Sarcoid Reaction Research Articles

WHAT TO EXPECT FROM MICROBLADING OF THE EYEBROWS

Microblading of the eyebrows, a kind of cosmetic tattooing that has become very popular in the last decade, it can nevertheless cause adverse skin reactions at the tattoo site, including infections, allergic reactions, and even sarcoid reactions. These reactions can lead to a reduction in the quality of life. We report tow cases of adverse reactions following microblading of the eyebrows, the first patient 40-year-old women presenting with a 7 -month history of erythematous lesions on the eyebrow, A biopsy was performed, which came back a sarcoidosis granulomatous reaction, Our patient was put on intralesional corticosteroid and synthetic antimalarials with good improvement, the second patient have 38 year-old women consulting for erythematous, oozing, pruritic lesions after 3 days of application microblading of the eyebrows, . The dermatological examination revealed the presence of edematous erythematous plaques surmounted by vesicles with crumbling contours located on both eyebrows. The diagnosis of contact eczema was retained, and the patients was put on a low-class topical corticosteroid for 10 days with good improvement.

Lymphocytoma Cutis - A Case Report

Without tissue biopsy and holistic review of presentation, histology, and immunohistochemistry, lymphocytoma cutis (LC) can often be misdiagnosed as other benign conditions or malignant pathologies such as cutaneous B cell lymphoma (CBCL). A 36-year-old female presented with a two-year history of a progressive indurated, edematous plaque in the preauricular area. At presentation, the patient also had labs significant for thrombocytopenia and eosinophilia. Original treatment with topical steroids did not lead to clinical improvement of the lesions. Punch biopsy revealed reactive lymphoid hyperplasia with polyclonal lymphoid infiltrates of small lymphocytes, histiocytes, eosinophils, and plasma cells. Diagnosis of LC was made and our patient was treated with serial 5 mg intralesional triamcinolone injections. Clinical improvement was seen beginning at 2 months. Diagnosing LC can be particularly difficult as the clinical presentation is ubiquitous and can resemble several other conditions such as CBCL, cutaneous lupus erythematosus, sarcoid, or hypersensitivity reactions. Recognition of the typical histologic findings of top-heavy dermal mixed-cellular infiltrates along with polyclonal kappa and lambda hybridization on immunohistochemistry is often essential in arriving at the correct diagnosis. Following diagnosis of LC, long-term surveillance is recommended as malignant transformation is a possibility.

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.

Splenic sarcoid reaction mimicking metastases in patients after uterine cancer surgery: a report of two cases

BackgroundTumor-associated sarcoid reactions have been observed with various tumors; however, they have not been reported with uterine cancer. We present two cases of splenic sarcoid reactions that mimicked metastases a few years after uterine cancer surgery.Case presentationCase 1 involved a 67-year-old female patient diagnosed with endometrial cancer (pT1aN0M0, pStage Ia, grade 1). The patient underwent open total abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic lymphadenectomy. Three years after the initial surgery, computed tomography (CT) and positron emission tomography CT showed multiple splenic masses with increasing numbers and sizes. Splenic metastases were diagnosed, and laparoscopic splenectomy was performed. The histopathological analysis revealed sarcoid reactions in the spleen. Case 2 involved a 47-year-old female patient diagnosed with endometrial cancer (pT1aN0M0, pStage Ia, grade 1). The patient underwent laparoscopic total abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic lymphadenectomy. Two years after the initial surgery, multiple splenic masses were observed. We performed laparoscopic splenectomy for the splenic metastases. Granuloma formations were identified in the splenic specimen and perisplenic lymph nodes that were removed simultaneously, resulting in a final diagnosis of sarcoid reaction. A review of the lymph nodes at the time of the previous uterine surgery revealed granuloma formation. Other than the presence of splenic masses, no findings suggestive of recurrence were observed in these cases. Uterine cancer and sarcoid reactions progressed without recurrence after splenectomy.ConclusionsTo the best of our knowledge, this is the first report of the late development of splenic sarcoid reactions after uterine cancer surgery. Sarcoid reactions and metastases are difficult to diagnose based on preoperative imaging results. However, reviewing the specimen at the time of the initial resection, the number of lesions, and the clinical findings (other than imaging findings) may aid in the determination of the correct diagnosis.

