Focal spleen sarcoidosis: clinical and diagnostic characteristics

Purpose of the study. Analysis of literature data on cases of spleen sarcoidosis focal manifestations.
Materials and methods. A search was conducted for publications in the PubMed database using the keywords "splenic sarcoidosis", "isolated splenic sarcoidosis" and "primary splenic sarcoidosis" for the period from 1944 to 2024. Articles describing clinical observations of spleen sarcoidosis were selected, where it was possible to reliably determine the presence of focal manifestations of spleen sarcoidosis with a descriptive diagnostic picture, morphological verification, as well as additional information about lesions of other organs.
Results. The analysis of these articles revealed 128 cases of spleen sarcoidosis, of which isolated focal spleen sarcoidosis was detected in 41 (32.0 %) cases. Combined sarcoidosis (in which the lesion of the spleen was combined with one or two other localizations or was part of a multiple lesion of the entire organism) accounted for 68.0 % of cases. Sarcoidosis developed synchronously or after surgical treatment of cancer in 22 (17.2 %) cases: synchronously – 12 (54.5 %) cases; in the postoperative period – 10 (45.5 %). An analysis of the identified observations is carried out. The main clinical and radiation characteristics of focal sarcoidosis of the spleen, as well as the most common other localizations in our analysis, are highlighted.
Conclusion. Spleen lesions can occur in various clinical situations, ranging from asymptomatic patients to critically ill patients. However, focal formations of the spleen are quite rare, which makes it difficult to collect data from large groups of homogeneous morphological forms for analysis and development of criteria for differential diagnosis, therefore, the presence of a focus in the spleen often causes difficulties for specialists to make a diagnosis. The review identifies the incidence rates of focal spleen sarcoidosis and highlights its main clinical and radiation characteristics. Knowledge of these signs makes it possible to differentiate the disease, especially with an isolated lesion.

1. Chuchalin AG, Avdeev SN, Aisanov ZR, Baranova OP, Borisov SE, Geppe NA, et al. Sarcoidosis: federal clinical guidelines for diagnosis and treatment. Pulmonologiya. 2022;32(6):806–833. (In Russ.). https://doi.org/10.18093/0869-0189-2022-32-6-806-833

2. Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H Jr, Bresnitz EA, et al.; Case Control Etiologic Study of Sarcoidosis (ACCESS) research group. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med. 2001 Nov 15;164(10 Pt 1):1885–1889. https://doi.org/10.1164/ajrccm.164.10.2104046

3. Sève P, Pacheco Y, Durupt F, Jamilloux Y, Gerfaud-Valentin M, Isaac S, et al. Sarcoidosis: A Clinical Overview from Symptoms to Diagnosis. Cells. 2021 Mar 31;10(4):766. https://doi.org/10.3390/cells10040766

4. Crouser ED, Maier LA, Wilson KC, Bonham CA, Morgenthau AS, Patterson KC, et al. Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2020 Apr 15;201(8):e26–e51. https://doi.org/10.1164/rccm.202002-0251st

5. 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 Aug;160(2):736–755. https://doi.org/10.1164/ajrccm.160.2.ats4-99

6. Gezer NS, Başara I, Altay C, Harman M, Rocher L, Karabulut N, Seçil M. Abdominal sarcoidosis: cross-sectional imaging findings. Diagn Interv Radiol. 2015 Mar-Apr;21(2):111–117. https://doi.org/10.5152/dir.2014.14210

7. Madaule S, Lauque D, Sailler L, Arlet P, Carles P. Les splénomégalies sarcoïdosiques: caractéristiques cliniques et évolutives. A propos de 17 observations [Splenomegaly in sarcoidosis: clinical features and outcome. Analysis of 17 cases]. Rev Med Interne. 2004 May;25(5):348–356. (French). https://doi.org/10.1016/j.revmed.2003.11.007

8. Pérez-Grueso MJ, Repiso A, Gómez R, Gonzalez C, de Artaza T, Valle J, et al. Splenic focal lesions as manifestation of sarcoidosis: Characterization with contrast-enhanced sonography. J Clin Ultrasound. 2007 Sep;35(7):405–408. https://doi.org/10.1002/jcu.20322

