The histologic spectrum of cutaneous sarcoidosis: a study of twenty-eight cases

Authors

  • Nigel J. Ball,

    Corresponding author
    1. Departments of Pathology and Medicine (Dermatology), The University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, and
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  • Grace T. Kho,

    1. Department of Laboratory Medicine, Royal Jubilee Hospital, Victoria, British Columbia, Canada
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  • Magdalena Martinka

    1. Departments of Pathology and Medicine (Dermatology), The University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, and
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Nigel J. Ball, MB, BS, FRCPC, Dermatopathology, Department of Pathology and Laboratory Medicine, Vancouver General Hospital, JPN Room 1404, 855 West 12th Avenue, Vancouver, Canada BC V5Z 1M9
Tel: +1 604 875 5555x68328
Fax: +1 604 875 4797
e-mail: nball@vanhosp.bc.ca

Abstract

Background:  Naked sarcoidal granulomas (NSGs) are the characteristic histologic finding in sarcoidosis. This descriptive study was designed to identify the frequency of other histologic changes in cutaneous sarcoidosis.

Methods:  The slides from 28 sequential biopsies previously diagnosed as sarcoidosis in patients with known systemic sarcoidosis were reviewed.

Results:  Classic NSGs were identified in 25 biopsies (89%). Four biopsies contained tuberculoid granulomas, two with neutrophils suggesting infection (cultures negative). Five biopsies contained interstitial granulomas that resembled granuloma annulare and necrobiosis lipoidica in one case each. Additional histologic findings included birefringent foreign material in 14 biopsies (50%), focal necrosis (43%), elastophagocytosis (39%), linear peri-neural granulomas resembling leprosy (25%), increased dermal mucin (18%) and lichenoid inflammation (14%) [two with plasma cells resembling syphilis (7%)]. In all but three cases, the clinical morphology of the lesions suggested sarcoidosis. Special stains for mycobacteria and fungi were negative.

Conclusions:  The histologic changes in cutaneous sarcoidosis are more diverse than previously recognized. In sarcoidosis, foreign material may be a frequent nidus for cutaneous granuloma formation. Histologic examination without the clinical history could lead to a misdiagnosis of leprosy, syphilis, other infectious granulomas, rosacea, granuloma annulare, necrobiosis lipoidica, and foreign body reaction in selected cases from this series.

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