Calcium Oxalate in Sarcoid Granulomas: With Particular Reference to the Small Ovoid Body and a Note on the Finding of Dolomite

Abstract

The nature, prevalence, and specificity of birefringent calcific particles in granulomas of sarcoidosis have been examined, including histochemical reactions, single particle, and microchemical analyses. Particular attention was paid to small ovoid forms of which most were calcium oxalate monohydrate. Larger crystals, those within giant cells, and the birefringent component of a Schaumann complex were also calcium oxalate. Small ovoids appeared to originate in macrophages and to be precursors of other forms; they were found in 86% of lymph nodes and 73% of surgical lung specimens. They were not specific for sarcoidosis. Organisms could not be certainly identified in them. Their origin is discussed in relation to activated macrophages, calcium, and oxalate metabolism, and the role of calcium oxalate in granulomas is considered. Four particles from two cases were dolomite and two were a calcium-sulphur compound. The biologic origin of dolomite is reviewed.

Physicochemical characterization of inorganic deposits associated with granulomas in cutaneous sarcoidosis

“…Calcite deposits were observed at distance from granulomas, within the connective tissue of dermis in four patients, two with hypercalcemia. Calcium oxalate and phosphate deposits have been reported in sarcoidosis, however, to the best of our knowledge, we report the first cases of calcite deposits . Presence at the nanometre scale of these deposits, including in patients with normal serum calcium level, raises the question that calcium carbonate deposits in tissues around granulomas could be a common not yet highlighted finding in conjunction with the role of the granuloma in vitamin D and calcium metabolism …”

“…Calcium oxalate and phosphate deposits have been reported in sarcoidosis, however, to the best of our knowledge, we report the first cases of calcite deposits. 19 Presence at the nanometre scale of these deposits, including in patients with normal serum calcium level, raises the question that calcium carbonate deposits in tissues around granulomas could be a common not yet highlighted finding in conjunction with the role of the granuloma in vitamin D and calcium metabolism. 20 In conclusion, such a study needs to be extended to samples from other organs affected by sarcoidosis, mostly lung and mediastinal lymph nodes exposed to environmental and occupational pollutants.…”

Deposition of calcium salts in a case of pulmonary zygomycosis: histopathologic and chemical findings

“…It should be noted that calcium oxalate crystals may be seen in circumstances other than fungal infections and oxalosis [18]. These include localized pulmonary accumulation of calcium oxalate crystals after aspiration of plant material with a high oxalate content such as rhubarb and within sarcoid granulomas [19,20].…”

Diagnosis of Pulmonary Sarcoidosis

“…They may be mistaken for fungi because the yellowbrown pigment may stain positive with methenamine silver and may demonstrate a yeastlike budding appearance (Ro et al 1987;) These inclusions, while described in sarcoidosis, are found in many other granulomatous diseases such as hypersensitivity pneumonitis, berylliosis, fungal infection, talc, tuberculosis and nontuberculosis mycobacterial infection. (Mukhopadhyay and Gal 2010;Reid and Andersen 1988). The online atlas of granulomatous diseases by Yale Rosen, M.D is an excellent resource to visualize all these features (http://granuloma.homestead.com/).…”