9. Valeyre D, Prasse A, Nunes H, Uzunhan Y, Brillet PY, Müller-Quernheim J. Sarcoidosis. Lancet. 2014 Mar 29;383(9923):1155–1167. https://doi.org/10.1016/s0140-6736(13)60680-7

10. Tana C, Dietrich CF, Schiavone C. Hepatosplenic sarcoidosis: contrast-enhanced ultrasound findings and implications for clinical practice. Biomed Res Int. 2014;2014:926203. https://doi.org/10.1155/2014/926203

11. Sumiyoshi A, Sannoe Y, Tanaka K. Rhabdomyosarcoma of the esophagus--a case report with sarcoid-like lesions in its draining lymph nodes and the spleen. Acta Pathol Jpn. 1972 Aug;22(3):581–589.

12. Lapertosa G. Un caso di linfogranuloma maligno con alterazioni di tipo sarcoidosico nella milza [Case of malignant lymphogranuloma with sarcoid-type changes of the spleen]. Pathologica. 1975 Jan-Feb; 67(963-964):61–68.

13. Mukhin AS, Kornev BM, Shatalov NN, Anisimov LL, Lebedev SP. Liver and spleen damage in sarcoidosis. Sovetskaya meditsina. 1980;8:26–29. (In Russ.).

14. Venho KK, Selroos O, Haahtela T, Mönkäre S. Splenic granulomas in Farmer's lund disease. An extrapulmonary manifestation of extrinsic allergic alveolitis. Acta Med Scand. 1982;211(5):413–414.

15. Shatalov NN, Anisimov LL, Kornev VM, Kamalov YuR, Mamonova EN. Spleen damage in sarcoidosis. Clinical Medicine. 1985;63(6):58–61.

16. Prugberger E., Prieger J., Szinay G., Farkas K. Pajzsmirigy és lépérintettség akut sarcoidosisban. Rendkívüli módon elhunyt flatal nöbeteg ritka bonclelete [Thyroid and spleen involvement in acute sarcoidosis. Rare pathological findings in a young woman having died under unusual circumstances]. Morphol Igazsagugyi Orv Sz. 1987 Oct;27(4):274–279.

17. Legrand I, Hassan M, Brauner M. Manifestations radiologiques de la sarcoïdose splénique et gastroduodénale. A propos de 2 observations [Radiological manifestations of splenic and gastroduodenal sarcoidosis. Apropos of 2 cases]. J Radiol. 1988 Jan; 69(1):39–43.

18. Ishizaki T, Kuroda H, Kuroda T, Nakai T, Miyabo S. Sarcoidosis with multiple calcification. Jpn J Med. 1988 May; 27(2):191–194. https://doi.org/10.2169/internalmedicine1962.27.191

19. Kitamura M, Ishizaki T. Sarcoidosis of the liver and spleen in Japan. Nihon Rinsho. 1994 Jun;52(6):1595–1598.

20. Guilarte López-Mañas J, Bellot García V, Gallego Rojo FJ, Casado Caballero FJ, Ardoy Ibáñez FM, Ortego Centeno N, Caballero Plasencia AM. Colestasis intrahepática crónica asintomática y múltiples nódulos hipodensos en hígado y bazo: manifestaciones de un caso de sarcoidosis [Asymptomatic chronic intrahepatic cholestasis and multiple hypodense nodules in the liver and the spleen: manifestations of a case of sarcoidosis]. Gastroenterol Hepatol. 1996 Aug-Sep;19(7):359–362.

21. Molina M, Ortega G, Rivera MD, Pérez-Luján R. Sarcoidosis extratorácica con esplenomegalia gigante y osteolisis craneal [Extrathoracic sarcoidosis with giant splenomegaly and cranial osteolysis]. An Med Interna. 1996 Dec; 13(12):598–600.