Malignancy and sarcoidosis: A single center experience from Turkey

Objective: The relationship between cancer and sarcoidosis has been a research topic for a long time. An increased risk of sarcoidosis and sarcoid-like reactions is suggested in patients with malignant disease. The present study aimed to describe the clinical characteristics and the prognosis of 15 Turkish patients who had a diagnosis of both malignancy and sarcoidosis. Methods: The patients admitted to our department between October 2013 and October 2018 were included in this study. Patient data including, the demographic data, clinical, radiological, pathological findings, and applied treatment modalities were retrieved from hospital database. Results: The study included 14 females and 1 male with a mean age of 53.3±11.4 years. Malignancy was the preceding diagnosis in 13 patients. The mean interval time between two diagnoses was 4±3.6 years. Fourteen patients recovered from their cancer, only 1 patient with relapsed NHL was deceased. The most common type of malignancy was breast (n=7) and endometrium (n=3) carcinoma. Surgery was the primary therapeutic modality in 14 patients. Additionally patients received certain drugs which might contribute to onset of sarcoidosis such as Cyclophosphamide (n=8), Adriamycin (n=8), Trastuzumab (n=2), and Rituximab (n=1). Ten patients were asymptomatic for sarcoidosis and 7 patients had stage I pulmonary sarcoidosis. Two third of the patients (n=10) did not receive any therapy for sarcoidosis. Conclusion: This study involves a few number of patients and according to the analysis of this group the presence of malignancy and sarcoidosis in the same patient might promote good prognosis for both entities. However the onset of sarcoidosis during the follow-up period is a challenging clinical condition and a biopsy is needed for differential diagnosis and management decision. Yet the biopsy might not be enough to differentiate between sarcoidosis and the sarcoid reactions related to malignancy. Future studies are needed to enlighten the underlying pathogenesis.

ЭФФЕКТИВНОСТЬ ВЕРИФИКАЦИИ ТУБЕРКУЛЕЗА ОРГАНОВ ДЫХАНИЯ У БОЛЬНЫХ СО ЗЛОКАЧЕСТВЕННЫМИ НОВООБРАЗОВАНИЯМИ ВНЕЛЕГОЧНОЙ И ЛЕГОЧНОЙ ЛОКАЛИЗАЦИЙ

Aim: to analyze effectiveness of the algorithm for verification of pulmonary TB and the structure of clinical forms of pulmonary TB in patients with malignancies of extrapulmonary or pulmonary localizations. Materials and methods. A cohort retrospective study included 126 patients with malignancies and the diagnosis of active TB or residual post-TB changes or other lung diseases verified by sputum studies (stage 1), bronchoscopy (stage 2), and diagnostic surgery (stage 3).Results. The effectiveness of diagnosis verification based on three stages was 96%. The diagnosis of TB was significantly more frequent – in 40.5% (р < 0.001) than sarcoid reactions – 11.1%, metastatic tumors in the lungs – 15.1%, newly detected malignancies with comorbid TB – 6.3%, or bronchiectasis – 27% of cases. Stage 1 was effective for diagnosis verification in 30.9%, stage 2 – 61.6%, and stage 3 – 100% of cases. In 51 TB patients extrapulmonary malignancies prevailed – 84.3% vs lung cancer – 15.7% (р = 0.001); the most common were breast cancer (25.4%) and gastrointestinal cancer (15.7%). In 60.8% of cases TB was detected during complete/incomplete remission of cancer, in 21.5% – during new detection of cancer/TB comorbidity, in 17.6% – during cancer recurrence (р < 0.001). Active TB was diagnosed in 60.8%, residual post-TB changes – 39.2% of cases (р < 0.05). We established the prevalence of infiltrative pulmonary TB (25.8%) and intrathoracic lymph node TB (25.8%) vs other forms of pulmonary TB (р < 0.05). The detection of M. tuberculosis (MTB) DNA by molecular genetic methods was higher (77.4% of observations) than the detection of AFB by luminescent microscopy (58.1%) or MTB by cultural methods (38.7%) (р < 0.05). We obtained results of drug susceptibility testing in 67.9% of cases. TB was caused by drug susceptible MTB in в 68.4% and drug resistant MTB – 31.6% of cases (р < 0.05). Extensive drug resistance was determined in 15.7%, multiple drug resistance – 5.2%, and poly/monoresistance – 5.2% of cases. Conclusion. Among patients with malignancies, pulmonary TB was commonly detected during cancer remission; in two thirds of observations TB was confirmed by detection of MTB in sputum samples and bronchobiopsies, predominantly by molecular genetic methods; two thirds of cases had drug susceptible TB.

