Pathology of Pulmonary Sarcoidosis

Non-necrotizing granulomas are the hallmark of sarcoidosis (2,93) (Hg. lOA-D). Histiocytes, epithelioid cells, and multinucleated giant cells comprise the center of the granuloma, surrounded by lymphocytes, plasma cells, and fibroblasts in the 

TBFNA cytology in this context was 79%, and specificity, 92% (107). Complications of transthoracic FNA include pneumothoraces (10-60%) or hemoptysis (5-10%) (106). The optimal approach to diagnosing mediastinal lymph nodes (i.e., TBNA or CT-guided FNA) depends on the expertise and preference of the local institution. 

Surgical lung biopsy is rarely required to diagnose sarcoidosis. However, when the above procedures are not definitive, biopsy of mediastinal lymph nodes and/or lung may be warranted. This can be done with cervical mediastinoscopy, the Chamberlain procedure (a parasternal mini-thoracotomy to biopsy aortopulmonary window or para-aortic nodes), or video-assisted thoracoscopic surgical biopsy (VATS) (28,108). 

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Figure 10 See color insert.) Pathology of pulmonary sarcoidosis. (A, B) Gross appearance of lungs. (A) Primarily dense fibrosis. (B) Primarily honeycomb change in upper lobe. (C) Typical non-necrotizing granulomas in bronchial wall. (D) Pearls on a string arrangement of parenchymal granulomas (C, D, H E stain, x40).

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