Sarcoidosis of the female genital tract

Czech version

Authors: A. Šefčíková ¹; M. Turková ²; M. Žurková ³
Authors‘ workplace: Porodnicko-gynekologické oddělení Slezské nemocnice, Opava, primář MUDr. A. Dörr, CSc. ¹; Porodnicko-gynekologická klinika FN a LF UP, Olomouc, přednosta prof. MUDr. R. Pilka, Ph. D. ²; Klinika plicních nemocí a tuberkulózy FN a LF UP, Olomouc, přednosta prof. MUDr. V. Kolek, DrSc. ³
Published in: Ceska Gynekol 2016; 81(6): 458-462

Overview

Objective:
To present the findings of sarcoidosis on female genital tract.

Design:
Review.

Setting:
Department of Obstetric and Gynecology, Silesian Hospital Opava.

Methods:
Overview of published findings from case studies.

Conclusion:
Sarcoidosis is a multisystem granulomatous disorder of unclear cause. It typically involves the lymph nodes of mediastinum, predominantly billateral and/or pulmonary infiltrates. We find extrapulmonary involvement in 30–50% of cases. Sarcoidosis of the female reproductive system is a rare, it represent less than 1% cases of sarcoidosis. Lesions there may affect any organ, including the vulva, vagina, cervix, uterus, fallopian tube and ovary, but also for example placenta and breast. There is also recorded the incidence of multiple localization on female genitalia. Since sarcoidosis of this area is so rare, often proceeds asymptomatic and recognized only as an incidental finding, there are mention only the case histories in literature yet.

Clinical symptoms may be non-specific, often imitating a tumor, or tend to be specific, depending on the localization of disability such as perineal pain, pain in the scar after the previous birth trauma, persistent pruritus, itching, irritation, dyspareunia, menstrual cycle disorders, menorrhagia, metrorrhagia, postmenopausal bleeding, amenorrhoe, abdominal pain, endometrial polypoid lesions, recurrent or persistent serometra or discharge. The diagnosis is made up of histologically – we are demonstrating noncaseating granulomas.

The therapy is difficult, there are no available official guidelines. If the lesions are clinically silent, we can observed them because they may spontaneously disappear. If we are embarking on medical therapy, we start from a local application, and if this is unsuccessful then we approach the systemic administration. Corticosteroids are the drug of choice. If we diagnose the sarcoidosis of the female genital organs we must exclude systemic disease of sarcoidosis. The prognosis of disease is good.

Keywords:
extrapulmonary sarcoidosis, sarcoidosis of the female reproductive tract, granulomatous disease

Sources

1. Allen, SL., Judson, MA. Vaginal involvement in a patient with sarcoidosis. Chest, 2010, 137(2), p. 455–456. doi: 10.1378/chest.09-0076.

2. Bakali, E., Brown, L., Woltmann, G., Tincello, DG. Solitary vaginal sarcoidosis without other manifestations of systemic disease. J Obstet Gynaecol, 2012, 32(8), p. 814–816. doi: 10.3109/01443615.2012.710665

3. Boakye, K., Omalu, B., Thomas, L. Fallopian tube and pulmonary sarcoidoses. A case report. J Reprod Med, 1997, 42(8), p. 533–535.

4. Cormio, G., Leone, L., Camporeale, A., Loizzi, V. A case of sarcoidosis mimicking recurrences of endometrial cancer. J Obstet Gynaecol, 2015, 35(5), p. 540–542. doi: 10.3109/01443615.2014.979778.

5. Decavalas, G., Adonakis, G., Androutsopoulos, G., et al. Sarcoidoses of the vulva: a case report. Arch Gynecol Obstet, 2007, 275(3), p. 203–205. Epub 2006 Aug 16.

6. Elstein, M., Woodcock, A., Buckley, CH. An unusual case of sarcoidosis. Br J Obstet Gynaecol, 1994, 101(5), p. 452–453.

7. Frederick, J., Di Carlo, J., Jilma, P., et al. Sarcoidosis of the uterus. Arch Pathol Lab Med, 1989, 113.

8. Guan, H., Ali, SZ. Uterine cervical sarcoidosis identified on pap test: cytomorphologic findings and differential diagnosis, Acta Cytol, 2011, 55(4), p. 368–371. doi: 10.1159/000326952. Epub 2011 Jul 22.