Sarcoid Granulomas and Systemic Sarcoidosis Triggered by Cosmetic Tattoos.

Cosmetic tattooing of eyebrow and lips has become very popular and is expected to be paralleled by more frequent complications. We present 4 cases of granulomas in cosmetic tattoos complicated by regional or systemic manifestations of sarcoidosis including affection of the lungs in 2 cases, the activity triggered by the tattoo. Three cases of traditional decorative tattoos on extremities serve as reference. It is noteworthy that cosmetic tattoos despite small size and thereby low relative dose of pigment injected in the skin can trigger fully developed systemic sarcoidosis. It is hypothesized that iron oxide pigments popular in cosmetic tattoo inks of red or brown color may be prone to elicit sarcoid reactions and thus carry a special risk of granuloma. In decorative tattoos, carbon black is the commonest trigger. It is emphasized that the finding of granulomas in tattoos shall be followed by search of other manifestations of sarcoidosis through patient history and diagnostic examinations to exclude pulmonary, ocular, and other organ manifestations. Patients with granulomas in tattoos shall be informed that active sarcoidosis, if not already present, can become manifest later with a latency of months or years and often with abrupt debut when the triggering tattoo may be overlooked by the doctor who is unfamiliar with this less common type of sarcoidosis.

A Clinical Case of Generalized Sarcoidosis with a Predominant Lesion of the Spinal Cord

Sarcoidosis, as systemic epithelioid cell granulomatosis, can be accompanied by damage not only to the intrathoracic lymph nodes and lungs, but also to other organs, in particular, the central nervous system and peripheral lymph nodes. In the spectrum of extrathoracic lesions, spinal cord sarcoidosis occurs only in 6-8 % of cases of all brain lesions. The presented clinical example illustrates the lesion of the spinal cord at the level of the thoracic region, although the literature more often describes the lesion of the cervical region. The disease was accompanied by sarcoidosis of the intrathoracic lymph nodes with rapid spontaneous regression and sarcoidosis of the supraclavicular lymph node. The diagnosis was confirmed after a peripheral lymph node biopsy. Spinal cord sarcoidosis in this patient was characterized by rapid regression against the background of parenteral administration of dexamethasone for 14 days, followed by transfer to tablet forms of prednisone. The positive dynamics of spinal cord sarcoidosis refuted the assumption of the presence of a sarcoid reaction in the lymph nodes against the background of a spinal cord tumor. The use of a course of rehabilitation techniques contributed to the recovery of working capacity.

