What is your diagnosis and how would you characterize the designated lesions in Figures 1 & 2? (Black Arrows)
Hematoxylin and eosin stained FFPE tissue section (200x original magnification
Granulomatous myopathy, most consistent with Sarcoidosis (so-called “Sarcoid Myopathy”). The granulomatous inflammation of Sarcoidosis may show a perivascular distribution and may cause vascular compromise (vasculopathy or vasculitis). Of note, Sarcoidosis is a diagnosis of exclusion (i.e. other causes of granulomatous inflammation must be excluded). See references.
References:
Cohen Aubart F, Abbara S, Maisonobe T, et al. Symptomatic muscular sarcoidosis: Lessons from a nationwide multicenter study. Neurol Neuroimmunol Neuroinflamm. 2018 Mar 16;5(3):e452. PMID: 29845092.
Le Roux K, Streichenberger N, Vial C, et al. Granulomatous myositis: a clinical study of thirteen cases. Muscle Nerve. 2007 Feb;35(2):171-7. PMID: 17068767.
Ungprasert P, Ryu JH, Matteson EL. Clinical Manifestations, Diagnosis, and Treatment of Sarcoidosis. Mayo Clin Proc Innov Qual Outcomes. 2019 Aug 2;3(3):358-375. PMID: 31485575.
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