Node Sarcoidosis Research Articles

Pulmonary Sarcoidosis and Intrathoracic Lymph Node Sarcoidosis or Sarcoid Reaction?

The article describes a clinical case pulmonary and lymph node sarcoidosis which development coincided with the implantation of mammary gland implants and their partial destruction. It discusses the differential diagnosis of sarcoidosis and sarcoid reaction to the contents of implants.

Sarcoidosis revealed by long-term fever at the Vierzon Hospital: About a case and literature review

Sarcoidosis is a systemic disease mainly affecting the mediastinum and the lungs. The other manifestations are much rarer and lead to diagnostic and therapeutic wanderings. The present study reports a case of lymph node sarcoidosis revealed by a long-lasting fever. The diagnosis is based on clinical and paraclinical arguments and the elimination of other causes of lymphadenopathy. The evolution is favorable after 6 months of corticosteroid therapy.

Minor Salivary Gland Biopsy for the Diagnosis of Neurosarcoidosis

Introduction: The definite diagnosis of neurosarcoidosis is challenging since it requires a compatible histology of the nervous system. When neurosarcoidosis is suspected, other systemic manifestations are investigated to confirm the diagnosis. A minor salivary gland biopsy (MSGB) is often performed since it is minimally invasive. The objective of the present study was to assess its performance for the diagnosis of neurosarcoidosis. Methods: A retrospective single-center study included patients who underwent a MSGB in a tertiary neurological university hospital (Lyon, France) between 2015 and 2018. Clinical presentations unlikely to be compatible with neurosarcoidosis were excluded. Positive cases of neurosarcoidosis were defined as definite, probable, and possible cases, according to the latest international neurosarcoidosis diagnostic criteria from the Neurosarcoidosis Consortium Consensus Group. Results: A total of 529 patients underwent a MSGB for clinical manifestations compatible with neurosarcoidosis. Among the 13 who fulfilled the criteria for neurosarcoidosis, only one had a positive MSGB. The sensitivity of MSGB was 7.7% (95% CI [0.2–36.0%]) and the specificity was 100.0% (95% CI [99.3–100%]). Conclusion: Considering the low sensitivity of MSGB for the diagnosis of NS, MSGB should be performed in selected indications, including a suspicion of spinal cord sarcoidosis, or when there is a strong clinical, laboratory, and radiological suspicion of NS. MSGB should rather not be performed when the chest CT-scan does not show signs of pulmonary or lymph node sarcoidosis.

Isolated cervical lymph node sarcoidosis: a diagnostic challenge of a case report

Sarcoidosis is a granulomatous disorder involving multi-systemic organs. Patients invariably have lung involvement but some may have extrapulmonary disease. Rarely, cervical lymphadenopathy is the only sign without mediastinal or pulmonary abnormalities. We report a Malay male who complained of neck swelling exclusively. On imaging, multiple enlarged cervical lymph nodes deep to the sternocleidomastoid muscle were seen. An excision biopsy revealed non-caseating granulomas with epithelioid macrophages. Extensive investigations led to the diagnosis of isolated cervical lymph node sarcoidosis. Sarcoidosis can present as cervical lymphadenopathy alone, without mediastinal or lung disease. The presence of epithelioid granulomas on histopathology warrants the exclusion of other granulomatous diseases. Isolated cervical lymph node sarcoidosis is only diagnosed in the presence of consistent clinical and radiological findings. In this case, close monitoring for systemic sarcoidosis is important as it can manifest later in life.