Primary hepatic neuroendocrine tumor with sarcoid like granulomas: A case report

Primary hepatic neuroendocrine tumor (PHNET) is a rare entity comprising 0.3% of all neuroendocrine tumors. Tumors coexisting with granulomas are occasionally noted with malignancies in the lymph nodes draining the tumor or within the primary tumor itself. Tumor-related sarcoid reactions are noted only in carcinomas and its association with a NET has been extremely rare.: We report a case of PHNET in a 63-year male who presented with various comorbidities who was incidentally detected with a liver space-occupying lesion (SOL). Contrast enhanced CT scan of the abdomen revealed a well-defined exophytic mass in the liver involving segment 6. Subsequently, 68Ga DOTANOC PET/CT scanning revealed somatostatin receptor-expressing well-defined lesion measuring 5.1 x 5.0 cm in segment 6 (SUV MAX 19). A diagnosis of either a primary or a metastatic neuroendocrine tumor was made and non-anatomical wedge resection of the tumor was done with a detailed exploration of the abdominal cavity to look for a primary focus that did not reveal any other lesion or mass. Histologically, the tumor was confirmed to be a Neuroendocrine Tumor along with the presence of tumor-related sarcoid like granulomas in the adjoining hepatic parenchyma.: Diagnosis of a PHNET requires a combination of a negative abdominal survey at the time of the operative procedure, pathologic evaluation of specimen, and a negative imaging workup for extrahepatic NET in both the pre and postoperative settings.

COVID-19 И САРКОИДОЗ: КОМОРБИДНОСТЬ, ПОСЛЕДСТВИЯ, ПРИЧИННО-СЛЕДСТВЕННЫЕ СВЯЗИ. ОБЗОР ЛИТЕРАТУРЫ

Abstract. Introduction. Sarcoidosis and COVID-9 are diseases in which the response of the human immune system plays a significant role in the pathogenesis. Descriptions of cases of a combination of these diseases and the development of a granulomatous reaction in those who have undergone COVID-19 make it relevant to study these two diseases. Aim. The aim of the work was to analyze publications available in electronic libraries that included information about patients with sarcoidosis during the COVID-19 pandemic. Material and methods. A search was conducted in the domestic electronic library E-library, as well as PubMed / Medline, Web of Science and Google Scholar for two keywords “COVID-19” and “sarcoidosis”. 47 papers were selected and analyzed. Results and discussion. An analysis of basic research indicates the possibility of mutual influence of these diseases at the level of cytokines, enzymes and immune system reactions. Moreover, 33 common differentially expressed genes have been identified. When diagnosing sarcoidosis and COVID-19 using computed tomography, similar patterns were noted, with the exception of focal dissemination, which is characteristic only for sarcoidosis. Hopes are placed on software capable of self-learning based on verified cases. The incidence of COVID-19 in patients with sarcoidosis ranged from 0.34% to 4%. The course of COVID-19 in these patients was not severe or threatening, with the exception of elderly patients with initially severe sarcoidosis with ventilatory insufficiency and comorbidities. In the post-covid period, cases of sarcoidosis or sarcoid reactions that developed after recovery have been described. Similar reactions have been described after vaccination against coronavirus infection. These facts also testify in favor of the generality of immunological and metabolic changes that determine the mutual influence of diseases. Conclusion. The combination of sarcoidosis and COVID-19 occurred during the pandemic, but in most cases did not lead to mutual aggravation of the conditions. The development of granulomatous processes after COVID-19 and vaccination against this disease makes further fundamental research aimed at finding common links in the pathogenesis of these diseases relevant.

Can infections trigger sarcoidosis?

Can infections trigger sarcoidosis?

Sarcoidosis or Sarcoid Reaction With Lung Cancer in Ethnic Han Chinese Patients: A Single Center Experience and Literature Review

