A 45-year-old patient with known sarcoidosis presents with bilateral anterior uveitis, posterior synechiae, and vitreous 'snowball' opacities. Fluorescein angiography shows periphlebitis (candle-wax drippings). Which granuloma-forming pathological process is responsible, and what is the characteristic histopathological finding in sarcoid granulomas?
- A Caseous necrosis-containing granulomas with Langhans giant cells — identical to tuberculosis
- B Non-caseating (naked) granulomas with Langhans-type giant cells containing Schaumann bodies and asteroid bodies ✓
- C Eosinophilic microabscesses surrounded by palisading histiocytes (palisading granulomas)
- D Foreign body-type giant cells without defined granuloma architecture
Correct answer: B. Non-caseating (naked) granulomas with Langhans-type giant cells containing Schaumann bodies and asteroid bodies
Explanation
Sarcoidosis is characterized by non-caseating (naked) granulomas composed of tightly packed epithelioid histiocytes and Langhans-type multinucleated giant cells — WITHOUT central necrosis (distinguishing it from TB). The giant cells in sarcoid granulomas contain inclusion bodies: Schaumann bodies (laminated calcified concretions) and asteroid bodies (stellate eosinophilic inclusions of lipid-protein). Candle-wax drippings (periphlebitis) on FA represent granulomatous infiltrates along retinal vessels. Elevated serum ACE and lysozyme support the diagnosis.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.