PMC4246249_01
PET and CT scan. PET (alternation corrected and non-alternation corrected) and low dose CT images showing a pattern of bilateral hilar and mediastinal uptake in the lymph nodes, characteristic of sarcoid-like reaction, close to a parenchymal abnormality highly suspicious for a lung cancer in the left upper lobe.
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The PET uptake of the mediastinum was quite characteristic for a sarcoid-like reaction (see Fig. 1).
Non-caseating granulomas in one of the mediastinal lymph node. The granulomas are well formed and consist primarily of epitheloid histiocytes with multinucleated giant cells. These granulomas are characteristic of sarcoidosis lymphadenopathy. The pan-cytokeratin staining was negative, excluding a sarcoid-like reaction to tumor cells (not shown).
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Mediastinoscopy was performed to exclude metastatic disease and histology confirmed a noncaseating granulomatous inflammation of the mediastinal lymph nodes without metastases (Fig. 2).