<h3>Purpose/Objective(s)</h3> The aim of the present study was to analyze the clinical characteristics of the sarcoidosis (SA) or sarcoid reaction (SR) with lung cancer in ethnic Han Chinese patients. <h3>Materials/Methods</h3> A retrospective review based on discharge summaries from January 2004 to December 2014 was performed with tissue-proved at Shanghai Pulmonary Hospital and the cases report of Chinese patients had been revived. The clinical and follow-up data of those patients were collected and their clinical features, treatment and prognosis were analyzed. <h3>Results</h3> Of the 536 sarcoidosis patients, 1.31% (7/536) patients with lung cancer in our hospital. With the patients in literature, 12 patients had the SA or SR with lung cancer. Our report patients (median 60 yrs; 58.71±7.59 yrs) were significantly older than the patients with SA only (49.19±10.83 yrs, P=0.002<0.05). Our lung cancer patients with SA or SR were predominantly in women (F/M: 5/2). And the most common type was adenocarcinoma (100%, 7/7). The symptoms of those patients were not specific. 57.14% (4/7) had no symptoms, 28.57% (2/7) had cough, 14.29% (1/7) had chest pain. All patients presented lymph node involvement. The size of the lung cancer was from 0.5-6cm (2.47±1.90). The treatment of cancer and SA/SR did not influence each other. Our cases were followed up for 18 to 90 months (average 36 months) and were all alive during the follow-up period. <h3>Conclusion</h3> The incidence of SA/SR with lung cancer is not high in our subjects and easily associated with early stage of lung cancer. The biopsy of lung and lymph nodes is essential to accurate diagnose and the right TNM stage of lung cancer. The SA/SR may be a protective factor against lung cancer relapse.

Diagnosis distribution in cases with granulomatous inflammation in lung, pleura, and lymph node biopsies: an experience from a tertiary level single center chest diseases and thoracic surgery hospital.

Background:Granulomatous inflammation is found in a wide range of diseases, and most commonly associated with sarcoidosis and tuberculosis. Granulomas are pathologically classified into two main groups; necrotic and non-necrotic.Objectives:The aim of this study was to evaluate the radiological, laboratory, and pathological findings of a large patient population with granuloma in biopsy samples, to determine the final diagnostic distribution.Methods:This study was designed as a retrospective, descriptive, observational, cross-sectional study. It was conducted in patients with granulomatous inflammation detected in lung, pleural, mediastinal, hilar, and/or peripheral lymph node biopsies. Demographic information, radiological, microbiological, and laboratory results of the patients were obtained via the information processing system of the hospital. The diagnoses recorded were re-evaluated by at least two experienced clinicians and the final diagnosis distributions were made.Results:A total of 392 patients were included in the study. Non-necrotizing inflammation was detected in 268 patients, and necrotizing granulomatous inflammation was found in 124 patients. The most common cause of non-necrotizing inflammation was sarcoidosis, and tuberculosis in the case of necrotizing inflammation. A total of 77.2% of sarcoidosis patients had non-necrotizing inflammation and 54.3% of the tuberculosis patients had necrotizing inflammation. In the diagnosis distribution of granulomatous inflammation sarcoidosis, mycobacterium infections (especially tuberculosis), sarcoid reaction due to malignancy, pneumoconiosis, granulomatosis with polyangiitis and hypersensitivity pneumonitis were detected, respectively. A total of 392 patients were diagnosed with 13 different diseases. In 15 patients (3.8%) no specific diagnosis could be made.Conclusions:The diagnosis of granulomatous inflammation detected in biopsy samples is common for clinicians and a differential diagnosis is difficult in many cases. A patient’s clinical findings, laboratory results, and radiological appearance, should be evaluated in detail and a final diagnosis only made following a multidisciplinary discussion. The presence of necrosis in tissue samples alone is not a reliable finding for a final diagnosis.

Identification of characteristic subepithelial surface granulomatosis in immune-related adverse event-associated enterocolitis.

Immune checkpoint inhibitors (ICIs) have provided an additional treatment option for various types of human cancers. However, ICIs often induce various immune‐related adverse events (irAEs). Enterocolitis is a major irAE with poorly understood histopathological characteristics. In this study, we retrospectively investigated the histopathology of colon tissue samples from 17 patients treated with ICIs. There were two major histological patterns of colitis: an ulcerative colitis‐like pattern and a graft vs host disease‐like pattern. Although these two patterns of colitis were mutually exclusive, both patterns often showed a characteristic that we call “subepithelial surface granulomatosis” (SSG), which has not been reported in other types of colitis. SSG was found even in colon tissue without symptoms or endoscopic findings of colitis. Given the increasing reports of sarcoid reaction or exacerbation of tuberculosis after treatment with ICIs, granuloma formation could be a histological hallmark of systemic immune activation by ICIs. Although statistical significance was not obtained, probably because of the small sample size, SSG may be a surrogate biomarker of systemic anticancer immune activation. We propose that a prospective study with larger sample size be performed.