Transbronchial cryobiopsy for mediastinal lesions: a pilot study

To describe a novel transbronchial cryobiopsy technique for mediastinal lesions after initial ultrasound assessment and EBUS-TBNA. Transbronchial cryobiopsy (TBCB) was performed in 35 patients with suspicious mediastinal lesions between November 2020 and September 2022. Age of patients ranged from 22 to 75 years (median 50 [39; 62]). Men-to-women ratio was 13:22. According to morphological data, patients with sarcoidosis (n=13), NSCLC (n=7) and metastases of other tumors (n=3) prevailed. There were patients with B-cell lymphoma (n=1), Castleman disease (n=1) and small cell lung cancer (n=2). Among 15 biopsies for immunohistochemical examination, samples were sufficient for final morphological conclusion in 11 (73.3%) cases (95% CI 48.5-89.1). In 4 (11.4%) cases (95% CI 4.5-26), examination was uninformative. Repeated biopsy was performed in 2 cases, and sarcoidosis of thoracic lymph nodes was confirmed. Sensitivity, specificity and accuracy of transbronchial cryobiopsy were 93.3, 100 and 94%, respectively. There were no clinically significant complications. In one case, chest X-ray revealed pneumomediastinum without need for additional treatment. Transbronchial mediastinal cryobiopsy is a perspective method for diagnosis of mediastinal neoplasms. Apparently, this approach may be advisable in patients with suspected sarcoidosis or lymphoproliferative diseases.

САРКОИДОЗ И COVID-19: ОПЫТ ФГБНУ «ЦНИИТ»

Our objective was to study the impact of prior sarcoidosis treatment and past COVID-19 on the course of sarcoidosis in patients hospitalized in the Central TB Research Institute. The study enrolled 60 sarcoidosis patients with past COVID-19. We studied case records, clinical manifestations of sarcoidosis and COVID-19, X-ray images, gas exchange function tests. Pulmonary sarcoidosis and sarcoidosis of intrathoracic lymph nodes (ITLN) without involvement of other organs or systems prevailed. The severity of COVID-19 significantly varied, though we did not reveal any correlation between the clinical and radiological patterns of sarcoidosis and the severity of viral lung disease. Exacerbation of sarcoidosis was observed in 27 patients (45%), though without involvement of other organs or systems. We did not detect any significant decrease in diffusing capacity of the lungs or partial pressure of oxygen in arterial blood in sarcoidosis patients after COVID-19. Fifty-two patients (38%) with chronic sarcoidosis continued therapy with systemic glucocorticosteroids (SGCS) during the COVID-19 disease, the stable course of sarcoidosis was observed during one year after COVID-19. The share of patients who did not receive SGCS due to COVID-19 without subsequent exacerbation of sarcoidosis was only 25.64%. The onset of sarcoidosis within one year after COVID-19 was observed in 12 out of 60 patients (20%).

КЛИНИЧЕСКИЕ АСПЕКТЫ СОЧЕТАНИЯ COVID-19 И ХРОНИЧЕСКИХ ЗАБОЛЕВАНИЙ ОРГАНОВ ДЫХАНИЯ – СОБСТВЕННЫЙ ОПЫТ

We conducted a cohort prospective open study to evaluate the impact of COVID-19 on the course of chronic pulmonary disease (CPD). The study enrolled 68 CPD patients after COVID-19. We analyzed patients’ complaints, life histories, bronchopulmonary disease records, comorbidity records, examination records, archived data of multispiral CT (MSCT) of the chest. CPD included sarcoidosis of intrathoracic lymph nodes (ITLN) and pulmonary sarcoidosis (36.7%), chronic obstructive pulmonary disease (COPD) (30.9%), bronchial asthma (BA) (17.6%). Other CPD were rare – hypersensitivity pneumonitis (5.8%), bronchiectatic lung disease (5.8%), rheumatoid lung disease (2.9%). We did not establish any association between the nosological form of CPD and the need for hospitalization for COVID-19. According to MSCT data, most patients (61%) had signs of viral pneumonia. The comparative analysis of viral lesion in the lungs (by MSCT data) did not detect any correlation between this specific parameter and the nosological form of CPD. We did not detect any correlation between the nosological form of CPD and the frequency of viral pneumonia. The analysis of CPD exacerbation frequency during 1–3 and 3–6 months after COVID-19 showed that exacerbations occurred in 63.2% of patients, mostlduring 1–3 months after COVID-19 (50% of patients vs. 13.2% of patients during 3–6 months). The differences in exacerbation frequencies during 1–3 months vs. 3–6 months after COVID-19 were only statistically significant in patients with COPD or BA. In the post-COVID-19 period (one through 12 months) the most frequent complaints (67.6%) were weakness, cough, and dyspnea of different degrees.

