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Clinical Problem Solving: Pathology
June 2009

Pathology Quiz Case 2: Diagnosis

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2009;135(6):619-620. doi:10.1001/archoto.2009.42-b

Sarcoidosis is a granulomatous disorder that affects multiple organ systems and whose cause is still uncertain. It typically presents in the second to fourth decades of life, with women more frequently affected than men.1The diagnosis is made according to clinical features and pathologic findings. The clinical characteristics of sarcoidosis include bilateral hilar lymphadenopathy on chest radiography, erythema nodosum, uveitis, and maculopapular skin lesions. Multiple organs may be involved, with the most common organ being the lung in 95% of cases.2The parotid gland was found to be solely involved in 4% to 6% of cases.2,3It has also been reported that up to 30% of patients with systemic sarcoidosis may have parotid involvement1; however, large variations were noted in a recent study of 26 patients, only 5% of whom had parotid involvement.4Neurologic symptoms may be the sole presenting complaint in 5% of patients with sarcoidosis of any organ system, with facial nerve weakness being the most common neurologic deficit, independent of parotid involvement.1,5Of note, uveoparotid fever, or Heerfordt syndrome, is a specific entity in which parotid sarcoidosis occurs in association with uveitis. The classic pathologic finding is the presence of multiple noncaseating granulomas, which are occasionally confluent in lymph nodes.