A Case of Advanced Gastric Cancer with Multiple Lymphadenopathy Occurring as a Sarcoid Reaction

A Case of Advanced Gastric Cancer with Multiple Lymphadenopathy Occurring as a Sarcoid Reaction

Ekstra-torasik maligniteli hastalarda EBUS-TBİA tanı değeri ve PET-BT ile ilişkisi

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a well-established diagnostic tool for lung cancer, sarcoidosis, and suspected metastatic extra-thoracic malignancy (ETM). Patients with primary ETM often have hypermetabolic mediastinal/hilar lymph node enlargement in the PET-scan done for initial staging or post treatment followup. We aimed to determine the diagnostic performance of EBUS-TBNA and the relationship between PET-SUV values and diagnosis of malignancy metastasis in patients with ETM.Results of EBUS-TBNA in ETM patients with suspected MLN metastasis were retrospectively analysed (May 2016 to July 2019). Non-malign results were confirmed for surgery or clinical/radiological followup. Lymph nodes with a high FDG-uptake (SUV > 2.5, MLN) were reported as suspicious for metastasis.Of the 588 EBUS procedures, 109 were included in the analysis. Patient' mean age was 62.5 ± 10.1 years; there were 35 men and 74 women. Primary malignancies were breast cancer in 33, gastrointestinal in 23, female genital tract in 17, head and neck in 14, genitourinary cancer in 13, malignant melanoma in 6, sarcoma in 2 and kaposi sarcoma in 1. According to EBUS-TBNA smear and cell block histopathologic evaluations, 16 patients' results (14.7%) were malignant compatible with metastasis of ETM. Among the 93 patients with non-malignant diagnosis, EBUS-TBNA revealed a granulomatous lympadenitis compatible with sarcoid reaction in 7 and tuberculosis in 2. A total of 9 patients underwent surgical procedures after EBUSTBNA, with a definitive histological diagnosis of granulomatous lymphadenitis in 2, malignancy in 5 and, reactive lymph node in 2. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of EBUS-TBNA were 76.19% (95% CI 52.83-91.78), 100% (95% CI 95.89-100.00), 100%, 94.62% (95% CI 89.12-97.12) and 95.4%, respectively.EBUS-TBNA sampling has high diagnostic performance. Histopathological confirmation requirement for MLN should be kept in mind in patients with ETM, even they have negative EBUS results.

Sarcoidosis asociada a panuveítis en el área de un tatuaje: Reporte de caso

Background: One of the cutaneous reactions associated with tattoos is sarcoidosis and the most frequent presentation is systemic involvement; within this, the manifestation of uveitis and sarcoidal reactions associated with tattoos is little described. Clinical case: A 27-year-old man with a clinical picture of six months of evolution consisting of general malaise, subjective fever, chills, myalgias, arthralgia, cough with hemoptysis, edema in lower limbs, and in whom red eye, diminution of visual acuity, and papules that infiltrated one of the tattoos that were placed, six months earlier, on the right arm and left forearm, were found. Conclusion: Sarcoidosis associated with tattooing is a disease that requires a high index of suspicion, where its infiltration should make the clinician suspect the disease and make an active search for systemic involvement, especially in a patient with a uveal compromise that can lead to blindness. It must keep in mind that, although rare, this triple association is possible (tattoo, systemic sarcoidosis, and panuveitis).