Abstract 3870: Patterns of CD112R expression in normal lymphatic tissues, inflammation and cancer

Abstract CD112R is an inhibitory immune checkpoint receptor and a putative target for novel immune therapies, but little is known about its molecular epidemiology in healthy and diseased tissues. To study the prevalence and expression level of CD112R+ immune cells, we analyzed more than 200 samples of normal lymphatic, inflamed and cancerous tissues in a microenvironment tissue microarray format (4mm tissue spot diameter) and large sections using fluorescent multiplex immunohistochemistry. CD112R expression was detected at variable intensity levels in 47% of CD8+ cytotoxic lymphocytes, 49% of CD4+ T helper cells, 30% of FOXP3+ regulatory T helper cells and in 25% of CD56+ natural killer cells, but no expression was seen in CD11c+ dendritic cells and CD68+ macrophages. All analyzed compartments across normal and diseased tissues showed a small subset (CD8: 9±18%, CD4: 5±15%, FOXP3: 2±5%) of immune cells with supramaximal CD112R expression. The highest fraction of cells with supramaximal CD112R expression was found in the subset of CD8+ cytotoxic T cells in the Peyer's patches of ileum (62%), the intergranuloma area of lymph node sarcoidosis (27%) and in ovarian cancer (37%). In cancerous tissues, the density and the fraction cytotoxic T cells with supramaximal CD112R expression was highly variable and ranged from 5% in bladder cancer to 3% in lung cancer and 36% in ovarian cancer. A high variability of the number of cells with supramaximal CD112R expression was also seen within every tumor entity. In summary, our analysis shows that CD112R expression is abundant in various subsets of immune cells but identifies a small fraction of cells with exceedingly high CD112R levels. The widespread occurrence of CD112R+ cytotoxic T cells in the cancer microenvironment may suggest considerable opportunities for checkpoint inhibitors targeting CD112R. Citation Format: Niclas Christian Blessin, Tim Mandelkow, Elena Bady, Claudia Hube-Magg, Guido Sauter, Ronald Simon, Christoph Fraune, Maximilian Lennartz, Sören A. Weidemann, Katharina Möller, Doris Höflmayer. Patterns of CD112R expression in normal lymphatic tissues, inflammation and cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3870.

Thyroid carcinoma with atypical metastasis to the pituitary gland and unexpected postmortal diagnosis.

SummaryPapillary thyroid gland carcinoma is the most common type of malignancy of the endocrine system. Metastases to the pituitary gland have been described as a complication of papillary thyroid cancer in few reported cases since 1965. We report the case of a 68-year-old female patient with a well-differentiated form of thyroid gland cancer. Despite it being the most common malignant cancer of the endocrine system, with its papillary form being one of the two most frequently diagnosed thyroid cancers, the case we present is extremely rare. Sudden cardiac arrest during ventricular fibrillation occurred during hospitalization. Autopsy of the patient revealed papillary carcinoma of the thyroid, follicular variant, with metastasis to the sella turcica, and concomitant sarcoidosis of heart, lung, and mediastinal and hilar lymph nodes. Not only does atypical metastasis make our patient’s case most remarkable, but also the postmortem diagnosis of sarcoidosis makes her case particularly unusual.Learning points:The goal of presenting this case is to raise awareness of the clinical heterogeneity of papillary cancer and promote early diagnosis of unexpected metastasis and coexisting diseases to improve clinical outcomes.Clinicians must be skeptical. They should not fall into the trap of diagnostic momentum or accept diagnostic labels at face value. Regardless of the potential mechanisms, clinicians should be aware of the possibility of the coexistence of thyroid cancer and sarcoidosis as a differential diagnosis of lymphadenopathy.This case highlights the importance of the diagnostic and therapeutic planning process and raises awareness of the fact that one uncommon disease could be masked by another extremely rare disorder.

Sarcoidosis among hospitalized patients in Poland: a study based on a national hospital registry.

