Uterine cervical sarcoidosis identified on pap test: Cytomorphologic findings and differential diagnosis

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.