Presentation
Weight loss., night sweating. Clinical exam revealed left axillary lymph nodes. Abdominal US revealed splenomegaly and abdominal lymphadenopathy. Suspected lymphoma.
Patient Data
Multiple pathologically enlarged lymph nodes were seen at:
- Cervical lymph nodes: Enlarged lower and to less extent upper deep cervical lymph nodes as well as supraclavicular lymph nodes.
- Mediastinal and axillary: enlarged superior mediastinal, prevascular, aorto-pulmonary, retrocaval, paratracheal, subcarinal, and bilateral hilar regions. Bilateral enlarged axillary lymph nodes more on the left.
- Abdominal: Enlarged celiac, porta-hepatis, portocaval, mesenteric, para-aortic, aorto-caval and iliac lymph nodes.
Enlarged liver with no focal lesions.
Marked splenomegaly with multiple small confluent hypodense focal lesions.
Lung window showed: Bilateral pulmonary diffuse nodular densities peri bronchovascular and subpleural in distribution with beaded fissures.Bilateral scattered subpleural ground glass patches
The patient had an excision biopsy of the left axillary lymph nodes which revealed sarcoidosis.
Case Discussion
In this case, it would be hard to differentiate between sarcoidosis and lymphoma. The extensive widespread enlarged lymph nodes and the splenomegaly with focal lesions were suggestive of lymphoma. However, the distribution of the enlarged mediastinal lymph nodes, mainly the right paratracheal and bilateral hilar nodes, as well as the pulmonary changes mainly the perilymphatic nodular thickening seen at the central interstitium along the bronchovascular bundles with centrilobular nodules and the peripheral interstitium mainly at the subpleural lung were all suggestive of sarcoidosis. Also, the small multiple innumerable hypodense focal lesions in the spleen were suggestive of granulomatous infiltrates rather than lymphomatous infiltrates.
The patient had an excision biopsy of the left axillary lymph nodes which revealed sarcoidosis.