Case 227. Reference case 227B

　 　 　 　
　 The multinucleated giant cells are immunoreactive for CD68, confirming that they derived from macrophages (immunostaining). Desmin was negative. 　
　 　 　 　

　

 　 The lesion can be distinguished from sarcoidosis, based on the lack of granulomatous reaction and the fulminant clinical course.