Sarcoidosis is a systemic granulomatous disease mainly affecting the lungs, although granulomas can also involve any other organ. We sought to describe patients during their first hospitalization for sarcoidosis in Poland from 2008 to 2015. To our knowledge, this is the first evaluation of the disease in Poland based on a hospital morbidity database. We conducted a retrospective, population‑based study, using hospital discharge records compiled by the National Institute of Public Health in the years 2008 to 2015. Among the 23 097 patients included in the study, men were predominant (54.7%). The mean and median ages at hospitalization were 44.7 years (95% CI, 44.5-44.9) and 42 years, respectively. Most patients (65%) resided in urban areas. The average annual incidence rate of sarcoidosis was 7.5 per 100 000 (95% CI, 7.1-7.9). The lungs were the most commonly affected organ (57.9%), while the remaining cases included sarcoidosis of lymph nodes and no lung involvement (18%), the skin (1.4%), and other or unspecified sites (22.7%). Skin sarcoidosis occurred significantly more frequently in women, while sarcoidosis of the lungs with coexisting sarcoidosis of lymph nodes was significantly more prevalent in men. Seasonal variability in sarcoidosis incidence was observed. Sex and age may have a significant impact on the occurrence of sarcoidosis in Poland. Changes in seasonality may suggest the role of environmental factors. These data on sarcoidosis in Poland may be helpful in comparative analyses with other European countries.

Co-existence of Sarcoidosis of Cervical Lymph Nodes and Breast Carcinoma - a rare case report and review of literature

Co-existence of Sarcoidosis of Cervical Lymph Nodes and Breast Carcinoma - a rare case report and review of literature

Esophageal cancer associated with a sarcoid-like reaction and systemic sarcoidosis in lymph nodes: supportive findings of [18F]-fluorodeoxyglucose positron emission tomography\u2013computed tomography during neoadjuvant therapy

BackgroundIn patients with esophageal cancer, differentiation between lymph node metastasis and lymphadenopathies from sarcoidosis or sarcoid-like reactions of lymph nodes is clinically important. Herein, we report two esophageal cancer cases with lymph node involvement of sarcoid-like reaction or sarcoidosis.Case presentationOne patient received chemotherapy and the other chemoradiotherapy as initial treatments. In both cases, [18F]-fluorodeoxyglucose positron emission tomography–computed tomography (FDG-PET/CT) was performed before and after chemo(radio)therapy. After the treatment, FDG uptake was not detected in the primary tumor, but it was slightly reduced in the hilar and mediastinal lymph nodes in both cases. These non-identical responses to chemo(radio)therapy suggest the presence of sarcoid-like reaction of lymph nodes associated with squamous cell carcinoma of the esophagus. Curative surgical resection was performed as treatment.ConclusionsThese FDG-PET/CT findings may be helpful to distinguish between metastasis and sarcoidosis-associated lymphadenopathy in esophageal cancer.

Systemic treatment for sarcoidosis was needed for 16% of 1810 Caucasian patients.

Sarcoidosis is a systemic granulomatous disease predominantly affecting the lungs, although granulomas can also involve all other organs. Fortunately, it is often a self-limiting disease and aggressive treatment is not indicated in majority of cases. However, treatment is recommended when critical organs are affected or the disease is progressive. So far, there is lack of reliable information regarding the frequency of treatment in Caucasian population or data are discordant. The aim of this study was to evaluate the prevalence of systemic immune-modulating treatment in a large cohort of sarcoidosis patients. We performed a retrospective analysis of patients discharged from our institution with the final diagnosis 'sarcoidosis' (ICD-10: D86) from January 2010 to December 2013. 1810 sarcoidosis patients were hospitalized during these four years, 47.6% were females, mean age was 43.5 ± 12.2 years. The majority (80.6%) were discharged as pulmonary and/or lymph node sarcoidosis (D86.0, D86.1, D86.2). Only 281 (15.5%) patients were discharged with systemic treatment, 60.1% of them were men (OR 1.5; 95% CI: 1.1-1.9, P = .0047). The 44.8% of patients who had sarcoidosis also involving an organ other than the lungs (D86.8) were much more likely to be treated: OR 5.6; 95% CI: 4.2-7.4, P < .0001). Older age (>50) was also identified as a risk factor for treatment (odds ratio: 1.8; 95% CI: 1.5-2.4). Less than 16% sarcoidosis patients required systemic treatment. Older men with multiorgan sarcoidosis were more likely to be treated.