22. Robertson AS, Hawighorst H. Unklarer MR-Befund der Milz. Milzbeteiligung bei systemischer Sarkoidose [Unknown MRI finding of the spleen. Splenic involvement in systemic sarcoidosis]. Radiologe. 1997 Dec; 37(12):1017–1018. (In German). https://doi.org/10.1007/s001170050315

23. Shigematsu H, Kurita A, Omura Y, Kubo Y, Takashima S, Mandai K. Gastric cancer with sarcoid reactions in the regional lymph nodes, the stomach wall, and the splenic parenchyma: report of a case. Surg Today. 1999;29(6):549–552. https://doi.org/10.1007/bf02482351

24. Mestiri I, Dridi L, Hantous S, Merai S, Djeneyah F, Ben Miled-Mrad K. Sarcoïdose nodulaire de la rate. Une nouvelle observation [Nodular sarcoidosis of the spleen. A new case]. Rev Med Interne. 1999 Nov; 20(11):1048–1050. (In French). https://doi.org/10.1016/s0248-8663(00)87091-5

25. Sharma OP, Vucinic V, James DG. Splenectomy in sarcoidosis: indications, complications, and long-term follow-up. Sarcoidosis Vasc Diffuse Lung Dis. 2002 Mar;19(1):66–70.

26. Czekajska-Chehab E, Kieszko R, Drop A, Milanowski J, Krawczyk P. Nodular lesions in the spleen diagnosed by US and CT in the course of sarcoidosis. Ann Univ Mariae Curie Sklodowska Med. 2003;58(1):118–123.

27. Brader P, Scheidl S, Reittner P. Lungenkavernen einer Sarkoidose mit nodulärem Leber- und Milzbefall [Lung caverns in sarcoidosis with nodular liver and spleen involvement]. Rofo. 2004 Oct; 176(10):1515–1517.

28. Payne MM, Kaimatchiev V, Loriax M. Pathologic quiz case: multiple splenic nodules. Splenic sarcoid. Arch Pathol Lab Med. 2005 Mar;129(3):419–420. https://doi.org/10.5858/2005-129-419-pqcmsn

29. Zia H, Zemon H, Brody F. Laparoscopic splenectomy for isolated sarcoidosis of the spleen. J Laparoendosc Adv Surg Tech A. 2005 Apr;15(2):160–162. https://doi.org/10.1089/lap.2005.15.160

30. Gorriño Angulo M, Isusi M, Oleaga L, Grande D. Sarcoidosis con afectación sistémica. A propósito de dos casos [Sarcoidosis with systemic involvement: a report of two cases]. Radiologia. 2007 May-Jun; 49(3):194–197. https://doi.org/10.1016/s0033-8338(07)73749-9

31. Wang YT, Han YP, Xu H, Chen HZ, Sheng K, Li Q. Splenic sarcoidosis: a case report and review of literature. Zhonghua Nei Ke Za Zhi. 2009 May;48(5):367–370.

32. Kitamura A, Takiguchi Y, Sugiura T, Kitazono S, Kurosu K, Tanabe N, et al. Symptomatic splenomegaly in a young Japanese man with sarcoidosis accompanied by spleen, liver, kidney, lung and lymph node lesions. Nihon Kokyuki Gakkai Zasshi. 2009 Aug;47(8):742–745.

33. Giovinale M, Fonnesu C, Soriano A, Cerquaglia C, Curigliano V, Verrecchia E, De Socio G, Gasbarrini G, Manna R. Atypical sarcoidosis: case reports and review of the literature. Eur Rev Med Pharmacol Sci. 2009 Mar;13 Suppl 1:37–44

34. Chen MY, Cai JT, Du Q, Wang LJ. Sarcoidosis of spleen presenting with solitary thrombopenia. Eur J Intern Med. 2009 Jan;20(1):e12. https://doi.org/10.1016/j.ejim.2007.09.022

35. Joglekar SP, Hudson RL, Logasundaram R, Pereira JH. 'Surgical cure' for non-parathyroid hypercalcemia. World J Surg Oncol. 2009 Mar 2;7:23. https://doi.org/10.1186/1477-7819-7-23

36. Cuilliere-Dartigues P, Meyohas MC, Balladur P, Gorin NC, Coppo P. Splenic sarcoidosis: an unusual aetiology of agranulocytosis. Am J Hematol. 2010 Nov;85(11):891. https://doi.org/10.1002/ajh.21661

37. Kurata A, Takayama N, Terado Y, Hirano K, Yokoyamda K, Fujioka Y. Sarcoidal granulomas in the spleen associated with multiple carcinomas. Sarcoidosis Vasc Diffuse Lung Dis. 2010 Jul;27(2):153–159.

