A case report-a subcutaneous sarcoidosis mimicking tumour

Sarcoidosis is a multisystem granulomatous disorder of unknown aetiology that affects individuals worldwide and is characterized pathologically by the presence of non-caseating granulomas in involved organs and tissues.1 Jonathan Hutchinson described the first case in 1869.2 It involves skin, lung, lymph nodes, eyes, joints, brain, kidneys, and heart. Skin involvement is the second most following pulmonary sarcoidosis. Nodular Muscle involvement in sarcoidosis was first reported by Licharew in 1908. 25% patients of sarcoidosis presents with cutaneous lesions, it varies in morphologies, including papules, nodules, plaques, and infiltrated scars3 versus subcutaneous sarcoidosis occurs in 1.4 to 6 % patients of systemic sarcoidosis. Subcutaneous sarcoidosis affects women commonly, in their fifth and sixth decades. Lesions could be multiple, bilateral, asymmetrical, asymptomatic hard indurate mobile subcutaneous nodule/nodules located in upper extremities, commonly involves forearm, without any changes in overlying epidermis.4 Nodular muscular sarcoidosis often mimics a tumour .To rule out this confusion MRI and muscle biopsy are useful investigations.5,6 Biopsy and histopathological examination is the gold standard method of diagnosis which shows “naked” granuloma formation which has sparse lymphocytes at margin with epithelioid cells with little or no necrosis. Diagnosis is confirmed after ruling out differentials which cause granulomatous lesion.7 Initial treatment option is steroid. Immunosuppressive agents have been used in corticosteroid resistant form.8 Here, we report the case of asymptomatic nodular sarcoidosis with pulmonary involvement showing bilateral hilar lymphadenopathy and small pulmonary nodules on imaging which was initially thought to be fibro-sarcoma.