Complete diagnostic work-up and prognosis prediction for cardiac sarcoidosis with atrioventricular block: Importance of cardiac magnetic resonance image (MRI) and positron emission tomography (PET)

A 56-year old woman complained of chest discomfort and dyspnea on exertion for one month. She had been diagnosed as mediastinal lymph node sarcoidosis through endobronchial ultrasonography guided transbronchial lymph node aspiration. Electrocardiogram at presentation demonstrated sequential first and second degree 2:1 atrioventricular block. Further imaging study with gadolinium enhanced cardiac magnetic resonance image and 18F-fluoro-2-deoxyglucose positron emission tomography confirmed the diagnosis of sarcoidosis involving heart. Intravenous steroid therapy without pacemaker implantation improved conduction abnormality to normal sinus rhythm. Follow-up 18F-FDG-PET demonstrated full improvement of cardiac and extracardiac lesion with maintenance oral steroid therapy for 5-month.

Neurosarcoidosis in a Tertiary Referral Center: A Cross-Sectional Cohort Study.

The aim of this study was to evaluate clinical characteristics, diagnostic strategy, and treatment in patients with neurosarcoidosis in a tertiary referral centre.In a cross-sectional study, we included all patients with neurosarcoidosis treated at our tertiary referral center between September 2014 and April 2015.We identified 52 patients, among them 1 patient was categorized as having definite neurosarcoidosis, 37 probable neurosarcoidosis, and 14 possible neurosarcoidosis. Neurologic symptoms were the first manifestation of sarcoidosis in 37 patients (71%). Chronic aseptic meningitis was the most common presentation (19/52 patients [37%]), followed by cranial neuropathy (16/52 patients [31%]). Serum angiotensin-converting enzyme and lysozyme levels were elevated in 18 of 41 (44%) and 12 of 26 cases (46%). Pulmonary or lymph node sarcoidosis was identified by chest X-ray in 21 of 39 cases (54%) and by computed tomography of the chest in 25 of 31 cases (81%); Fluorodeoxyglucose-Positron emission tomography showed signs of sarcoidosis in 15 of 19 cases (79%). Thirty-one of the 46 cases receiving treatment (67%) improved, 13 cases (28%) stabilized, and 2 cases (4%) deteriorated. First-line treatment with corticosteroids resulted in satisfactory reduction of symptoms in 21 of 43 patients (49%). Seventeen patients (33%) needed second-line cytostatic treatment, and 10 patients (19%) were treated with tumor necrosis factor-α inhibitors.The majority of patients with neurosarcoidosis present with chronic meningitis without a history of systemic sarcoidosis. The diagnosis can be difficult to make because of the poor sensitivity of most diagnostic tests. Half of patients had a satisfactory reduction of symptoms on first-line therapy.

Hypercalcémie révélant une sarcoïdose chez un enfant

Sarcoidosis is a systemic granulomatosis disease with a classic triad of presentation: typical clinical and radiological signs, presence of tuberculoid granuloma without caseum in histopathology, and exclusion of other causes of granulomatosis, especially tuberculosis. Sarcoidosis is rare in the general population, and even more so in children. In the literature, few cases of sarcoidosis associated with hypercalcemia have been reported in children. We report here the case of a 14-year-old boy with bone marrow and lymph node sarcoidosis suspected, based on poor general condition with hypercalcemia. The patient was treated with hydration, diuretics, and bisphosphonates with good results. We also performed a literature review of published cases of hypercalcemia since 1990 with a diagnosis of sarcoidosis in children, comparing 23 cases (including ours) on clinical and epidemiological, biological, imaging, and histopathological diagnosis. When hypercalcemia is present in the initial clinical presentation, the diagnosis of sarcoidosis is usually made in younger children. Classical locations of the lesions, including lung, skin, and lymph nodes, were highly suggestive of sarcoidosis. Corticosteroids are commonly used to treat sarcoidosis lesions including hypercalcemia. In conclusion, sarcoidosis in children remains difficult to diagnose because the disease is rare and it is common to have nonspecific symptoms in the clinical picture (with diagnosis delayed between 3months and several years). The classic triad is not always present. Sarcoidosis should be systematically considered and investigated in case of hypercalcemia of unknown cause in children.

