Special Issue "New Frontiers in the Diagnosis of Sarcoidosis"

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Immunology".

Deadline for manuscript submissions: closed (15 November 2021) | Viewed by 9257

Special Issue Editors

Prof. Dr. Cosima Schiavone
E-Mail Website
Guest Editor
Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, “G. d’Annunzio” University of Chieti-Pescara, 65122 Chieti, Italy
Interests: internal Medicine; ultrasound; gastrenterology
Special Issues, Collections and Topics in MDPI journals
Dr. Claudio Tana
E-Mail Website
Guest Editor
COVID-19 Medicine Unit and Geriatrics Clinic, SS Annunziata Hospital of Chieti, 66100 Chieti, Italy
Interests: internal medicine; rare disorders; sarcoidosis; clinical imaging; ultrasound
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues, 

Sarcoidosis is a granulomatous disease that can affect every body organ to a different extent. Usually, the involvement of lung and intrathoracic lymph nodes dominates, but no tissue is virtually spared from the disease. The diagnostic role of imaging, such as computed tomography and magnetic resonance, is to reveal the presence of parenchymal infiltrates, lymphadenopathy, and also by documenting organ enlargement, nodular lesions, and patchy infiltration in extrapulmonary sites. The use of conventional ultrasound but even more that of contrast-enhanced ultrasound (CEUS) has been demonstrated to be useful to detect occult lesions and to describe the characteristics of some nodules that are not otherwise evident on the baseline examination. Finally, recent studies have highlighted that FDG PET/CT is also useful in staging the disease, in order to assess the presence of occult lesions, disease extent, treatment response and to identify the most suitable site for biopsy. 

The aim of this Special Issue is to report an overview of the latest research on the diagnosis of Sarcoidosis. Authors are invited to submit original research articles and review papers about the diagnostic advances of imaging techniques that could assist clinicians in clinical practice. 

Prof. Cosima Schiavone
Dr. Claudio Tana
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Sarcoidosis
  • Granuloma
  • Infiltration
  • Computed tomography
  • Magnetic-resonance imaging
  • Contrast-enhanced ultrasound
  • FDG-PET/CT

Published Papers (8 papers)

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Editorial

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Editorial
The Chameleon Behavior of Sarcoidosis
J. Clin. Med. 2021, 10(13), 2780; https://doi.org/10.3390/jcm10132780 - 24 Jun 2021
Cited by 2 | Viewed by 611
Abstract
Sarcoidosis is a multisystem disease that raises several diagnostic difficulties in routine clinical practice due to its multisystemic involvement and the presence of nonspecific clinical pictures, except in some isolated cases [...] Full article
(This article belongs to the Special Issue New Frontiers in the Diagnosis of Sarcoidosis)

