Atypical sarcoidosis diagnosed using endobronchial ultrasound-guided mediastinal lymph node biopsy with fine biopsy forceps: Two case reports

Figure 1 Macroscopic view of tissue samples obtained via sequential endobronchial ultrasound-guided techniques. A and B: Larger core histological specimens (diameter ≥ 3 mm) from endobronchial ultrasound (EBUS)-transbronchial forceps biopsy (EBUS-transbronchial forceps biopsy; 1.2-mm forceps) via the same puncture tract; C: Cytological aspirate from EBUS-transbronchial needle aspiration (EBUS-transbronchial needle aspiration; 21-G needle).

Figure 2 Hematoxylin and eosin staining of endobronchial ultrasound-guided transbronchial forceps biopsy specimens, (magnification, × 40). A: Shows well-formed non-caseating granulomas with multinucleated giant cells, surrounded by lymphocytic infiltrates. Special stains (acid-fast bacilli, periodic acid-schiff, and Gomori methenamine silver) were negative for infection; B and C from a subcarinal lymph node exhibits compact non-caseating granulomas without necrosis, consistent with sarcoidosis; B: Multinucleated giant cells and surrounding lymphocytes are visible; C: Under hematoxylin and eosin staining, dense non - caseating granulomas in dark purple can be observed. The proportion is 25 µm.

Figure 3 Reveals a hypermetabolic consolidation in the right upper lung lobe with multiple fluorodeoxyglucose-avid enlarged mediastinal and hilar lymph nodes, initially suggestive of primary lung malignancy with lymphangitic carcinomatosis and nodal metastases. A and B: Hypermetabolic consolidation in the right lung; C: Multiple enlarged lymph nodes in the mediastinum and hilar regions.

Figure 4 Pulmonary computed tomography revealed. A and B: An irregular, heterogeneous mass (2.7 cm × 2.0 cm) in the right upper lobe with associated obstructive pneumonia; C and D: Right hilar and paratracheal lymphadenopathy (arrows), pleural effusion, and mediastinal nodal enlargement.

Figure 5 Pulmonary enhanced computed tomography showed. A: Multiple enlarged lymph nodes in the mediastinum, and bilateral hilar regions (some poorly demarcated from the mid-esophagus); B: Bilateral pulmonary nodules; C: Enlarged lymph nodes in the mediastinum; D: Localized right pleural thickening.

Figure 6 Positron emission tomography-computed tomography revealed. A and B: Multiple hypermetabolic lymph node enlargements; C and D: Multiple segmental thickenings of the right pleura with increased metabolic activity.