9. Hillerdal, G., Nou, E., Osterman, K., Schmekel, B. Sarcoidosis: epidemiology and prognosis; a 15-year European study. Am Rev Respir Dis, 1984, 130, p. 29–32.

10. Judson, MA., Baugman, RP., Teirstein, AS., et al. Defining organ involvement in sarcoidosis, the ACCESS proposed instrument. ACCESS research group. A case of control etiologic study of sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis, 1999, 16, p. 75–86.

11. Lošťáková, V., Kolek, V., Vašáková, M. Sarkoidóza – doporučený postup diagnostiky, terapie a sledování vývoje onemocnění. Sekce intersticiáních plicních procesů České pneumologické a ftiseologické společnosti, 2015.

12. Menzin, AW., You, TT., Deger, RB., et al. Sarcoidosis in a uterine leiomyoma. Int J Gynaecol Obstet, 1995, 48(1), p. 79–84.

13. Mohammad, O., Almoujahed, L., et al. Uterine granulomas. Clinical and pathologic features. American society for clinical pathology, 2002.

14. Neumann, G., Rasmussen, KL., Olesen, H. Premenopausal metrorrhagia as a symptom of sarcoidosis. Eur J Obstet Gynecol Reprod Biol, 2002, 104(2), p. 171–173.

15. Parveen, AS., Elliott, H., Howells, R. Sarcoidosis of the ovary. J Obstet Gynaecol. doi:10.1080.

16. Pearce, KF., Nolan, TE. Endometrial sarcoidoses as a cause of postmenopausal bleeding. A case report. J Reprod Med, 1996, 41(11), p. 878–880.

17. Rosa e Silva, JC., de Sá Rosa e Silva, AC., Aguiar, FM., et al. Isolated endometrial polypoid sarcoidosis in a post-menopausal patient: case report. Maturitas, 2006, 53(4), p. 489–491. Epub 2006 Jan 20.

18. Rosenfeld, SI., Steck, W., Breen, JL. Sarcoidosis of the female genital tract: a case presentation and survey of the world literature. Review. Int J Gynaecol Obstet, 1989, 28(4), p. 373–380.

19. Römer, T., Schwesinger, G., Foth, D. Endometrial sarcoidosis manifesting as recurrent serometra in a postmenopausal woman. Acta Obstet Gynecol Scand, 2001, 80(5), p. 482–483.

20. Şahin, N., Solak, A., Karaarslan, S., Doruk, S. Sarcoidoses of the vagina treated with methotrexate. Climacteric, 2016, 19(3), p. 308–310. doi: 10.3109/13697137.2015.1117067. Epub 2015 Dec 1.

21. Sandvei, R., Bang, G. Sarcoidoses of the uterus. Acta Obstet Gynecol Scand, 1991, 70(2), p. 165–167.

22. Schol, PB., De Waard, J., Van Praag, MC., et al. Vaginal sarcoidosis. J Obstet Gynaecol, 2013, 33(4), p. 426. doi: 10.3109/01443615.2012.761183.

23. Tamauchi, S., Shimomura, Y., Hayakawa, H. Endometrial cancer with sarcoidosis in regional lymph nodes: a case report. Case Rep Oncol, 2015, 8(3), p. 409–415. doi: 10.1159/000440800. eCollection 2015 Sep-Dec.

24. Tosolini, AB., Dawborn, JK., Sinclair, R. Genitourinary sarcoidosis. Aust N Z J Med, 1999, 29(2), p. 285–286.

25. Vera, C., Funaro, D., Bouffard, D. Vulvar sarcoidosis: case report and review of the literature. Review. J Cutan Med Surg, 2013, 17(4), p. 287–290.

26. Xu, F., Cheng, Y., Diao, R., et al. Sarcoidosis: vaginal wall and vulvar involvement. Sarcoidosis Vasc Diff Lung Dis, 2012, 29(2), p. 151–154.

27. Zurkova, M., Kolek, V., Tomankova, T., Kriegova, E. Extrapulmonary involvement in patient with sarcoidosis and comparison of routine laboratory and clinical data to pulmonary involvement. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. doi:10.5507/bp.2014.026

28. Zurkova, M., Turkova, M., Tichy, T., et al. Sarcoidosis of female reproductive organs in a postmenopausal woman: a case report and review of the literature: is there a potential for hormone therapy? Menopause, 2015, 22, 5.