Primary skin sarcoidosis: From the point of pathologist

Introduction. Sarcoidosis is a multisystemic disease of unknown etiology that can affect multiple organs. Diagnostics of granuloma is a common finding in pathologists practice, especially of specific granulomas in special inflamations. The role of pathologist in the differential diagnosis is to identify the presence of granuloma. Diagnosis of sarcoidosis is based on histological findings of the affected tissue, but also in the framework of clinical picture, radiological and laboratory findings. The skin is affected in one third of cases. Case report. A female patient is shown in this report, born in 1975. The disease in this patient is manifested with clinical signs of skin changes in a part of the thorax, as well as on the left upper arm. Preoperative diagnostic procedures have been conducted and they were within the normal limits. Both changes were asymptomatic and were resolved with radical surgery. After final histopathological diagnosis, additional differential diagnostic procedures were conducted such as radiology and laboratory tests, but there has been no outcome which indicate attack or changes on other organs. It turned out to be a primary sarcoidosis of skin, and only in places that are surgically treated. Conclusion. Findings of sarcoid granuloma in the skin requires a detail examination primarily due to the possible existence of sarcoid changes in other tissues, especially lung tissue. It also excludes this is a tuberculous change and requires adequate therapeutic treatment for the diagnosis of sarcoidosis. Only the occurrence of such a change on the skin, without any other manifestation in the organs, can be primary, and is the only clinical manifestation of the disease. Sarcoidosis, the skin disease, in case shown here, was not the manifestation of systemic disease in multiple organs, nor a secondary phenomenon.