Multifocal extrathoracic lymphadenopathy mimicking lymphoma: an atypical presentation of sarcoidosis without thoracic involvement

Sarcoidosis is a systemic granulomatous disease of unknown etiology, typically affecting the lungs and bilateral hilar or mediastinal lymph nodes. We present a rare case of sarcoidosis in a 42-year-old woman with extensive lymphadenopathy involving cervical, axillary, retrocrural, peritoneal, retroperitoneal, and iliac regions, without pulmonary or mediastinal involvement, thereby radiologically simulating lymphoma. Histopathological evaluation revealed noncaseating granulomatous inflammation without evidence of malignancy or infection. This case highlights the diagnostic challenge posed by extrapulmonary sarcoidosis and underscores the critical role of biopsy in differentiating it from lymphoproliferative disorders. A high index of suspicion is essential when sarcoidosis presents without its classic thoracic features.