38. Jöst C, Aiginger C, Prosch H. Isolierte Sarkoidose der Milz und Leber als Ultraschall-Zufallsbefund [Isolated sarcoidosis of the spleen and liver as incidental ultrasound finding]. Rofo. 2010 Apr;182(4):353–354. (In German). https://doi.org/10.1055/s-0028-1109829

39. Ogiwara Y, Mori S, Iwama M, Sawabe M, Takemoto M, Kanazawa N, et al. Hypoglycemia due to ectopic secretion of insulin-like growth factor-I in a patient with an isolated sarcoidosis of the spleen. Endocr J. 2010;57(4):325–330. https://doi.org/10.1507/endocrj.k09e-370

40. Stryckers M, Voet D, Vogelaers D, Afschrift M, Verstraete K, Van Belle S. Contrast-enhanced ultrasonography in hepatosplenic sarcoidosis. Acta Clin Belg. 2011 Nov-Dec;66(6):429–431.

41. Raber EL, Haba J, Beck P. Splenic sarcoidosis: a case report and review of the imaging findings of multiple incidental splenic lesions as the initial presentation of sarcoidosis. Can J Gastroenterol. 2011 Sep;25(9):477–478. https://doi.org/10.1155/2011/748920

42. Hsu HL. Multiple splenic tumors, hypercalcemia, and acute renal failure. Isolated splenic sarcoidosis. Gastroenterology. 2011 Jan;140(1):e7–8. https://doi.org/10.1053/j.gastro.2010.01.062

43. Wang YT, Han YP, Li Q, Chen HZ. Recurrence of sarcoidosis: the follow-up of splenic involvement. Heart Lung. 2012 Nov- Dec;41(6):e44–8. https://doi.org/10.1016/j.hrtlng.2011.09.010

44. Palade R, Voiculescu D, Suliman E, Simion G. Splenic sarcoidosis – a case report. Chirurgia (Bucur). 2012 Sep-Oct;107(5):670–674.

45. Konishi H, Komatsu S, Ichikawa D, Sougawa A, Okamoto K, Shiozaki A, et al. Diagnostic problems in gastric cancer patients with sarcoidosis-case report and literature review. Gan To Kagaku Ryoho. 2012 Nov; 39(12):2330–2332.

46. Fong ZV, Wong J, Maley WR, Sandorfi N, Winter JM, Koniaris LG, et al. Sarcoid-reaction mimicking metastatic malignant hepatopancreatobiliary tumors: report of two cases and review of the literature. J Gastrointest Surg. 2012 Jun;16(6):1245–1250. https://doi.org/10.1007/s11605-011-1820-3

47. Tana C, Iannetti G, D'Alessandro P, Tana M, Mezzetti A, Schiavone C. Pitfalls of contrast-enhanced ultrasound (CEUS) in the diagnosis of splenic sarcoidosis. J Ultrasound. 2013 Mar 2;16(2):75–80. https://doi.org/10.1007/s40477-013-0013-1

48. Grzelak P, Augsburg Ł, Majos A, Stefańczyk L, Górski P, Piotrowski W, Antczak A. Diagnostic potential of contrast-enhanced ultrasound (CEUS) in the assessment of spleen and liver granulomas in the course of sarcoidosis. Pneumonol Alergol Pol. 2013;81(5):424–428.

