A 54 year old female patient undergoes a routine insurance physical examination. Chest x-ray revealed bilateral hilar masses. Biopsy of the masses shows granulomata, but acid-fast and fungal stains are negative for organisms. Which of the following diseases should be suspected?

Sarcoidosis is a multisystem disease characterized by noncaseating granulomata in a variety of organs. The disease may be symptomatic (respiratory and constitutional symptoms) or may be discovered incidentally when chest x-ray or autopsy reveals bilateral hilar adenopathy. Definitive diagnosis is based on biopsy, which revealed non-caseating granulomata that are negative for fungi or acid-fast bacilli. Caroli's disease is a congenital malformation of the bile duct system. Raynaud's disease is a vasospasm of vessels that causes temporary ischemia in the hands. Scleroderma, or progressive systemic sclerosis, is characterized by progressive fibrosis of skin and internal organs. Ref: Chen E.S., Moller D.R. (2013). Chapter 54. Sarcoidosis. In J.B. Imboden, D.B. Hellmann, J.H. Stone (Eds), CURRENT Diagnosis & Treatment: Rheumatology, 3e.