Presentation
Increasing abdominal pain, polyuria, and bilateral leg pain. Outpatient bloodwork revealed severe hypercalcemia.
Patient Data
Ultrasound of the right hemiscrotum
1. transverse (left) and longitudinal (right) views demonstrate a small mixed cystic and solid intratesticular lesion with internal calcifications and internal vascularity
2. epididymis is enlarged at 1.6 cm and appears hypoechoic with normal internal color doppler flow
3. inguinofemoral lymph node that is abnormally round, enlarged at 1.2 cm, and lacks a normal fatty hilum
Non-contrast CT scan of the chest demonstrates bilateral diffuse pulmonary nodules which are peribroncovascular in distribution. Several nodules are triangular in shape and are adherent to the minor fissure of the right lung. There are also mediastinal lymph nodes and a calcified left hilar lymph node.
Non-contrast CT of the abdomen and pelvis demonstrates hepatosplenomegaly as well as mildly enlarged and abnormally round lymph nodes throughout the retroperitoneum and bilateral iliac chains, with several more enlarged lymph nodes in the inguinofemoral chains.
Histology
Enlarged lymph node with fibrosis and giant cells; no evidence of malignancy
Immunohistochemical/special stain(s) is/are performed. Medical necessity for performing stain(s): To rule out metastatic carcinoma, as well as fungal and tuberculous disease.
The stain(s) is/are evaluated following validation of appropriate control reactivity, with the following result(s):
AE1/AE3 - Negative
GMS-fungus - Negative
AFB - Negative
Case Discussion
The diagnosis of sarcoidosis is commonly based on clinical and radiologic findings and supported by histology 1. In this patient, once the diagnosis of sarcoidosis was confirmed, inguinal node biopsy and negative tumor markers ruled out malignancy.
Case contributors:
- Cecile Swift
- Roger Rozzi, DO
- Kathleen Dumford, MD
- Dave Gabbert, DO