Isolated Cervical Lymph Node Sarcoidosis Presenting in an Asymptomatic Neck Mass: A Case Report
A 37-year-old female patient presented with a palpable non-tender mass on the right side of her neck for 1 month. She had no other symptoms such as coughing, sputum production, rhinorrhea, arthralgia, fever, body weight loss, or dyspnea. Physical examination revealed a palpable non-tender mass on the right side of her neck but no splenomegaly or hepatomegaly. She had no uveitis. The erythrocyte sedimentation rate was 11 mm/hr (normal range for female individuals, <25 mm/hr), with a C-reactive protein level of 0.14 mg/dL (normal range, 0-0.5 mg/dL) and a serum angiotensin converting enzyme level of 23.9 U/L (normal range, 9.0-47.0 U/L). Neck computed tomography showed an approximately 50-mm abnormal LN at level V on the right and an approximately 28-mm abnormal LN at level II on the right (). Multiple enlarged LNs were noted at levels II, III, IV, and V on the right. Chest computed tomography showed no abnormal nodular infiltration at either lung, but showed enlarged LNs in the left supraclavicular and left axillar areas.\nFine needle aspiration from the right cervical LN revealed granulomatous inflammation with focal and central necrosis. Acid fast bacilli (AFB) stain was negative, and polymerase chain reaction for mycobacterium was also negative. Excisional biopsy of right neck LN (level V) was performed. A 4×2.5-cm pink ovoid granulomatous mass was observed at the posterolateral side of the sternocleidomastoid muscle. The mass was well encapsulated, with mild adhesion to the surrounding soft tissue. Excisional LN biopsy from the right side of the neck revealed granulomatous inflammation with focal and central necrosis (). AFB stain showed no AFB positive bacilli in the excisional LN. Polymerase chain reaction for mycobacterium tuberculosis and non-tuberculous mycobacterium were again negative in the excisional LN. Clinically, we excluded all other exogenous conditions that may cause granulomatous inflammation in the lung, and sarcoidosis was diagnosed.\nImmunohistochemistry showed diffuse high expression of tumor necrosis factor-α (TNF-α) in epithelioid cells and multinucleated giant cells. Interleukin (IL)-1β was focally expressed in the granuloma. However, transforming growth factor-β (TGF-β) was not expressed in the granulomatous lesion (). We administered 10 mg/day prednisolone. Follow-up chest computed tomography after 3 months showed no interval change from baseline. The patient had no symptoms and no palpable LNs at the 6-month follow-up visit.