Question

A patient with history of cough, chest pain, and dyspnea has imaging that reveals giant cell granuloma formation and stellate inclusions. What is the likely diagnosis?

• A. Tuberculosis
• B. Sarcoidosis
• C. Lung cancer
• D. Fungal infection

Hint:

Non-caseating granulomas with asteroid bodies or Schaumann bodies = sarcoidosis.

Answer 1

The Correct Option is B

Step 1: Understanding the Question:
The question provides histological clues (non-caseating granulomas with specific inclusions) to differentiate between systemic granulomatous diseases of the lung.
Step 2: Detailed Explanation:

Sarcoidosis: This is a multisystem disease of unknown etiology characterized by non-caseating granulomas.

Histological Inclusions: Sarcoid granulomas often contain two classic inclusions:
1. Asteroid Bodies: These are stellate (star-shaped) inclusions within the cytoplasm of giant cells. They are made of compressed cytoskeletal filaments.
2. Schaumann Bodies: These are laminated, basophilic concretions composed of calcium and protein.

Differential - Tuberculosis: TB is characterized by caseating (necrotic) granulomas and the presence of Acid-Fast Bacilli (AFB). It does not typically feature asteroid bodies.

Imaging: Sarcoidosis classically presents with bilateral hilar lymphadenopathy on chest X-ray.

Biochemistry: Elevated Serum ACE (Angiotensin Converting Enzyme) levels and hypercalcemia are common findings in active sarcoidosis.

Step 3: Final Answer:
The presence of giant cell granulomas with "stellate inclusions" (Asteroid bodies) is a classic histological finding for Sarcoidosis.