6
Diagnosis
Table 2. Key Pathological Features of Sarcoidosis
Favors Sarcoidosis Against Sarcoidosis
Granuloma presence
Numerous • Few
Absent but with nodular hyalinized
fibrosis representing healed granulomas
(scattered multinucleated giant cells may
be detectable)
• Absent
Granuloma morphology
Compact, tightly formed collections
of large "epithelioid" histiocytes and
multinucleated giant cells. Granulomas
ten to stay discrete
• Loosely organized collections
of mononuclear phagocytes/
multinucleated giant cells
Nonnecrotic or focal and usually minimal
ischemic necrosis
• Extensive necrosis
• Dirty necrosis (containing nuclear
debris)
• Palisading granulomas
Fibrosis beginning at the granuloma
periphery with extension centrally into the
granuloma, with or without calcification
Lesion location
Perilymphatic; around bronchovascular
bundles and fibrous septa containing
pulmonary veins, and near visceral pleura
• Lack of lymphangitic distribution
• Intra-alveolar granulomas
In necrotizing sarcoid angiitis and
granulomatosis: granulomatous angiitis
with invasion of vascular walls
Accompanying histology
Sparse surrounding lymphocytic infiltrate • Robust surrounding inflammatory
infiltrate (including lymphocytes,
neutrophils, eosinophils, and plasma
cells)
• Secondary lymphoid follicles
Microorganism stains and cultures
Negative • Positive
Multidisciplinary clinical features
Intra- and extrathoracic involvement • Extrathoracic involvement only
