Can a pulmonary sarcoidosis granuloma resolve spontaneously?

From the Guidelines

Sarcoidosis in the lungs can indeed resolve on its own without treatment in many cases, with up to one-third of patients experiencing spontaneous remission depending on geography and genetic factors. Sarcoidosis is not actually a tumor but rather an inflammatory condition characterized by granulomas (collections of inflammatory cells) that can form in various organs, most commonly the lungs. According to the study by F.F. Rahaghi et al. 1, some patients develop chronic or progressive obliterative fibrotic disease, causing significant morbidity and mortality. However, many cases, particularly Stage 1 disease, can undergo spontaneous remission within two years without specific treatment, as noted in the European position paper on rhinosinusitis and nasal polyps 2020 1.

Key Points to Consider

• About 75% of patients with Stage 1 disease can be managed symptomatically with NSAIDS, and around 65% of those with Stage 2 disease can spontaneously regress 1.
• Patients with more advanced disease, as evidenced by raised SACE or extrapulmonary involvement, will usually require treatment, and about 50% may experience a relapse 1.
• For those with persistent or severe symptoms, corticosteroids like prednisone are the primary treatment, with other medications such as methotrexate, hydroxychloroquine, or TNF inhibitors used for cases that don't respond to steroids 1.
• Regular follow-up with pulmonary function tests and chest imaging is important to monitor the condition's progression or resolution, even in mild cases, with lung function monitored every 6-12 months 1.

From the Research

Lung Sarcoidosis Tumor Disappearance

• The disappearance of a lung sarcoidosis tumor is possible, as approximately 10% to 82% of patients with pulmonary sarcoidosis experience spontaneous remission without serious sequelae 2.
• The rate of spontaneous remission varies depending on the stage of the disease, with Scadding stages I and II having a higher chance of radiographic remission (approximately 30%-80% of cases) compared to stage III (10%-40% chance of resolution) and stage IV (no chance of resolution) 3.
• Treatment with oral glucocorticoids, such as prednisone, can also lead to improvement in symptoms and stabilization of the disease, although prolonged use may be required to control symptoms and prevent relapse 2, 3, 4.
• In some cases, immunosuppressive agents, such as methotrexate and azathioprine, and anti-tumor necrosis factor (TNF) medications may be used as alternative or additional treatments to glucocorticoids 4, 5.
• The development of fibrosis and precapillary pulmonary hypertension can affect the likelihood of tumor disappearance, with stage IV fibrocytic sarcoidosis having a higher risk of mortality 3.

Factors Affecting Tumor Disappearance

• The stage of the disease at diagnosis and the presence of pulmonary symptoms, such as cough and dyspnea, can influence the likelihood of tumor disappearance 2, 3.
• The use of oral glucocorticoids and other immunosuppressive agents can also impact the rate of tumor disappearance, although the optimal doses and treatment durations are still being studied 2, 4, 5.
• The development of precapillary pulmonary hypertension and fibrosis can reduce the likelihood of tumor disappearance and increase the risk of mortality 3.