J Cutan Med Surg. 2013 Nov-Dec;17(6):377-83. doi: 10.2310/7750.2013.13035.
Sarcoidosis is a systemic inflammatory disorder with cutaneous involvement present in 25% of cases. The presence of naked granulomas histologically is the hallmark of sarcoidosis. The presence of necrotizing granulomas is highly suggestive of other granulomatous conditions and leads the clinician to pursue other diagnoses, such as infectious causes.
We describe two cases of sarcoidosis in which necrotizing granulomas were present on biopsy. Both patients had ulcerated cutaneous lesions of sarcoidosis. In one case, the presence of these atypical histologic features led to a delay in diagnosis of almost 10 years. We review the various histopathologic findings associated with cutaneous sarcoidosis and discuss a potential connection between ulcerated sarcoidosis and atypical histologic findings.
When atypical histopathologic features are present, the differential diagnosis of sarcoidosis should not be excluded.
结节病是一种全身性炎症性疾病，25%的病例有皮肤受累。组织学上存在无覆盖的肉芽肿是结节病的标志。坏死性肉芽肿的存在高度提示其他肉芽肿性疾病，并促使临床医生寻找其他诊断，如感染原因。
我们描述了两例活检中存在坏死性肉芽肿的结节病病例。两名患者均有溃疡性结节病皮肤损伤。在一例中，这些非典型组织学特征的存在导致诊断延迟了近 10 年。我们回顾了与皮肤结节病相关的各种组织病理学发现，并讨论了溃疡性结节病和非典型组织学发现之间的潜在联系。
当存在非典型组织病理学特征时，不应排除结节病的鉴别诊断。