49. Bauones S, Le Corroller T, Durieux O, Guenoun D, Del Grande J, Pirro N, Champsaur P. Splenic sarcoidosis mimicking neoplastic disease. J Clin Ultrasound. 2014 Jan;42(1):38–41. https://doi.org/10.1002/jcu.22031

50. Souto MM, Tempes BC, Lambert BF, Trindade EN, Trindade MR. Laparoscopic splenectomy for isolated splenic sarcoidosis. JSLS. 2014 Jan-Mar;18(1):155–159. https://doi.org/10.4293/108680814x13868878212956

51. Dennis BA, Jajosky RP, Harper RJ. Splenic sarcoidosis without focal nodularity: a case of 1,25-dihydroxyvitamin D-mediated hypercalcemia localized with FDG PET/CT. Endocr Pract. 2014 Feb;20(2):e28–33. https://doi.org/10.4158/ep13240.cr

52. Sada M, Saraya T, Ishii H, Goto H. Sudden multiple fractures in a patient with sarcoidosis in multiple organs. BMJ Case Rep. 2014 Apr 7;2014:bcr2013201408. https://doi.org/10.1136/bcr-2013-201408

53. Sreelesh KP, Kumar ML, Anoop TM. Primary splenic sarcoidosis. Proc (Bayl Univ Med Cent). 2014 Oct;27(4):344–345. https://doi.org/10.1080/08998280.2014.11929154

54. Kobe C, Maintz D, Fischer T, Drzezga A, Chang DH. Prostate-Specific Membrane Antigen PET/CT in Splenic Sarcoidosis. Clin Nucl Med. 2015 Nov;40(11):897–898. https://doi.org/10.1097/rlu.0000000000000827

55. Ruiz Serrato A, Guerrero León MÁ, Jiménez Martín J, Gómez Lora D. Isolated splenic sarcoidosis. Reumatol Clin. 2015 Jan- Feb;11(1):54–55. English, Spanish. https://doi.org/10.1016/j.reuma.2014.01.006

56. Yonenaga Y, Kushihata F, Inoue H, Watanabe J, Tohyama T, Sugita A, Takada Y. Sarcoidosis manifesting as hepatic and splenic nodules mimicking ovarian cancer metastases: A case report. Oncol Lett. 2015 Oct;10(4):2166–2170. https://doi.org/10.3892/ol.2015.3566

57. Shima T, Tanaka Y, Katsuragi K, Fujio N, Nakatani S, Kobayashi Y, Hida T. Sarcoid reaction in the spleen after sigmoid colon cancer resection: a case report. Surg Case Rep. 2016 Dec;2(1):115. https://doi.org/10.1186/s40792-016-0244-4

58. Tu C, Lin Q, Zhu J, Shao C, Zhang K, Jiang C, et al. Isolated sarcoidosis of accessory spleen in the greater omentum: A case report. Exp Ther Med. 2016 Jun;11(6):2379–2384. https://doi.org/10.3892/etm.2016.3221

59. Rana SS, Sharma V, Sharma R, Srinivasan R, Gupta R. Safety and utility of endoscopic ultrasound-guided fine-needle aspiration of focal splenic lesions: a retrospective analysis. Ann Gastroenterol. 2017;30(5):559–563.

60. Wadhwa P, Vaideeswar P. Hepatic, splenic and thyroidal nodular sarcoidosis. Indian J Pathol Microbiol. 2017 Oct-Dec;60(4):608–609. https://doi.org/10.4103/ijpm.ijpm_242_17

61. Tetikkurt C, Yanardag H, Pehlivan M, Bilir M. Clinical features and prognostic significance of splenic involvement in sarcoidosis. Monaldi Arch Chest Dis. 2017 Dec 21;87(3):893. https://doi.org/10.4081/monaldi.2017.893

62. Bachmeyer C, Fayand A, Georgin-Lavialle S, Fedida B, Naccache JM, Lionnet F, Amiot X. Massive Splenomegaly Indicating Sarcoidosis. Am J Med. 2017 Apr;130(4):e141–e142. https://doi.org/10.1016/j.amjmed.2016.11.033

63. Jhaveri K, Vakil A, Surani SR. Sarcoidosis and Its Splenic Wonder: A Rare Case of Isolated Splenic Sarcoidosis. Case Rep Med. 2018 Nov 5;2018:4628439. https://doi.org/10.1155/2018/4628439

