Sarcoidosis diagnosed on transbronchial fine needle aspiration smears: a case report with new information on asteroid bodies.

BACKGROUND: Sarcoidosis is a multisystem granulomatous disorder of unknown etiology. The fine needle aspiration cytologic features are noncaseating granulomas, lymphocytes and multinucleated giant cells (MGCs) with or without asteroid bodies. A 41-year-old man, an ex-smoker, presented to the Pulmonary Division of Mubarak Al-Kabeer Hospital, Safat, Kuwait, with chief complaints of dyspnea, wheezing and persistent cough of 6 weeks' duration. The imaging findings revealed air-space disease involving the right and left lowe lobes and widened mediastinum with bilateral hilar and subcarinal lymphadenopathy. Such possibilities as tuberculosis, sarcoidosis and lymphoma were considered based on clinical and imaging findings. The patient underwent transbronchial needle aspiration of the enlarged paratracheal and subcarinal lymph nodes and transbronchial biopsy. Smears from the subcarinal lymph node and paraffin sections of the transbronchial biopsy revealed noncaseating epithelioid granulomas. Smears from the lymph node in addition showed asteroid bodies in epithelioid histiocytes and MGCs. Both the cytologic and histopathologic diagnoses were sarcoidosis This case report highlights the presence of asteroid bodies in epithelioid histiocytes for the first time in a case of sarcoidosis.