Review

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Review
Histology of Cardiac Sarcoidosis with Novel Considerations Arranged upon a Pathologic Basis
J. Clin. Med. 2022, 11(1), 251; https://doi.org/10.3390/jcm11010251 - 04 Jan 2022
Viewed by 562
Abstract
Sarcoidosis is a rare disease of isolated or diffuse granulomatous inflammation. Although any organs can be affected by sarcoidosis, cardiac sarcoidosis is a fatal disorder, and it is crucial to accurately diagnose it to prevent sudden death due to dysrhythmia. Although endomyocardial biopsy [...] Read more.
Sarcoidosis is a rare disease of isolated or diffuse granulomatous inflammation. Although any organs can be affected by sarcoidosis, cardiac sarcoidosis is a fatal disorder, and it is crucial to accurately diagnose it to prevent sudden death due to dysrhythmia. Although endomyocardial biopsy is invasive and has limited sensitivity for identifying granulomas, it is the only modality that yields a definitive diagnosis of cardiac sarcoidosis. It is imperative to develop novel pathological approaches for the precise diagnosis of cardiac sarcoidosis. Here, we aimed to discuss commonly used diagnostic criteria for cardiac sarcoidosis and to summarize useful and novel histopathologic criteria of cardiac sarcoidosis. While classical histologic observations including noncaseating granulomas and multinucleated giant cells (typically Langhans type) are the most important findings, others such as microgranulomas, CD68+ CD163 pro-inflammatory (M1) macrophage accumulation, CD4/CD8 T-cell ratio, Cutibacterium acnes components, lymphangiogenesis, confluent fibrosis, and fatty infiltration may help to improve the sensitivity of endomyocardial biopsy for detecting cardiac sarcoidosis. These novel histologic findings are based on the pathology of cardiac sarcoidosis. We also discussed the principal histologic differential diagnoses of cardiac sarcoidosis, such as tuberculosis myocarditis, fungal myocarditis, giant cell myocarditis, and dilated cardiomyopathy. Full article
(This article belongs to the Special Issue New Frontiers in the Diagnosis of Sarcoidosis)
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Review
Advances in Diagnostic Imaging for Cardiac Sarcoidosis
J. Clin. Med. 2021, 10(24), 5808; https://doi.org/10.3390/jcm10245808 - 11 Dec 2021
Viewed by 1178
Abstract
Sarcoidosis is a systemic granulomatous disease of unknown etiology, and its clinical presentation depends on the affected organ. Cardiac sarcoidosis (CS) is one of the leading causes of death among patients with sarcoidosis. The clinical manifestations of CS are heterogeneous, and range from [...] Read more.
Sarcoidosis is a systemic granulomatous disease of unknown etiology, and its clinical presentation depends on the affected organ. Cardiac sarcoidosis (CS) is one of the leading causes of death among patients with sarcoidosis. The clinical manifestations of CS are heterogeneous, and range from asymptomatic to life-threatening arrhythmias and progressive heart failure due to the extent and location of granulomatous inflammation in the myocardium. Advances in imaging techniques have played a pivotal role in the evaluation of CS because histological diagnoses obtained by myocardial biopsy tend to have lower sensitivity. The diagnosis of CS is challenging, and several approaches, notably those using positron emission tomography and cardiac magnetic resonance imaging (MRI), have been reported. Delayed-enhanced computed tomography (CT) may also be used for diagnosing CS in patients with MRI-incompatible devices and allows acceptable evaluation of myocardial hyperenhancement in such patients. This article reviews the advances in imaging techniques for the evaluation of CS. Full article
(This article belongs to the Special Issue New Frontiers in the Diagnosis of Sarcoidosis)
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Review
Novelties in Imaging of Thoracic Sarcoidosis
J. Clin. Med. 2021, 10(11), 2222; https://doi.org/10.3390/jcm10112222 - 21 May 2021
Cited by 1 | Viewed by 731
Abstract
Sarcoidosis is a systemic granulomatous disease affecting various organs, and the lungs are the most commonly involved. According to guidelines, diagnosis relies on a consistent clinical picture, histological demonstration of non-caseating granulomas, and exclusion of other diseases with similar histological or clinical picture. [...] Read more.
Sarcoidosis is a systemic granulomatous disease affecting various organs, and the lungs are the most commonly involved. According to guidelines, diagnosis relies on a consistent clinical picture, histological demonstration of non-caseating granulomas, and exclusion of other diseases with similar histological or clinical picture. Nevertheless, chest imaging plays an important role in both diagnostic assessment, allowing to avoid biopsy in some situations, and prognostic evaluation. Despite the demonstrated lower sensitivity of chest X-ray (CXR) in the evaluation of chest findings compared to high-resolution computed tomography (HRCT), CXR still retains a pivotal role in both diagnostic and prognostic assessment in sarcoidosis. Moreover, despite the huge progress made in the field of radiation dose reduction, chest magnetic resonance (MR), and quantitative imaging, very little research has focused on their application in sarcoidosis. In this review, we aim to describe the latest novelties in diagnostic and prognostic assessment of thoracic sarcoidosis and to identify the fields of research that require investigation. Full article
(This article belongs to the Special Issue New Frontiers in the Diagnosis of Sarcoidosis)
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Review
Clinical Features and Diagnosis of Cardiac Sarcoidosis
J. Clin. Med. 2021, 10(9), 1941; https://doi.org/10.3390/jcm10091941 - 01 May 2021
Cited by 2 | Viewed by 1069
Abstract
Cardiac sarcoidosis (CS) is an unusual, but potentially harmful, manifestation of systemic sarcoidosis (SA), a chronic disease characterized by organ involvement from noncaseating and nonnecrotizing granulomas. Lungs and intrathoracic lymph nodes are usually the sites that are most frequently affected, but no organ [...] Read more.
