PMC6875373_01
Magnetic resonance images in T1-weighted axial view (a), T2-weighted axial view (b), and T2-weighted sagital view (c), identifying a lesion on the dorsal plane of the right wrist, extending to the inner face but without vascular or tendinous invasion, measuring about 100 x 60 x 18 mm in diameter, with well-defined limits.
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An ultrasound, complemented with nuclear magnetic resonance, identified a lesion on the dorsal plane of the right wrist, extending to the inner face, but without vascular or tendinous invasion, measuring about 100 x 60 x 18 mm in diameter and having well-defined limits (Figure 1).
Chest high-resolution computed tomography image showing marked and diffuse alteration of pulmonary parenchyma permeability, thickening of the interlobular septa, and fine bronchovascular and subpleural micronodularity, associated with mediastinal lymphadenopathy.
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Histological analysis: transbronchial biopsy (a, b) revealing granulomatous inflammatory process compatible with lung sarcoidosis; bone marrow biopsy showing hypercellularity with plasmocyte infiltration (c) and kappa light chain restriction (d).
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Bronchial biopsy histological results revealed mild chronic inflammatory infiltrate with multiple nonnecrotizing sarcoid-type epithelioid granulomas and giant multinucleated Langerhans cells (Figures 3(a) and 3(b)). For further evaluation of serum monoclonal IgG kappa gammopathy, a bone marrow aspirate and biopsy were performed, showing a hypercellular bone marrow with 60% plasma cells and plasmocyte infiltration with K light chain restriction, respectively (Figures 3(c) and 3(d)).