Difficulties of differential diagnostics of primary hyperparathyroidism and sarcoidosis of cervical lymph nodes

A case of isolated sarcoidosis of cervical lymph nodes is reported that was first erroneously interpreted as parathyroid adenoma. The patient was a 70 year-old woman presenting with hypercalcemia and elevated blood parathormone level. The ultrasound study showed the presence of a tissue mass measuring 1.5 cm in the projection of the inferior right parathyroid gland. The scintigraphic study with 99mTc MIBI demonstrated the accumulation of the radiopharmacological agent in the tissue mass that was identified as an adenoma of the parathyroid gland. The surgical removal of this neoplasm together with the adjacent lymph nodes resulted in the normalization of the blood calcium and parathormone levels. The histological study revealed sarcoidosis of lymph nodes in the absence of lesions in other organs. A literature review of the problem pertaining to hypercalcemia associated with sarcoidosis of cervical lymph nodes is presented with special reference to the difficulties encountered in differential diagnostics of this condition.

Cervical Lymph Node Sarcoidosis Mimicking a Parathyroid Adenoma: A Clinical Case

We report a case of cervical lymph node sarcoidosis misdiagnosed as parathyroid adenoma. This is the second case described in the literature in which lymph node sarcoidosis was misdiagnosed as parathyroid adenoma on Tc-99m sestamibi (MIBI) scan, the first case localized in the neck. A 64-year-old woman presented with a hypercalcemia. Neck ultrasonography revealed a paratracheal hypoechoic mass of 15 mm with peripheral vascularization. MIBI scan and SPECT/CT identified a MIBI-positive area corresponding to the nodule detected by ultrasonography suggestive for a lower right parathyroid adenoma. A mass interpreted as the lower parathyroid was excised associated to a total thyroidectomy. Pathologic examination revealed a granulomatous lymph node consistent with active sarcoidosis. Sarcoidosis should be suspected as a cause of unexplained hypercalcemia and the differential diagnosis of hypercalcemia, even in presence of MIBI uptake, must include sarcoidosis localized in an isolated cervical lymph node.

Tumor necrosis factor-α production by blood mononuclear cells in different manifestations of sarcoidosis

Summary. Tumor necrosis factor-α (TNF-α) is a polypeptide mediator and proinflammatory cytokine that plays an important role for pathogenesis of sarcoidosis. The aim of this study was to investigate spontaneous and induced by M.bovis antigen (BCG) and mitogen concanavalin (Con A) production of TNF-α by peripheral blood mononuclear cells in patients with different manifestations of sarcoidosis. The study involved 22 patients with active sarcoidosis of intrathoracic lymph nodes and lungs. TNF-α production was studied in supernatants of blood mononuclear cell cultures using sandwich method and immunoenzyme analysis (ELISE). We found a significant increase in spontaneous and induced TNF-α production in patients with acute sarcoidosis compared to asymptomatic patients and with healthy volunteers. TNF-α hyperproduction induced by non-specific mitogen Con A was also revealed in all sarcoidosis patients regardless of activity of the disease in comparison with healthy controls. These data may indicate an increased functional activity of the immune cells and their tendency to hyperreactivity in response to antigen in patients with sarcoidosis.

Isolated Cervical Lymph Node Sarcoidosis Presenting in an Asymptomatic Neck Mass: A Case Report

Sarcoidosis, a systemic granulomatous disease of unknown etiology. The presentation of sarcoidal granuloma in neck nodes without typical manifestations of systemic sarcoidosis is difficult to diagnose. We describe the case of a 37-year-old woman with an increasing mass on the right side of neck. The excisional biopsy from the neck mass showed noncaseating epithelioid cell granuloma of the lymph nodes. No evidence of mycobacterial or fungal infection was noted. Thoracic evaluations did not show enlargement of mediastinal lymph nodes or parenchymal abnormalities. Immunohistochemistry showed abundant expression of tumor necrosis factor-α in the granuloma. However, transforming growth factor-β was not expressed, although interleukin-1β was focally expressed. These immunohistochemical findings supported characterization of the granuloma and the diagnosis of sarcoidosis. Sarcoidosis can present with cervical lymph node enlargement without mediastinal or lung abnormality. Immunohistochemistry may support the diagnosis of sarcoidosis and characterization of granuloma.