CTICasesConcurrent Sarcoidosis and Small Lymphocytic Lymphoma (CLL)
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Imaging findings
A 40-year-old man presented with massive, partially calcified, bilateral hilar and mediastinal lymphadenopathy, exhibiting a lumpy-bumpy appearance. A partially calcified pseudoaneurysm of the aorta from remote trauma was also noted. EBUS biopsy of a subcarinal node showed non-necrotizing granulomas and a monoclonal cell population. Excisional biopsy confirmed both non-necrotizing granulomas and small lymphocytic lymphoma (CLL). Bone marrow biopsy was positive for CLL. PET showed stable, avid lymphadenopathy, with modest perilymphatic nodularity in the lungs.
Key takeaways
This complex case highlights the challenge of diagnosing and managing concurrent sarcoidosis and lymphoma. The presence of both non-necrotizing granulomas and lymphoma cells on biopsy necessitates careful consideration of sarcoid-like reactions versus true sarcoidosis, and how to manage potentially asymptomatic lymphoma alongside sarcoidosis. The lymphadenopathy had a classic sarcoid-like distribution.
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