Uterine Cervical Sarcoidosis Identified on Pap Test: Cytomorphologic Findings and Differential Diagnosis

Abstract

Background: Sarcoidosis is a multisystem inflammatory disease of uncertain etiology that is histopathologically characterized by non-necrotizing granulomas. It typically involves the lungs and lymph nodes, but has been reported in many other organ systems as well. Sarcoidosis involving the female genital tract, the uterus in particular, is a rare event with isolated accounts in the medical literature. Case: We present a rare occurrence of cervical sarcoidosis in a Pap test of a 31-year-old woman with a history of biopsy-proven mediastinal lymph node sarcoidosis and mediastinal pleomorphic liposarcoma with status post chemotherapy. The Surepath smear showed crowded cellular groups with abundant epithelioid histiocytes and lymphocytes consistent with granulomatous inflammation. No granular necrotic debris or polarizable foreign body material was identified. There were no microorganisms present. The cytomorphologic features and differential diagnoses are discussed. Conclusion: Uterine cervical sarcoidosis, although rare, can be an overlooked cause of non-necrotizing granulomatous inflammation in a cervical Pap test. Sarcoidosis should be a diagnosis of exclusion; other common conditions with similar morphologic presentation such as non-necrotizing tuberculosis, foreign body-related granulomatous inflammation, and neoplastic/chemotherapy-related sarcomatoid reaction need to be excluded in conjunction with the patient’s clinical history.

Tuberculous cervicitis: A brief report with cytohistological correlation and differential diagnosis

“…Other granulomatous diseases of the cervix should be considered, such as amoebiasis, 27 schistosomiasis, 28 sarcoidosis, 29 and history of prior biopsy and surgery 30 should be considered in differential diagnosis.…”

Uterine Sarcoidosis: A Rare Extrapulmonary Site of Sarcoidosis

“…Like any other extra pulmonary manifestation of sarcoidosis, most of the patients have concomitant pulmonary involvement and the disease seems to occur more frequently in the Black population. A majority of the patients present with menstrual irregularities; menorrhagia, metrorrhagia, and postmenopausal bleeding are more commonly reported symptoms than amenorrhea [6, 8–17]. Some of the patients were asymptomatic, and the diagnosis was made based on examination of the hysterectomy or autopsy specimens [6].…”

“…Some cases of uterine sarcoidosis presented with cervical erosions [8], endometrial polypoid lesions [18], and recurrent serometra [16]. Others were incidental findings on cervical pap smear [17] and patients who underwent surgery for uterine myomas. Endometrial curettage led to the diagnosis in the majority of the cases; in others the diagnosis was made on examination of the hysterectomy, polypectomy, and autopsy specimens [6, 17, 18].…”

“…Others were incidental findings on cervical pap smear [17] and patients who underwent surgery for uterine myomas. Endometrial curettage led to the diagnosis in the majority of the cases; in others the diagnosis was made on examination of the hysterectomy, polypectomy, and autopsy specimens [6, 17, 18]. Sampling bias probably accounts for the increased reporting of uterine sarcoidosis compared to other parts of the female genital tract [8].…”

Female Asthma Has a Negative Effect on Fertility: What Is the Connection?

“…There are only few data on this topic. Some studies have by biopsy shown that systemic diseases such as sarcoidosis or tuberculosis can affect the endometrial mucosa by causing granulomatous inflammation in the endometrial lining [51]. Another study by Kurganov [52] in rodents showed that the endometrial mucosa during and after a systemic infection/chronic inflammation was infiltrated by eosinophils and that the infiltrated endometrium was unable to incorporate the embryonated egg.…”