Splenic sarcoid reaction mimicking metachronous metastasis in patients after distal gastrectomy for gastric cancer: a case report and literature review

BackgroundThe occurrence of sarcoid reactions has been recognized in various cancers. The common location for observing these granulomas is mainly the lymph nodes, but a rare occurrence in the spleen has been reported.Almost all splenic sarcoid reactions associated with gastric cancer have been resected synchronously and diagnosed accidentally, and a rare metachronous occurrence of a sarcoid reaction in the spleen after distal gastrectomy can mimic cancer metastasis. We describe a rare case of a splenic sarcoid reaction recognized in a patient with gastric cancer 6 months after distal gastrectomy.Case presentationAn 82-year-old man underwent laparoscopic distal gastrectomy for gastric cancer (T3N0M0, stage IIA). Six months after gastrectomy, CT and 18F-fluorodeoxyglucose (FDG)-PET/CT showed the appearance of a splenic mass. We diagnosed solitary splenic metastasis from gastric cancer and performed laparoscopic-assisted splenectomy. His splenic tumor was diagnosed as a sarcoid reaction by histopathological examination.ConclusionTo our knowledge, this is the first report of a splenic sarcoid reaction recognized 6 months after distal gastrectomy for gastric cancer without any chemotherapy. The splenic sarcoid reaction and cancer metastasis to the spleen were undistinguishable from the CT and FDG-PET/CT findings. The present case and literature review showed that cases of splenic sarcoid reactions associated with gastric cancer can also be accompanied by the occurrence of these granulomas in lymph nodes. When the appearance of a solitary mass is observed in the spleen after resection of primary cancer, it is necessary to consider not only cancer metastasis but also sarcoid reactions. Retrospective histopathological confirmation of the existence of sarcoid reactions in lymph nodes from resected specimens might possibly avoid incorrect diagnosis and intervention.

Tattoo pigment agglomerates measured in commercial ink stock products by computerised light microscopy.

The incidence of clinical complications such as granuloma formation and sarcoidosis is often seen in black tattoos and may be associated with agglomeration of black pigment. To measure count and dimensions of agglomerates in black tattoo inks vs red inks and to compare old inks and new inks of identical brands. Examination was performed by light microscopy (Olympus BX51™ ) with magnification 40X, immersion oil. Photographs (Jenoptik Gryphax RGB camera) were taken of each ink sample and analysed by ImageJ software; count, area, width, height, circumference and circularity index were measured. Agglomerates were defined as width and height of objects above 800nm. Twenty-one new unopened black inks and 17 new unopened red inks were compared. Furthermore, five old black inks and five old red inks, that had been opened and stocked for over 2years, were compared with new products of the same brands. Black agglomerates were area wise and with respect to width, height and circumference significantly larger compared with red agglomerates and more circularly shaped. Count of agglomerates was lower in black inks than in red inks, in accordance with bigger dimensions of black agglomerates. Comparison of old and new inks indicated old inks have larger agglomerates but variable bottle size and storage conditions may have confounded results. Pigment agglomerates in black tattoo ink stock products were sized larger than agglomerates in red inks. Agglomerates found directly in black inks may predispose to granuloma formation in black tattoos causing sarcoid reaction.

Paraneoplastic sarcoidosis: a review.

Sarcoidosis is occasionally seen in association with malignancy, both at the time of cancer diagnosis or during follow up. The purpose of this study is to identify patients with paraneoplastic sarcoid, their associated malignancies and disease characteristics. We identified 289 patients diagnosed histologically with sarcoidosis over a 6-year period in one centre, from 2010 to 2016. Fifty of these patients had a prior or concomitant diagnosis of cancer. 17.3% of sarcoid cases had an associated malignancy. The most common malignancies were Gastrointestinal (20%), Haematological (18%), Lung (12%), Gynaecological (12%) and Head and Neck cancer (12%). 74% of sarcoid cases had pulmonary disease with sarcoid diagnostic tissue obtained most frequently via endobronchial ultrasound fine needle aspiration (68%). Most sarcoid cases (66%) were diagnosed within the first year of their malignancy diagnosis. Careful consideration needs to be given to the possibility that potential cancer recurrences suspected on imaging studies may indeed be sarcoid reactions.