Sarcoidosis of the stomach

A 25-year-old housewife presented with an 8-month history of epigastric pain, vomiting and weight loss. This was found to be due to sarcoidosis of the stomach. Her condition improved remarkably on steroids.     

Sarcoidosis involvement and adenocarcinoma of the stomach

A 59-years old woman showed 5 years after the diagnosis of a sarcoidosis of stage II--III according to Wurm and Reindell an abdominal symptomatology in the sense of an ulcerous disease. Radiological, endoscopical and bioptical examinations revealed a small contraction of the antrum, an ulcus at first diagnosed as benign and an adenocarcinoma. In the resected part of the stomach were found noncaseating granulomas with Epithelioid cells and Giant cells as well as the adenocarcinoma. 1 1/2 years after partial resection of the stomach (B II) a recurrence of the carcinoma near the anastomosis and metastases in the lymphonoduli of the abdomen were found by autopsy. Thoracic of abdominal manifestations of the sarcoidosis could no longer be demonstrated.     

Sarcoidosis of the stomach. A case report.

A case of sarcoidosis of the stomach in a 76-year-old woman is described. Fiberoptic gastroscopy and roengenograms presented the appearance of an infiltrating carcinoma. It was possible to follow the spontaneous behaviour or roentgenograms during a period of 4 years. A preceding, spontaneously remitted lesion of the lungs is described, and the lack of parallelism between the two lesions is discussed. The case is seen in the light of other cases described in the literature, and the difficulties concerning the differential diagnosis are discussed.     

Sarcoidosis of the stomach. Endoscopic diagnosis and possibilities of conservative treatment

Previously, the diagnosis of gastric sarcoidosis was only possible in retrospect - on the basis of the histology of the excised part of the stomach, since most patients with a suspected malignancy of the stomach or ulcerative haemorrhages underwent surgery. The diagnosis was verified by a positive Kveim test. Contemporary possibilities of endoscopic diagnosis, together with bioptic verification, permit conservative treatment as an alternative that spares the patient a resection of the stomach. Experience with such a conservative approach is, however, as yet somewhat scanty. The authors submit the case of a 31-year-old patient, in whom sarcoidosis of the stomach - initially identified at our department during 5000 routine fibroendoscopies of the upper digestive tract - was diagnosed endoscopically and bioptically and confirmed by the Kveim test. Prednisone (30 mg a day) was administered in decreasing doses - at present, the patient is on a maintenance dose of 5 mg a day. His digestive complaints quickly disappeared, he gained weight and returned to his job. Objectively, too, the macroscopic changes in the gastric mucosa regressed, although granulomas persist to a lesser extent in biopsy findings. With conservative treatment regular endoscopic and biopsy checkups are essential.     

Sarcoidosis of the Heart

Myocardial involvement in sarcoidosis occurs in about 27% of patients. Clinical manifestations include ventricular arrhythmias, conduction abnormalities, and sudden death. Diagnosis requires clinical suspicion and may be supported by electrocardiography, echocardiography, thallium imaging, gallium-67 scanning, and myocardial biopsy. Steroids seem to be beneficial in the treatment of myocardial sarcoidosis. Those who do not respond to medical treatment may benefit from cardiac transplantation.     

Sarcoidosis of the pancreas

A case of painful granulomatous infiltration of the pancreas occurred in a patient with well-documented sarcoidosis. In the few previous reports of symptomatic granulomatous pancreatitis, none occurred in a clear setting of sarcoidosis. Granulomatous pancreatitis alone has not been reported to cause exocrine or endocrine dysfunction and appears to improve with steroid therapy. Although distinctly rare, granulomatous involvement of the pancreas should be considered in the examination of patients with sarcoidosis and abdominal pain of unclear cause.     

Sarcoidosis of the esophagus

Summary Granulomatous involvement of the esophagus is an unusual manifestation of sarcoidosis. The present report describes a 33-year-old Negro woman who presented with dysphagia and a granulomatous stricture of the esophagus and had a positive Kveim test. There have been 5 previously reported cases of documented sarcoidosis of the esophagus, but in none of these was a Kveim test done. Although the specificity of the Kveim test remains controversial, it was positive in this case of esophageal sarcoidosis.     

Sarcoidosis

There have been several new insights into the cause and treatment of sarcoidosis. Studies of genetic variation have shown that specific genetic polymorphisms are associated with increased risk of disease or affect disease presentation. These polymorphisms include variation of MHC and cytokines such as tumour necrosis factor (TNF). Not all investigators have come to the same conclusion, suggesting an interaction of various factors, including the patient's ethnic origin. Treatment of sarcoidosis varies considerably. Patients with symptomatic disease for more than 2-5 years have been of particular interest. Corticosteroids remain the standard of care in such cases, but immunosuppressive drugs have proved steroid-sparing in many patients. New agents, including pentoxifylline, thalidomide, and infliximab have proved useful in selected cases. The effectiveness of these agents seems to lie in their ability to block TNF, especially in the treatment of chronic disease.