Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2015 Mar 21;21(11):3380-7.
doi: 10.3748/wjg.v21.i11.3380.

Colonic sarcoidosis: unusual onset of a systemic disease

Paola Erra  1 , Sonia Crusco  1 , Loredana Nugnes  1 , Anna Maria Pollio  1 , Gianni Di Pilla  1 , Giuseppe Biondi  1 , Giovanni Vigliardi  1
Affiliations
Case Reports

Colonic sarcoidosis: unusual onset of a systemic disease

Paola Erra et al. World J Gastroenterol. .

Abstract

Sarcoidosis is a multisystem chronic inflammatory condition of unknown etiology that has the potential to involve every tissue in the body. Sarcoidosis in the gastrointestinal system, and particularly the colon, is very rare. Here, we report the case of a 57-year-old man with no previous diagnosis of sarcoidosis who presented with new onset of abdominal pain and constipation. A colonoscopy revealed that the abdominal pain was caused by an obstructing lesion in the cecum-ascending colon and lacked a clear histologic diagnosis. Radiologic investigation revealed concentric wall thickening of the cecum-ascending colon with multiple satellite lymphadenopathies, highly suggestive of a malignancy. The patient underwent a laparotomy and a right hemicolectomy was performed. A diagnosis of colonic sarcoidosis was made after the resected specimen was examined. Additionally, a chest computed tomography scan revealed lung involvement with atypical radiologic features in the absence of respiratory symptoms. Only histologic examination of the surgical specimen can yield a diagnosis of gastrointestinal sarcoidosis due to the non-specificity of endoscopic and radiologic findings.

Keywords: Colon; Hemicolectomy; Noncaseating granuloma; Sarcoidosis; Systemic disease.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Abdominal computed tomography performed after colonoscopy. A: Transverse image of the cecum-ascending colon; B and C: Coronal images showing symmetric concentric wall thickening of the cecum-ascending colon mimicking a tumor lesion; heterogeneous hyperdensity of perivisceral fat tissue is also seen. Satellite lymphadenopathy (arrow) is observed along the ileocolic vessels; D: Enlarged appendix with a thickened wall and marked contrast enhancement.
Figure 2
Figure 2
Chest computed tomography performed after colonoscopy for whole-body staging. A and B: Asymmetric discrete airspace consolidation with air bronchograms in the right upper lobe; C: Numerous micronodular opacities are present in both upper pulmonary lobes (also seen in panel A) with distribution in the peribronchovascular interstitium. These findings showed no significant change after four weeks of antibiotic therapy; D: No pathologic hilar or mediastinal lymph node enlargement was observed.
Figure 3
Figure 3
Resected specimen after laparotomy. A: Right hemicolectomy was performed; B-D: A voluminous stenotic ulcerated lesion of the colonic wall in proximity to the ileocecal valve (arrow in D) was observed; E: Numerous peritoneal micronodules near the colonic lesion are shown.
Figure 4
Figure 4
Histologic examination of the intraoperative specimen. Hematoxylin and eosin staining showed A: Noncaseating epithelioid granulomas in the colonic wall (magnification × 5); B: Confluent granulomata in the colonic wall (magnification × 10); C: Perivisceral involvement (magnification × 5); D: Microscopic aspects of the sarcoidotic granulomas (magnification × 20).
Figure 5
Figure 5
Extracolonic sarcoidosis involvement. Hematoxylin and eosin staining revealed: Sarcoidotic involvement of locoregional lymphadenopathy (A, B) (A: × 10; B: magnification × 40); Sarcoidotic granulomas in the parietal peritoneum adjacent to the colonic lesion (C, D) (C: magnification × 2; D: magnification × 20).
See this image and copyright information in PMC

References

    1. MacArthur KL, Forouhar F, Wu GY. Intra-abdominal complications of sarcoidosis. J Formos Med Assoc. 2010;109:484–492. - PubMed
    1. Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med. 1999;160:736–755. - PubMed
    1. Henke CE, Henke G, Elveback LR, Beard CM, Ballard DJ, Kurland LT. The epidemiology of sarcoidosis in Rochester, Minnesota: a population-based study of incidence and survival. Am J Epidemiol. 1986;123:840–845. - PubMed
    1. Lynch JP, Kazerooni EA, Gay SE. Pulmonary sarcoidosis. Clin Chest Med. 1997;18:755–785. - PubMed
    1. Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ, et al. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med. 2001;164:1885–1889. - PubMed

Publication types

MeSH terms