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case_images: (A) Computed tomography (CT) scan of abdomen and pelvis with intravenous contrast enlarged precaval lymph node measuring 7.2 x 4.2 cm. (B) CT of abdomen and pelvis with intravenous contrast revealing diffuse nodular hepatomegaly and splenomegaly.
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case_images: There was, however, no visible pancreatic lesions, biliary duct dilatation, or gallbladder stones (Figure 1).
case_images: Hepatic sarcoidosis and nonalcoholic steatohepatitis. (A) Microscopic examination of hematoxylin and eosin (H&E, 100x) showing expanded portal areas containing occasional non-necrotizing granulomas, with a few demonstrating central necrosis. Mild macrovesicular steatosis and mild chronic inflammation were also noted. (B) A trichome special stain reveals increased portal fibrosis.
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case_images: Mild macrovascular steatosis and chronic inflammation is noted (Figure 2).
case_images: Whole body positron emission tomography-computed tomography (PET/CT) scan showing extensive hepatic uptake, hypermetabolic lymphadenopathy, and fluorodeoxyglucose (FDG)-avid osseous lesions in the lumbar spine.
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case_images: There was a concern of metastatic bone disease given the widespread distribution of the lesions (Figure 3).
case_images: T12 vertebra bone biopsy. Microscopic examination of hematoxylin and eosin-stained (H&E, 100x) bone biopsy reveals benign trabecular bone with the marrow space replaced by numerous non-necrotizing granulomas and fibrosis. No hematopoietic precursors are identified.
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case_images: The patient underwent a bone biopsy of the T12 vertebra, which revealed benign trabecular bone with replacement of the marrow space with numerous non-necrotizing granulomas and fibrosis consistent with diagnosis of vertebral sarcoidosis (Figure 4).