Clinico-pathological spectrum of cutaneous sarcoidosis: an experience from a government institute in North India

Abstract

Background and aims. Sarcoidosis is a multisystem granulomatous disease of unknown etiology and cutaneous involvement is the second most frequent manifestation in systemic sarcoidosis.
 The aim of the present study is to evaluate the clinical and pathological spectrum of cutaneous sarcoidosis and compare the same with literature available.
 Methods. The present retrospective study was conducted from January 2010–March 2015 and fifteen cases diagnosed as cutaneous sarcoidosis on biopsy were reviewed. The histological spectrum of cutaneous sarcoidosis was evaluated.
 Results. The mean age at diagnosis was 46 years. Nine (60%) cases out of 15 were females. Most common cutaneous lesions were nodules (46.6%) followed by papules (40%). Classically, lymphocyte-poor, non-caseating epithelioid cell granulomas, was the most common histologic finding. Inclusion bodies were seen in 20% cases with occasional presence of fibrinoid necrosis (13.3%). Peri-adnexal granuloma, seen in one case, raised the possibility of tuberculoid leprosy. Foreign body was seen in one case supporting the opinion that sarcoidosis and granulomatous foreign body reaction are not mutually exclusive. Epidermal changes including atrophy, loss of rete pegs, acanthosis, papillomatosis, hyperkeratosis, parakeratosis and basal cell vacuolation were seen in 46.6% cases. Reticulin was positive in all the cases while special stains for acid fast bacilli and fungi were negative.
 Conclusion. The clinical presentation of cutaneous sarcoidosis may be variable. Presence of naked, reticulin-rich granulomas is the most characteristic histopathological finding. Correlation of clinical history with histologic examination is essential to exclude other granulomatous diseases including leprosy, syphilis, other infectious granulomatous diseases and foreign body reaction.

Permanent Makeup Procedure Heralds the Development of Systemic Sarcoidosis

“…Moreover, epidermal changes such as atrophy and thinning are frequent features seen in 50% of cases [ 15 ]. Common imitators such as tuberculosis, leprosy, and fungal agents are generally ruled out by applying special stains, such as AFB, PAS, and reticulin [ 1 ].…”

“…Thus, it should be considered in the differential diagnoses while evaluating a patient with an enlarging or aggravated pre-existing scar [ 17 ]. A case study by Singh et al revealed that a foreign body at the site of a tattoo initiated the granuloma formation, which led to the development of a sarcoid lesion [ 1 ]. Moreover, several studies have shown that sarcoidosis-specific lesions commonly arise in pre-existing scars, tattoos, and surgical sites due to long-standing trauma [ 6 ].…”

“…Sarcoidosis, also known as a great dermatologic masquerader, is an idiopathic and systemic granulomatous disease that has a wide range of clinical manifestations [ 1 ]. The disease affects patients regardless of their race, sex, or age.…”

“…However, it is more prevalent in females aged 30 to 50 years, and it is more commonly found in patients of African descent [ 2 ]. Sarcoidosis predominantly targets the pulmonary system, yet one-fourth of all cases exhibit cutaneous manifestations, that can occur following an established systemic disease [ 1 ]. Given its manifold clinical presentations, adequate histologic diagnosis is crucial in establishing the proper diagnosis and initiating treatment of sarcoidosis.…”

Basal cell carcinoma associated with non-neoplastic cutaneous conditions: a comprehensive review

“…It is characterized by the formation of granulomas and most commonly occurs in the lungs, lymph nodes, and skin. Less often, other organs are affected such as the brain, eyes, heart, and liver [112][113][114]. Malignancy-associated sarcoidosis can be related to either the cancer or the treatment for the neoplasm [73,74,115].…”