64. Gaudemer A, Sauvet G, Hij A, Stanciu R, Farge-Bancel D, Algayres JP. Sarcoïdose splénique diagnostiquée par biopsie écho-guidée: à propos d’un cas [Splenic sarcoidosis diagnosed by US-guided biopsy: About a case]. Rev Med Interne. 2018 Mar;39(3):200–202. https://doi.org/10.1016/j.revmed.2017.11.012

65. Webb M, Conway KS, Ishikawa M, Diaz F. Cardiac Involvement in Sarcoidosis Deaths in Wayne County, Michigan: A 20-Year Retrospective Study. Acad Forensic Pathol. 2018 Sep;8(3):718–728. https://doi.org/10.1177/1925362118797744

66. Makis W, Palayew M, Rush C, Probst S. Disseminated Multi-system Sarcoidosis Mimicking Metastases on 18F-FDG PET/CT. Mol Imaging Radionucl Ther. 2018 Jun 7;27(2):91–95. https://doi.org/10.4274/mirt.29200

67. Mikamori M, Tanemura M, Furukawa K, Saito T, Ohtsuka M, Suzuki Y, Imasato M, Kishi K, Akamatsu H. Laparoscopic splenectomy for isolated splenic sarcoidosis: A case report. Int J Surg Case Rep. 2019;60:79–81. https://doi.org/10.1016/j.ijscr.2019.04.031

68. Garanzini EM, Scaramuzza D, Spadarella G, Di Guardo L, Marchianò A. Sarcoidosis-like disease mimicking metastases during adjuvant ipilimumab therapy in advanced melanoma patient: CT scan and MRI help in managing difficult clinical decision. BJR Case Rep. 2020 Sep 29;6(2):20190065. https://doi.org/10.1259/bjrcr.20190065

69. Rossi UG, Rutigliani M, Antonucci G, Rollandi GA. Hepatic and splenic sarcoidosis as multiple micro-nodular formations. Gastroenterol Hepatol. 2020 Feb;43(2):95–96. English, Spanish. https://doi.org/10.1016/j.gastrohep.2019.08.002

70. Kopparapu A, Odathil F, Bajaj G, Jarrett D, Kraleti S. Hepatosplenic sarcoidosis. Proc (Bayl Univ Med Cent). 2020 Apr 3;33(3):382– 383. https://doi.org/10.1080/08998280.2020.1739926

71. Matsuzawa H, Goto T, Ohshima S, Shibuya T, Sato W, Chiba M, et al. Sarcoidosis with Splenic Involvement Diagnosed with Endoscopic Ultrasound-guided Fine-needle Aspiration. Intern Med. 2020 Aug 15;59(16):2077–2081. https://doi.org/10.2169/internalmedicine.4512-20

72. Bodwal J, Napoleone M, Herath J. Post-mortem CT with macroscopic and microscopic correlation in a case of sudden death due to systemic sarcoidosis. Forensic Sci Med Pathol. 2020 Sep;16(3):544–547. https://doi.org/10.1007/s12024-020-00259-8

73. Tiwari A, Mithun CB. Sarcoidosis mimicking as liver & splenic abscess. Indian J Med Res. 2020 Nov;152(Suppl 1):S186–S187. https://doi.org/10.4103/ijmr.ijmr_2288_19

74. Okada H, Ouchi K, Saito T, Takahashi Y, Yamada M, Negami N, et al. Splenic sarcoid reaction mimicking metachronous metastasis in patients after distal gastrectomy for gastric cancer: a case report and literature review. Surg Case Rep. 2020 Jul 29;6(1):185. https://doi.org/10.1186/s40792-020-00955-1

75. Aedma SK, Chidharla A, Kelting S, Kasi A. Oxaliplatin-associated sarcoid-like reaction masquerading as recurrent colon cancer. BMJ Case Rep. 2020 Sep 8;13(9):e229548. https://doi.org/10.1136/bcr-2019-229548

76. Chikamori F, Yorita K, Yoshino T, Ito S, Mizobuchi M, Ueta K, et al. Sarcoidosis-lymphoma syndrome with portal hypertension: diagnostic clues and approach. Radiol Case Rep. 2021 Jun 12;16(8):2192–2201. https://doi.org/10.1016/j.radcr.2021.05.045

