In suspected granulomatous disease such as sarcoidosis, what granuloma type is typically observed on biopsy?

• A. Caseating granulomas
• B. Non-caseating granulomas
• C. Granulomas with eosinophils
• D. Fungal granulomas

Answer: (B)

Non-caseating granulomas are the hallmark finding in sarcoidosis. Granulomas are organized clusters of immune cells that form to wall off something the body can’t easily eradicate. In sarcoidosis, these clusters lack a central area of necrosis, so they’re non-caseating. This contrasts with caseating granulomas, which have a central cheesy necrosis and are classically seen with infections like tuberculosis and some fungal diseases. The non-caseating pattern helps point toward sarcoidosis rather than infection, though granulomatous infections can occasionally mimic it. So, when biopsy shows non-caseating granulomas, it fits the typical pattern for suspected sarcoidosis.