Clinical Features, Histopathology and Differential Diagnosis of Sarcoidosis

Sarcoidosis is a chameleon disease of unknown etiology, characterized by the growth of non-necrotizing and non-caseating granulomas and manifesting with clinical pictures that vary on the basis of the organs that are mainly affected. Lungs and intrathoracic lymph nodes are the sites that are most often involved, but virtually no organ is spared from this disease. Histopathology is distinctive but not pathognomonic, since the findings can be found also in other granulomatous disorders. The knowledge of these findings is important because it could be helpful to differentiate sarcoidosis from the other granulomatous-related diseases. This review aims at illustrating the main clinical and histopathological findings that could help clinicians in their routine clinical practice.

Hypercalcemia- A Common Abnormality With Uncommon Etiologies

Introduction: Hypercalcemia is a relatively common electrolyte abnormality which is generally associated with Parathyroid related disorders or Cancers. Rare aetiologies comprise of granulomatous disorders and haematological malignancies namely Sarcoidosis and Lymphoma. Parathyroid hormone related Peptide (PTH-rp) and Calcitriol are implicated in causing Hypercalcemia in mentioned aetiologies. Case Details: A 57 year gentleman was admitted following a 10 day history of feeling unwell, unsteadiness in gait, constipation and mild shortness of breath (SOB) on walking uphill. His medical history comprised of Type 1 Diabetes Mellitus (DM) and Hypertension (HTN). Regular medications did not comprise of any drugs that could lead to Hypercalcemia. Biochemic he was Hypercalcemic at 3.14 (2.20–2.60). Parathyroid Hormone levels (PTH) was 0.6 (1.1–4.7 pmol/l) which excluded Parathyroid driven aetiologies. ACE levels were normal and Myeloma screen was negative. 25-OH Vitamin D levels were within Normal limits. Management: Hypercalcemia was managed with Intravenous Fluids and optimum hydration which improved his Calcium levels, followed by subsequent normalisation. Given his suppressed PTH levels, he underwent whole body imaging to assess for evidence of underlying occult malignancy. The CT imaging of his chest, abdomen and pelvis revealed widespread Lymphadenopathy and hypodense lesions in the Spleen. The report stated likely Sarcoidosis accompanied by Splenic involvement, with the main differentials being Sarcoidois versus Lymphoproliferative disorder. This was discussed with the respiratory team and Steroids were not commenced taking into account the improvement in his Calcium levels following adequate hydration and fluids. The patient has been kept under close follow up with ongoing monitoring of his clinical status. Summary: Hypercalcemia has been described in patients with Granulomatous disorders and Haematological malignancies. The incidence of hypercalcemia in Sarcoidosis is estimated to be approximately 10%, with no association with a specific demographic. Granulomatous disorders and Haematological malignancies constitute the rare aetiologies of hypercalcemia and are characterised by a low-normal or suppressed PTH level. Diagnosis of Sarcoidosis is often challenging with the lack of gold standard tests. Serum ACE levels can be within normal limits in people with Sarcoidosis despite not being on Steroid therapy. Evaluation of serum PTH-rp and Calcitriol can aid in diagnosis and more importantly assisting in prognostication, thus guiding further management.

A Comprehensive Review of Infectious Granulomatous Diseases of the Gastrointestinal Tract

A granuloma is defined as a localized inflammatory reaction or a hypersensitive response to a nondegradable product leading to an organized collection of epithelioid histiocytes. Etiologies of granulomatous disorders can be divided into two broad categories: infectious and noninfectious (autoimmune conditions, toxins, etc.) causes. The endless list of causalities may prove challenging for gastroenterologists and pathologists to formulate a list of clearly defined differentials. This is true when distinguishing these etiologies based on various clinical presentations and endoscopic and histological findings. We aim to provide a comprehensive review of some of the frequent and rare infectious granulomatous diseases of the gastrointestinal tract documented in the literature to date. We provide an overview of each infectious pathology with an emphasis on epidemiology, clinical presentation, and endoscopic and histologic findings, in addition to treatment.

Frequency of Various Dermatoses Requiring Histopathological Evaluation For Definite Diagnosis; A Retrospective Analysis

Objective: To assess the frequency of various dermatological disorders those require histopathological analysis for definite diagnosis. Methods: We included 669 patients of either gender and all ages in this retrospective study, carried out in the Department of Dermatology, Jinnah Hospital, Lahore for a duration of 2 years. Their clinical data and histopathological reports were analyzed. The dermatoses were categorized into (a) papulosquamous disorders, (b) bullous disorders, (c) eczemas, (d) neoplasia, (e) granulomatous disorders, (f) connective tissue diseases, (g) drug reactions, (h) vasculitides, (i) chronic ulcers and (j) miscellaneous disorders. Results: The frequency of various dermatoses noted were as follows: papulosquamous disorders 28.25%, bullous disorders 11.5%, granulomatous disorders 11.5%, connective tissue diseases 10.61%, miscellaneous disorders 10%, eczemas 9.4%, chronic ulcers 7.17 neoplasia 6.8%, vasculitides 2.84% and drug reactions were 1.79% of total biopsies. Conclusion: The frequency of different diagnostic groups was unique in some respects and confirmed to other studies in others. The significantly high frequency of papulosquamous disorders highlighted the importance of these disorders. Key words: Skin biopsy, papulosquamous disorders, bullous disorders, eczemas, neoplasia, granulomatous disorders, connective tissue diseases, drug reactions, vasculitides, chronic ulcers.