We present a case of fatal sarcoidosis, the cause of death being presumed arrhythmia from cardiac sarcoidosis. The disease involved the lungs, heart, spleen and liver. On examination of the liver, there were five lesions macroscopically, showing a characteristic central stellate scar. 1 Histology revealed bland hepatocytes, fibrous septae and bile ductular reaction, along with fibrosis and giant cells. Immunohistochemistry showed a map-like staining pattern for glutamine synthetase. Sarcoidosis commonly involves the liver, following the lungs and mediastinal lymph nodes in frequency. 2 It can be associated with nodular regenerative hyperplasia of the liver. 3 To our knowledge, focal nodular hyperplasia has not previously been reported in association with sarcoidosis. The pathogenesis of focal nodular hyperplasia has been postulated as involving hypoperfusion or hyperperfusion, and is often associated with haemangiomata. 1 This case demonstrates development of multiple focal nodular hyperplasia in association with sarcoidosis of the liver, not previously described.
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