Pathologic evaluation showed nonnecrotizing granulomas (Figure 2). Results from Ziehl-Neelsen stain (for acid-fast organisms) were AZD8931 research buy negative, as were results on cultures and stains of BAL samples. On the basis of the biopsy, evaluation, and clinical presentation, the patient was diagnosed with sarcoidosis. Figure 2 Histopathologic examination of lung biopsy showing non-necrotizing granuloma amidst normal alveoli. The patient Inhibitors,research,lifescience,medical was given inhaled steroids for his pulmonary symptoms and then was initiated on oral prednisone with methotrexate

as a steroid-sparing agent. Follow-up chest radiograph after 6 months of treatment showed nearly complete resolution of the hilar lymphadenopathy. However, his physical examination showed progression of his epididymal masses, and his right testicle was firm. It was recommended that the patient follow up within 2 weeks with a repeat tumor markers evaluation and scrotal ultrasound. Inhibitors,research,lifescience,medical He was again counseled for surgical exploration, but he refused any further intervention. Sarcoidosis Basics Sarcoidosis is a chronic disorder of unknown etiology that is characterized by the development of lesions in Inhibitors,research,lifescience,medical multiple organ systems that histopathologically demonstrate noncaseating granulomas. The condition affects 1 to 6 of

every 1000 people worldwide, whereas the incidence in the United States is approximately 1 in 10,000.1 African Americans are affected at a rate 3- to 20-fold higher than whites, and women are affected approximately 10 times as frequently as men.2,3 Inhibitors,research,lifescience,medical The suspicion

of sarcoidosis usually results from an incidental chest radiograph finding of bilateral hilar lymphadenopathy, which is present in 90% of sarcoidosis patients.4 Although most patients are asymptomatic, the most common presenting symptoms include dyspnea, cough, chest pains, and weight loss. Eighty-four percent of patients present with intrathoracic conditions5; however, an analysis of patients with sarcoidosis predicted Inhibitors,research,lifescience,medical that 30% of patients might actually present with extrapulmonary disease.6 In cases of extrapulmonary disease, clinical presentation usually relates to the organ systems involved, which can include the skin, liver, spleen, eyes, lymph nodes, central nervous system, salivary glands, mucosae, joints, heart, bone marrow, muscles, and kidneys.7 Unless a patient has specific complaints, physical examination findings are generally nonspecific and may include hepatomegaly, and superficial lymphadenopathy, and subcutaneous nodules or reactive erythema nodosum. In the setting of a high clinical suspicion of sarcoidosis and normal results on chest radiograph, gallium-67 scanning may aid in detection by accumulating in areas of inflammation.5 Sarcoidosis remains a diagnosis of exclusion. Before a definitive diagnosis can be made, multiple other conditions that can share similar symptomatology and pathologic findings must be ruled out.