77. Kobayashi K, Einama T, Fujinuma I, Tsunenari T, Miyata Y, Iwasaki T, et al. A rare case of isolated splenic sarcoidosis: A case report and literature review. Mol Clin Oncol. 2021 Feb;14(2):22. https://doi.org/10.3892/mco.2020.2184

78. Samuel Rajeen K, Umakanth M. A Rare Presentation of Sarcoidosis in Which a Lady Presented With Massive Splenomegaly and Skin Manifestation Without Lung Involvement: A Case Report. Cureus. 2022 Jan 7;14(1):e21020. https://doi.org/10.7759/cureus.21020

79. Niwa T, Unno S, Yoshizawa Y, Yamada Y, Kobayashi Y, Kimata M, et al. Sarcoidosis diagnosed by a tiny esophageal lesion: a case report. Nihon Shokakibyo Gakkai Zasshi. 2022;119(3):251–258.

80. Brunner M, Ammer-Herrmenau C, Biggemann L, Ströbel P, König A, Ellenrieder V, Petzold G. Metastase oder Sarkoidose – eine diagnostische Herausforderung beim metastasierten Rektumkarzinom [Metastasis or sarcoidosis – a diagnostic pitfall in metastatic rectal carcinoma]. Z Gastroenterol. 2023 May;61(5):515–521. https://doi.org/10.1055/a-1880-1639

81. Woomer HM, Hamdani TN, Graffeo V, Mustafa B. A Pesky Spleen: A Painful Presentation of Extrapulmonary Sarcoidosis. Cureus. 2023 Aug 7;15(8):e43077. https://doi.org/10.7759/cureus.43077

82. Gallyamov EA, Shalygin AB, Kikhlyarov PV, Gorbacheva IV, Gadlevsky GS, Gololobov GYu, et al. Laparoscopic splenectomy for isolated sarcoidosis of the spleen. Clinical case. Surgical Practice. 2023;8(1):30–41. https://doi.org/10.38181/2223-2427-2023-1-3

83. Tanimoto A, Shibata M, Honma Y, Morino K, Kusanaga M, Abe S, Harada M. Two Cases with Isolated Splenic Sarcoidosis Diagnosed by an Ultrasound-guided Fine-needle Aspiration Biopsy. Intern Med. 2023 Jul 15;62(14):2077–2083. https://doi.org/10.2169/internalmedicine.0409-22

84. Kitamura K, Ogura T, Miyamoto R, Ishida H, Matsudaira S, Takahashi A, Kanda H, Fukuda T. Splenic sarcoid reaction mimicking metastases in patients after uterine cancer surgery: a report of two cases. Surg Case Rep. 2023 Sep 20;9(1):167. https://doi.org/10.1186/s40792-023-01753-1

85. Camastra G, Ciolina F. MRI of Splenic Sarcoidosis with T1 and T2 Mapping. Radiology. 2024 Feb;310(2):e232367. https://doi.org/10.1148/radiol.232367

86. Hashimoto A, Okamoto K, Kuwata S, Maruyama K, Shinden Y, Motoyama S, et al. Splenic Sarcoidosis with Concurrent Gastric Cancer Diagnosed by Robot-Assisted Surgery-A Case Report. Gan To Kagaku Ryoho. 2024 Dec; 51(13):1746–1748.

87. Webb AK, Mitchell DN, Bradstreet CM, Salsbury AJ. Splenomegaly and splenectomy in sarcoidosis. J Clin Pathol. 1979 Oct;32(10):1050– 1053. https://doi.org/10.1136/jcp.32.10.1050

88. Fordice J, Katras T, Jackson RE, Cagle PT, Jackson D, Zaleski H, Asimacopoulos PJ. Massive splenomegaly in sarcoidosis. South Med J. 1992 Jul;85(7):775–778. https://doi.org/10.1097/00007611-199207000-00028

89. Sauer J, Sobolewski K, Dommisch K. Splenic metastases--not a frequent problem, but an underestimate location of metastases: epidemiology and course. J Cancer Res Clin Oncol. 2009 May;135(5):667–671. https://doi.org/10.1007/s00432-008-0502-3

90. Grozdov DM. Surgery of the Liver, Bile Tract, Pancreas and Spleen. In: Surgery of the Spleen. Manual of Surgery. Edited by Petrovsky B.V. Moscow: "Medgiz" Publ., 1962, pp. 588–633. (In Russ.).

