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04 August 2021

Oral sarcoidosis: literature review and presentation of a primary manifestation

Authors: Marco Campana, Mariani Umberto, Valeria Martini, Riccardo Bonacina, Sonzogni Aurelio

The Objectives of this work are to propose a literature review from 2008 up to 2018 about oral manifestations of sarcoidosis and scar-sarcoidosis and to introduce a rare case of a primary intraoral manifestation of Scar-sarcoidosis.

Materials and Methods

First of all the research was set up in Pubmed and Medline search engines to select all articles concerning sarcoidosis and scar-sarcoidosis oral manifestations published from 2008 up to 2018. 28 cases were found responding to our selected key words. All sarcoidosis cases not involving oral tissues were not considered in this work. Besides a 40 years old male patient case is presented. He was sent us after a previous dermatological examination concerning an asymptomatic growth of an intraoral preexisting scar. We proceeded with anamnesis, clinic and radiological evaluation and finally an incisional biopsy was done. The histological result was sarcoidosis. Patient was referred for a pneumological examination. An oral and pneumological follow-up program is currently underway.

Results and Discussion

20 out of 28 selected cases are female and 8 male patients. Their age is from 30 to 60 years.
10 of them resulted as primary oral manifestations in sarcoidosis diagnosis. 
Most cases of oral manifestations are nodular neoformations, granulomatosis and asymptomatic hyperplasia localized in labial, buccal and palatal mucosa. Few cases are described with symptomatic ulcers and erosions.
In our case report histopathological evaluation refers to diagnosis of sarcoidosis. Therefore a pneumological examination is required. Following specialist evaluation and exams sarcoidosis diagnosis is set.
Sarcoidosis more frequently affects female patients in adulthood (30-60 y). Oral manifestations rarely are described even if sometimes can be the first sign of disease. Whenever oral manifestations are current are often asymptomatic.
Differential diagnosis is with traumatic fibroma, foreign body granuloma, amyloidosis and granulomatous diseases.
A multispecialty approach (hematological and pneumological) associated to histopathological report of granuloma without amyloid are essential for a sarcoidosis diagnosis.

Clinical significance

From all cases collected in the last 10 years and from experience achieved in the described case we can realize the great value of a correct diagnosis of sarcoidosis, but also how a correct diagnosis is difficult to achieve.
The variety of clinical manifestations and presence of more or less symptomatology can generate mistakes about diagnosis. It’s easy to direct our intuitions toward more frequent inflammatory and infective diseases.
A suggestive clinical, hematological and radiological description, presence of granulomas without amyloid and exclusion of similar conditions due to inflammatory diseases or autoimmune disease or inhalatorium diseases are primary for a correct diagnosis.
To complete diagnosis the collaboration of other specialists (hematologist and pulmonologist) is request.

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