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E1092. Neck Mass: Rare Case of Extra-Thoracic Sarcoidosis and Imaging Review
Authors
  1. Saad Farooq; KPC Health
  2. Drew McKinney; St. George's University
  3. Rahul Nayyar; Victor Valley Global Medical Center
  4. Krishna Das; Victor Valley Global Medical Center
Background
Sarcoidosis is a multi-organ granulomatous disease of unclear etiology that varies in age of patient presentation, population, and clinical manifestation. These variations present difficulties with diagnosis, treatment, and monitoring. Systemically spread non-caseating granulomas are the hallmark feature of sarcoidosis. The vast majority of cases present with thoracic involvement and only 10-15% of patients develop head and neck manifestations [1]. Although radiological evaluation is often strongly suggestive, the definitive diagnosis is ultimately made via histopathological examination. In this report, we show a rare case of biopsy-confirmed sarcoidosis limited to the cervical lymph nodes.

Educational Goals / Teaching Points
In this exhibit, we present a rare case of a patient diagnosed with cervical sarcoidosis, confirmed by lymph node biopsy. The intent of this exhibit is to describe a rare manifestation of the disease and its associated imaging and histopathological features. A brief imaging overview of sarcoidosis will also be discussed.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The patient in this report is a 54-year-old female presenting with palpable neck mass. Patient is otherwise healthy with no significant past medical history. Soft tissue ultrasound of the neck revealed a complex appearing enlarged cervical lymph node. Image-guided biopsy and histopathologic examination revealed non-caseating granulomas. The radiologic, pathologic and clinical information ultimately led to a diagnosis of extra-thoracic sarcoidosis.

Conclusion
Sarcoidosis, when found in the head and neck, usually presents with solitary neck masses, nasal lesions and/or cervical lymphadenopathy. In more than 90% of cases there is thoracic involvement with notable hilar or paratracheal lymphadenopathy. Disease involvement of lung parenchyma can vary and helps with determining prognosis. It should be noted that the result of a single lymph-node biopsy is not enough to diagnose a patient with Sarcoidosis, as an appropriate clinical presentation with a compatible imaging profile is necessary to make a definitive diagnosis of this systemic disease. In such rare cases such as this, biopsy is a crucial part of definitive diagnosis and necessary for further medical management.