PMC4899809_01
61-year-old male with sarcoidosis. CT of the abdomen with intravenous and oral contrast demonstrated a 4.0 x 3.2-cm, well-circumscribed, lobulated mass in the interpolar region of the left kidney (arrow).
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Staging computed tomography (CT) of the abdomen and pelvis demonstrated a low-attenuation, soft-tissue-density left renal mass (Fig. 1) that was concerning for renal-cell carcinoma or metastatic disease.
61-year-old male with sarcoidosis. The well-circumscribed left renal mass (arrow) is hypointense on T2-weighted images (A). Precontrast VIBE images demonstrate an isointense left renal mass compared to surrounding renal parenchyma (B). Arterial-phase VIBE demonstrated a hypointense mass with small regions of low intensity, suggestive of necrosis (arrow). Based on region-of-interest measurements, this mass demonstrated contrast enhancement (C). Portal venous phase T1 FLASH images showed an enhancing mass with small areas of hypointensity suggestive of necrosis (arrows) (D).
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Magnetic resonance imaging (MRI) of the abdomen showed a well-circumscribed, T2-hypointense left renal mass (Fig. 2A). On the precontrast, T1-weighted, fast low-angle shot (FLASH) and volumetric interpolated breath-hold examination (VIBE) sequences, the renal mass was isointense compared to the renal parenchyma (Fig. 2B). Postcontrast images demonstrated contrast enhancement, with focal areas of decreased intensity representing necrosis, also concerning for malignancy (Fig. 2C-D).
61-year-old male with sarcoidosis. Posteroanterior view of the chest revealed bilateral coarse reticulations with architectural distortion, traction bronchiectasis, and upward retraction of both hila (arrows) associated with calcified mediastinal and hilar nodes (arrowheads). Findings are suggestive of stage IV sarcoidosis.
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The constellation of findings was suggestive of stage 4 sarcoidosis (Figure 3, Figure 4).
61-year-old male with sarcoidosis. A. Unenhanced CT of the thorax with mediastinal window showed calcified mediastinal and bilateral hilar calcified nodes characteristic of prior granulomatous disease. B. Unenhanced CT of the thorax with lung window demonstrated upper-lobe-predominant reticulations, traction bronchiectasis, and upward retraction of both hila, consistent with fibrosis.
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The constellation of findings was suggestive of stage 4 sarcoidosis (Figure 3, Figure 4).
61-year-old male with sarcoidosis. Left renal ultrasound demonstrated an echogenic mass corresponding to the lesion seen on CT and MRI (arrow).
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Left renal ultrasound performed during ultrasound-guided biopsy demonstrated a rounded, echogenic mass in the upper pole (Fig. 5).
61-year-old male with sarcoidosis. Hematoxylin- and Eosin-staine, d paraffin-embedded section (magnification 50X) demonstrated noncaseating granulomata with giant cells surrounded by lymphohistiocytic inflammation (ellipse). A glomerulus with congested capillaries is seen above the central granuloma (arrow). Proximal tubules are also seen at the periphery of the section (arrowhead).
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Pathology revealed noncaseating granulomatous inflammation (Fig. 6).