Necrotizing sarcoid granulomatosis mimicking an intracranial neoplasm: Clinicopathologic features and review of the literature

We present a unique case of biopsy-proven necrotizing sarcoidosis involving the central nervous system (CNS) in a 52-year-old woman. The patient prese nted with a 3-month history of left-sided headache and sharp, shooting pain s on the left side of her face. She also has a previous history of sarcoido sis, histopathologically confirmed on parotid gland biopsy 24 years before. Imaging studies of the present lesion revealed a 1.8 x 1.4-cm mass in the left temporal lobe with signal Intensity suggestive of meningioma or low-gr ade glial neoplasm. Surgical resection was initiated, and intraoperative co nsultation with frozen sections revealed granulomata. The lesion was biopsi ed, and surgical intervention was terminated. Permanent sections failed to reveal bacteria, mycobacteria, fungi, or foreign bodies. A diagnosis of nec rotizing neurosarcoidosis was rendered. The patient was administered steroi d therapy and clinically responded favorably. At the most recent follow-up almost 2 years later, there was no evidence of recurrence or progression. N ecrotizing sarcoidosis has been reported most commonly In the lungs and rar ely In other organ systems. We report the first histologically proven case involving the CNS as well as a rare example of sarcoidosis and necrotizing sarcoid granulomatosis in the same patient. Sarcoidosis and Its necrotizing variant should be considered in the differential diagnosis of a granulomat ous mass lesion involving the CNS, particularly in the context of a history of systemic disease.