91. Kurata A, Terado Y, Schulz A, Fujioka Y, Franke FE. Inflammatory cells in the formation of tumor-related sarcoid reactions. Hum Pathol. 2005 May;36(5):546–554. https://doi.org/10.1016/j.humpath.2005.02.017

92. Brincker H. Sarcoid reactions in malignant tumours. Cancer Treat Rev. 1986 Sep;13(3):147–156. https://doi.org/10.1016/0305-7372(86)90002-2

93. Kojima M, Nakamura S, Fujisaki M, Hirahata S, Hasegawa H, Maeda D, et al. Sarcoid-like reaction in the regional lymph nodes and spleen in gastric carcinoma: a clinicopathologic study of five cases. Gen Diagn Pathol. 1997 Jun;142(5-6):347–352.

94. Saboo SS, Krajewski KM, O'Regan KN, Giardino A, Brown JR, Ramaiya N, Jagannathan JP. Spleen in haematological malignancies: spectrum of imaging findings. Br J Radiol. 2012 Jan;85(1009):81–92. https://doi.org/10.1259/bjr/31542964

95. Ignee A, Cui X, Hirche T, Demolo C, Barreiros AP, Schuessler G, Dietrich CF. Percutaneous biopsies of splenic lesions--a clinical and contrast enhanced ultrasound based algorithm. Clin Hemorheol Microcirc. 2014;58(4):529–541. https://doi.org/10.3233/ch-141813

96. Prabhakar HB, Rabinowitz CB, Gibbons FK, O'Donnell WJ, Shepard JA, Aquino SL. Imaging features of sarcoidosis on MDCT, FDG PET, and PET/CT. AJR Am J Roentgenol. 2008 Mar;190(3 Suppl):S1–6. https://doi.org/10.2214/ajr.07.7001

97. Shaikh F, Abtin FG, Lau R, Saggar R, Belperio JA, Lynch JP 3rd. Radiographic and Histopathologic Features in Sarcoidosis: A Pictorial Display. Semin Respir Crit Care Med. 2020 Oct;41(5):758–784. https://doi.org/10.1055/s-0040-1712534

98. Zykov KA, Popkova AM, Igonina NP, Samoilova NV, Krylova NS, Panevina AS, et al. Sarcoidosis. Modern ideas about diagnosis and treatment. Moscow: MGMSU, 2023; 76 p. (In Russ.).

99. Warshauer DM. Splenic sarcoidosis. Semin Ultrasound CT MR. 2007 Feb;28(1):21–27. https://doi.org/10.1053/j.sult.2006.10.004

100. Elsayes KM, Narra VR, Mukundan G, Lewis JS Jr, Menias CO, Heiken JP. MR imaging of the spleen: spectrum of abnormalities. Radiographics. 2005 Jul-Aug;25(4):967–982. https://doi.org/10.1148/rg.254045154

101. Sekine T, Amano Y, Hidaka F, Takagi R, Machida T, Naito Z, Kumita S. Hepatosplenic and muscular sarcoidosis: characterization with MR imaging. Magn Reson Med Sci. 2012;11(2):83–89. https://doi.org/10.2463/mrms.11.83

102. Barahona ZD. Cuándo solicitar PET/CT en la evaluación de sarcoidosis? [When should a PET/CT be requested in sarcoidosis?]. Rev Med Chil. 2019 Oct;147(10):1308–1314. https://doi.org/10.4067/s0034-98872019001001308

103. Ali Y, Popescu NA, Woodlock TJ. Extrapulmonary sarcoidosis: rapid spontaneous remission of marked splenomegaly. J Natl Med Assoc. 1996 Nov;88(11):714–716.