ABSTRACT
Sarcoidosis is a non-necrotizing granulomatous disease of unknown etiology presenting with variable systemic manifestations. Lung involvement is the most common initial presentation of sarcoidosis. Rarely, patients can present with initial non-pulmonary symptoms. Asymptomatic gastric sarcoidosis is a difficult diagnosis as it is not only rare but also under-recognized in the majority of cases. Its treatment is exclusively recommended for symptomatic cases only. However, it is of extreme significance to have the asymptomatic patients follow up outpatient regularly to prevent any major complications. Here, we present an interesting case of a 54-year-old African American female patient with only abdominal pain symptoms attributed to a hepatic abscess. A diagnosis of gastric sarcoidosis was solely based on the presence of non-necrotizing granulomas on biopsy following esophagogastroduodenoscopy (EGD). Incidentally, she was also found to have pulmonary sarcoidosis based on imaging. Her abdominal symptoms improved with abscess drainage and so, she was never started on steroids. She was followed up outpatient for pulmonary function tests. The patient continues to do well without any specific treatment for sarcoidosis. This case demonstrates the variability of sarcoidosis and the significance of biopsy in gastric sarcoidosis.
ABSTRACT
The majority of cases of dyspepsia are functional, with a very rare cause of organic dyspepsia being gastric sarcoidosis. Although gastric sarcoidosis is the most common gastrointestinal manifestation of sarcoidosis, it is asymptomatic in >99% of cases. This is a case of a 48-year-old with known pulmonary sarcoidosis who was diagnosed with gastric sarcoidosis after presenting with dyspepsia.
ABSTRACT
Sarcoidosis is a multisystem disease of unknown etiology, characterized by specific granulomas without caseous necrosis in the affected organs and tissues. Along with respiratory organs, the gastrointestinal tract may be affected by sarcoidosis. Due to the rarity of gastric involvement of sarcoidosis, substantial difficulties arise in verifying the diagnosis, making a differential diagnosis, and examining gastric biopsy specimens. The paper describes in detail pathological changes in the gastric wall tissue specimen in sarcoidosis and comparatively analyzes the findings with the data available in the literature.
Subject(s)
Sarcoidosis , Diagnosis, Differential , Granuloma , Humans , StomachABSTRACT
Sarcoidosis is a granulomatous disease of unknown etiology which may present with systemic manifestations. The diagnosis of gastric sarcoidosis needs much effort to accomplish as it is exceedingly rare, and the treatment is usually recommended exclusively for symptomatic disease. Here, we present a case of gastric sarcoidosis in a 31-year old black female patient with symptoms of nausea and epigastric pain. A diagnosis of gastric sarcoidosis was mainly based on the presence of non-necrotizing granulomas on biopsy following esophagogastroduodenoscopy (EGD). She was treated with steroid with high dose at first, followed by a slow taper and the symptoms responded to the treatment.
Subject(s)
Sarcoidosis/diagnosis , Stomach Diseases/diagnosis , Thoracic Diseases/diagnosis , Bronchoscopy , Diagnosis, Differential , Female , Glucocorticoids/therapeutic use , Humans , Middle Aged , Radiography, Thoracic , Sarcoidosis/complications , Sarcoidosis/drug therapy , Stomach Diseases/complications , Stomach Diseases/drug therapy , Thoracic Diseases/complications , Thoracic Diseases/drug therapy , Tomography, X-Ray ComputedABSTRACT
Gastric sarcoidosis with noncaseating granuloma is rare. Although corticosteroid produces a dramatic clinical response, it is unknown whether azathioprine show efficacy in prednisolone-dependent cases. Here, we report a case of gastric sarcoidosis in a 25-year-old man with severe epigastlargia. Gastroendoscopy revealed multiple map-like ulcerations. Histological examination showed multiple noncaseating granulomatous lesions in gastric mucosa, which were incompatible with diagnoses of Crohn's disease or tuberculosis. He was started on prednisolone at 30 mg/d, and his symptoms improved within 7-d. The prednisolone was gradually tapered by 5 mg every 2-wk, but oral azathioprine at 50 mg was added after symptoms recurred at tapered dose of 10 mg. Endoscopy 4-wk later showed healing ulcers, and, lymphocytic infiltration was absent. The efficacy of additional azathioprine in gastric sarcoidosis is not well defined. Here, we report a case of prednisolone-dependent gastric sarcoidosis that improved after additional azathioprine, and also review the literature concerning the treatment, especially for prednisolone-dependent cases.
Subject(s)
Azathioprine/administration & dosage , Glucocorticoids/administration & dosage , Immunosuppressive Agents/administration & dosage , Prednisolone/administration & dosage , Sarcoidosis/drug therapy , Stomach Diseases/drug therapy , Administration, Oral , Adult , Biopsy , Drug Administration Schedule , Drug Therapy, Combination , Endosonography , Gastroscopy , Humans , Male , Recurrence , Sarcoidosis/diagnosis , Stomach Diseases/diagnosis , Treatment OutcomeABSTRACT
Sarcoidosis is a multisystemic disorder that is characterized by the formation of noncaseating granulomas. Although sarcoidosis can affect any organ, gastrointestinal tract involvement in sarcoidosis is very rare, and gastric cancer associated with gastric sarcoidosis has hardly been reported. A 64-year-old female with a 10-year history of the medical treatment of gastric sarcoidosis received a routine follow-up gastrointestinal endoscopy and an irregular-shaped, elevated lesion was detected in the gastric corpus. The gastric mucosal surface was nodular and ulcerated throughout the stomach. The gastric lumen was narrow, and the gastric wall was stiff and nondistensible, resembling linitis plastica. The biopsies of the elevated lesion in the gastric corpus revealed well-differentiated adenocarcinoma. An endoscopic ultrasonography was then performed, but it failed to assess precisely the depth of cancer invasion because of sarcoidosis-related gastritis and fibrosis of the gastric wall. The patient underwent a laparoscopic total gastrectomy under the diagnosis of gastric cancer associated with gastric sarcoidosis. Histologic examination of the surgical specimen demonstrated well-differentiated adenocarcinoma in the gastric corpus, and the histologic mapping of cancer cells revealed that the tumor spread within the mucosal layer of the stomach. No lymph node metastasis was found. The patient's postoperative course was uneventful. We experienced a rare case of early gastric cancer associated with gastric sarcoidosis, which identified the troublesome issue that the assessment of depth of cancer invasion is difficult, because patients with longstanding gastric sarcoidosis may involve various degrees of fibrosis of the gastric wall.
Subject(s)
Adenocarcinoma/diagnosis , Adenocarcinoma/surgery , Sarcoidosis/complications , Stomach Diseases/complications , Stomach Neoplasms/diagnosis , Stomach Neoplasms/surgery , Biopsy , Colonoscopy , Diagnosis, Differential , Female , Gastrectomy , Gastroscopy , Humans , Middle Aged , Tomography, X-Ray ComputedABSTRACT
Gastrointestinal sarcoidosis is a rare form of extrapulmonary sarcoidosis. Most of the cases are represented by gastric involvement. We describe a patient with previous systemic sarcoidosis who presented with non-specific abdominal complaints. The workup showed the unusual combination of isolated active gastric sarcoidosis and quiescent activity of the disease elsewhere. We briefly review the clinical, diagnostic and therapeutic aspects of gastric sarcoidosis. We hope to increase awareness about this rare disease.