Cardiac sarcoidosis (CS) is an unusual, but potentially harmful, manifestation of systemic sarcoidosis (SA), a chronic disease characterized by organ involvement from noncaseating and nonnecrotizing granulomas. Lungs and intrathoracic lymph nodes are usually the sites that are most frequently affected, but no organ is spared and CS can affect a variable portion of SA patients, up to 25% from post-mortem studies. The cardiovascular involvement is usually associated with a bad prognosis and is responsible for the major cause of death and complications, particularly in African American patients. Furthermore, the diagnosis is often complicated by the occurrence of non-specific clinical manifestations, which can mimic the effect of more common heart disorders, and imaging and biopsies are the most valid approach to avoid misdiagnosis. This narrative review summarizes the main clinical features of CS and imaging findings, particularly of CMR and 18-Fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET) that can give the best cost/benefit ratio in terms of the diagnostic approach. Imaging can be very useful in replacing the endomyocardial biopsy in selected cases, to avoid unnecessary, and potentially dangerous, invasive maneuvers. Full article
(This article belongs to the Special Issue New Frontiers in the Diagnosis of Sarcoidosis)
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Review
Immunohistochemical Detection of Potential Microbial Antigens in Granulomas in the Diagnosis of Sarcoidosis
J. Clin. Med. 2021, 10(5), 983; https://doi.org/10.3390/jcm10050983 - 02 Mar 2021
Cited by 12 | Viewed by 1201
Abstract
Sarcoidosis may have more than a single causative agent, including infectious and non-infectious agents. Among the potential infectious causes of sarcoidosis, Mycobacterium tuberculosis and Propionibacterium acnes are the most likely microorganisms. Potential latent infection by both microorganisms complicates the findings of molecular and [...] Read more.
Sarcoidosis may have more than a single causative agent, including infectious and non-infectious agents. Among the potential infectious causes of sarcoidosis, Mycobacterium tuberculosis and Propionibacterium acnes are the most likely microorganisms. Potential latent infection by both microorganisms complicates the findings of molecular and immunologic studies. Immune responses to potential infectious agents of sarcoidosis should be considered together with the microorganisms detected in sarcoid granulomas, because immunologic reactivities to infectious agents reflect current and past infection, including latent infection unrelated to the cause of the granuloma formation. Histopathologic data more readily support P. acnes as a cause of sarcoidosis compared with M. tuberculosis, suggesting that normally symbiotic P. acnes leads to granuloma formation in some predisposed individuals with Th1 hypersensitivity against intracellular proliferation of latent P. acnes, which may be triggered by certain host or drug-induced conditions. Detection of bacterial nucleic acids in granulomas does not necessarily indicate co-localization of the bacterial proteins in the granulomas. In the histopathologic diagnosis of sarcoidosis, M. tuberculosis-associated and P. acnes-associated sarcoidosis will possibly be differentiated in some patients by immunohistochemistry with appropriate antibodies that specifically react with mycobacterial and propionibacterial antigens, respectively, for each etiology-based diagnosis and potential antimicrobial intervention against sarcoidosis. Full article
(This article belongs to the Special Issue New Frontiers in the Diagnosis of Sarcoidosis)
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Review
CT Findings in Pulmonary and Abdominal Sarcoidosis. Implications for Diagnosis and Classification
J. Clin. Med. 2020, 9(9), 3028; https://doi.org/10.3390/jcm9093028 - 20 Sep 2020
Cited by 10 | Viewed by 1350
Abstract
Sarcoidosis is a granulomatous disorder of unknown etiology characterized by noncaseating granulomas virtually in every organ and tissue. This finding represents the most important diagnostic clue to reach a correct definition of sarcoidosis, although the biopsy is invasive and has several risk procedures. [...] Read more.
Sarcoidosis is a granulomatous disorder of unknown etiology characterized by noncaseating granulomas virtually in every organ and tissue. This finding represents the most important diagnostic clue to reach a correct definition of sarcoidosis, although the biopsy is invasive and has several risk procedures. Several efforts are made to suspect the diagnosis of sarcoidosis by combining noninvasive elements, in particular from imaging, though these findings are often nonspecific and reflect the wide multifactorial pathogenesis. Every effort should be made to obtain a detailed radiological picture that, if associated with a suggestive clinical picture, could avoid the need of biopsy in some specific cases. In this narrative review, we aim to describe main computed tomography (CT) features of pulmonary and abdominal sarcoidosis, by reporting strengths and limits of this technique, in particular for the identification of extrapulmonary, isolated disease. Full article
(This article belongs to the Special Issue New Frontiers in the Diagnosis of Sarcoidosis)
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Review
Clinical Presentations, Pathogenesis, and Therapy of Sarcoidosis: State of the Art
J. Clin. Med. 2020, 9(8), 2363; https://doi.org/10.3390/jcm9082363 - 24 Jul 2020
Cited by 10 | Viewed by 1576
Abstract
Sarcoidosis is a systemic disease of unknown etiology characterized by the presence of noncaseating granulomas that can occur in any organ, most commonly the lungs. Early and accurate diagnosis of sarcoidosis remains challenging because initial presentations may vary, many patients are asymptomatic, and [...] Read more.
Sarcoidosis is a systemic disease of unknown etiology characterized by the presence of noncaseating granulomas that can occur in any organ, most commonly the lungs. Early and accurate diagnosis of sarcoidosis remains challenging because initial presentations may vary, many patients are asymptomatic, and there is no single reliable diagnostic test. Prognosis is variable and depends on epidemiologic factors, mode of onset, initial clinical course, and specific organ involvement. From a pathobiological standpoint, sarcoidosis represents an immune paradox, where an excessive spread of both the innate and the adaptive immune arms of the immune system is accompanied by a state of partial immune anergy. For all these reasons, the optimal treatment for sarcoidosis remains unclear, with corticosteroid therapy being the current gold standard for those patients with significantly symptomatic or progressive pulmonary disease or serious extrapulmonary disease. This review is a state of the art of clinical presentations and immunological features of sarcoidosis, and the current therapeutic approaches used to treat the disease. Full article
(This article belongs to the Special Issue New Frontiers in the Diagnosis of Sarcoidosis)
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