Extensive Sarcoid-Like Granulomas in a Patient with a Lymphoproliferative Disorder (Sarcoidosis-Lymphoma Syndrome)

 

Lymphoproliferative disorders which may show a sarcoid-like reaction:

(1) non-Hodgkin's disease

(2) Hodgkin's lymphoma

(3) multiple myeloma

 

A patient with sarcoidosis, lymphoma or both may present with:

(1) FUO

(2) bilateral hilar lymphadenopathy

(3) hepatomegaly

 

The sarcoid-like reaction may be so extensive as to obscure the lymphoproliferative disorder. Any biopsy showing sarcoidosis should be carefully examined for foci of plasma cells, eosinophils or atypical lymphoid cells; these may be very small and easily overlooked. Molecular techniques may be necessary to demonstrate a monoclonal proliferation.

 

The presence of an elevated serum angiotensin converting enzyme activity and/or serum calcium can be seen in both sarcoidosis and in non-Hodgkin's and Hodgkin's lymphoma without evidence of sarcoidosis (Dunphy et al, 2000).