Isolated Cervical Lymph Node Sarcoidosis Presenting in an Asymptomatic Neck Mass: A Case Report

Abstract

Sarcoidosis, a systemic granulomatous disease of unknown etiology. The presentation of sarcoidal granuloma in neck nodes without typical manifestations of systemic sarcoidosis is difficult to diagnose. We describe the case of a 37-year-old woman with an increasing mass on the right side of neck. The excisional biopsy from the neck mass showed noncaseating epithelioid cell granuloma of the lymph nodes. No evidence of mycobacterial or fungal infection was noted. Thoracic evaluations did not show enlargement of mediastinal lymph nodes or parenchymal abnormalities. Immunohistochemistry showed abundant expression of tumor necrosis factor-α in the granuloma. However, transforming growth factor-β was not expressed, although interleukin-1β was focally expressed. These immunohistochemical findings supported characterization of the granuloma and the diagnosis of sarcoidosis. Sarcoidosis can present with cervical lymph node enlargement without mediastinal or lung abnormality. Immunohistochemistry may support the diagnosis of sarcoidosis and characterization of granuloma.

Misleading appearance in cervical lymph node US diagnosis – a report on sarcoidosis, Warthin tumor and squamous cell carcinoma metastases

“…A recent study [9] found that the heterogeneous echotexture and the presence of coagulation necrosis are fairly specific for tuberculosis, when compared with sarcoidosis, on endobronchial US. However, a definite diagnosis of sarcoidosis implies clinical examination, radiologic, laboratory and histologic findings and when cervical lymph nodes are the only site involved, followup is needed [10,11].…”

Rare Presentations of Sarcoidosis: A Case Series

“…Histology is characterized by non-caseating epithelioid cell granulomas in the affected organs. Tumor necrosis factor α (TNF-α) is believed to play an essential role in the proliferation of macrophages and T lymphocytes and granuloma formation [ 5 ]. The diagnosis is established based on compatible clinical and radiologic findings supported by histology.…”

“…The typical clinical manifestations include systemic symptoms like fever, body pains, night sweats, weight loss, erythema nodosum, bilateral hilar lymphadenopathy, pulmonary infiltration, and cutaneous and ocular lesions. However, fifty percent of the patients may remain asymptomatic and picked up incidentally by chest radiograph [ 5 ]. Our first patient had systemic symptoms with a unilateral right hilar lymph node.…”

Kikuchi-Fujimoto Disease in a 25-Year-Old Female: A Case Report

“…Lymphadenopathy is one of the extrapulmonary manifestations of sarcoidosis which usually presents as hilar and\or paratracheal mediastinal lymphadenopathy and intra-abdominal lymphadenopathy. Cervical lymphadenopathy is not a common presentation of extrapulmonary sarcoidosis; however, a case of an isolated cervical lymph node sarcoidosis presenting with a neck mass has been reported in the literature [ 3 ]. The chest X-ray of this patient did not show mediastinal lymphadenopathy or reticular opacities as would be seen in pulmonary sarcoidosis.…”