giant cells is present (H&E stain, ×100). (B) High magnification of (A) shows hyalinized necrosis and surrounding epithelioid cells (H&E stain, ×200).

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  Figure 3 Immunohistochemical stains. (A) Diffuse positive expression of tumor necrosis factor-α in epithelioid cells and multinucleated giant cells. (B) Focal expression of interleukin-1β. (C) No expression of transforming growth factor-β in the granulomatous lesion (A-C, ×200).

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