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Unfortunately, up to a third of patients have unrelenting disease, leading to clinically significant organ impairment. A recurrence after 1 or more years of remission is uncommon (affecting Diagnosis The diagnosis of sarcoidosis is established on the basis of compatible clinical and radiologic findings, supported by histologic evidence in one or more organs of noncaseating epithelioid-cell granulomas in the absence of organisms or particles. In all other cases, a biopsy specimen should be obtained from the involved organ that is most easily accessed, such as the skin, peripheral lymph nodes, lacrimal glands, or conjunctiva. This review summarizes recent advances and addresses pitfalls in the diagnosis and treatment of sarcoidosis. The pathogenesis of pulmonary fibrosis in sarcoidosis remains uncertain. Granulomas are compact, centrally organized collections of macrophages and epithelioid cells encircled by lymphocytes. Some of the earliest studies of sarcoidosis reported associations with exposures to irritants found in rural settings, such as emissions from wood-burning stoves and tree pollen.
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45 The role of natural killer T cells in sarcoidosis remains undefined. 4 In Japan, the annual incidence ranges from 1 to 2 cases per 100,000 people 4 and peaks in the third decade of life. The highest annual incidence of sarcoidosis has been observed in northern European countries (5 to 40 cases per 100,000 people). These residues form pockets in the groove, interacting with the antigenic peptide side chains. For example, natural killer T cells were found in lymph-node specimens but not in skin lesions. If diagnosis requires pulmonary tissue, transbronchial biopsy by means of bronchoscopy has a diagnostic yield of at least 85% when multiple lung segments are sampled. However, the outcome of genomewide scans is known to be influenced by the population studied. 8 More recently, associations with sarcoidosis and exposure to inorganic particles, 9 insecticides, 10 and moldy environments 10,11 have been reported.
