Pathology: sarcoid spleen

Granulomatous disorders can affect the liver and spleen, and lead to enlargement of either organ.  Sarcoidosis is one such disorder, and in the splenic specimen above, notice the tan colored granulomas (collections of leukocytes, extracellular matrix).  This would be visible on CT and MRI.

Sarcoid in the liver can produce biochemical abnormalities, including an elevated alkaline phosphatase or transaminases, typically mild or moderate in degree.  A liver biopsy depicting granulomas is suggestive but not diagnostic, so the diagnosis should be made when there is more supporting evidence (demographic, ACE levels, pulmonary infiltrates/hilar adenopathy, autoantibodies).  Treatment is not required with sarcoid liver unless there is evidence of progressive fibrotic disease, in which case immunosuppression may be helpful.

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