A LOST TRUTH? C. TANAI, M.A. GIAMBERARDINO!, M. DI GIOACCHIN02, A. MEZZETTP and C. SCHIAVONEI 'DepartmentofMedicine and Science ofAging, "G. D'Annunzio" University, Chieti, Italy; 2Unit ofImmunotoxicologyandAllergy, Ce.s.I., "G. D 'Annunzio" University Foundation, Chieti, Italy ReceivedDecember20, 2012 - AcceptedApril 19, 2013

The hypothesis of a relationship between sarcoidosis and malignancy was firstly formulated in 1972 by Brincker. He documented an association of sarcoid reactions or sarcoidosis with 19 lymphomas and associated malignancies. Based on various epidemiological studies, for more than 20 years sarcoidosis has been considered as a condition at increased risk for cancer, particularly lymphoproliferative disorders. The existence of a sarcoidosis-lymphoma syndrome was therefore proposed, highlighting, as a potential mechanism, the uncontrolled lymphocyte proliferation and mitotic activity. A reduced ability to eliminate an antigen and chronic inflammation have been suggested as triggering events. Leading to a reduced tumor immune surveillance, a diminished myeloid dendritic cells (mDC) function, despite up­ regulated co-stimulatory and maturation markers, was also raised as potential mechanism. However, some subsequent studies have questioned the presence of a close association between the two entities and have explained those previously published as the result of selection bias and misclassification. Recently, a Swedish population-based cohort study documented a significant overall excess incidence of cancer among sarcoidosis patients, especially those with multiple hospitalizations or admission in older age, emphasizing again a potential neoplastic risk. Therefore, currently, whether these patients have an increased risk of developing malignant lesions is still debated. Larger and unbiased studies are needed before drawing definite conclusions. For more than 20 years an increased risk of developing neoplastic lesions was acknowledged in patients with sarcoidosis. Later, some studies questioned the presence of a close association between the two entities. Sarcoidosis is a multisystem granulomatous disease which most often affects the lungs but can also manifest with cardiomyopathy, arrhythmias, neurological symptoms, vision disturbances, hypercalcemia, and renal failure. An appropriate diagnostic approach includes the exclusion of other diseases such as lymphoma and tuberculosis and the documentation ofnon-caseating granulomas by biopsy of accessible sites. Sarcoidosis mainly affects female patients, with two peaks of incidence, between 25-40 and between 45-65 years, respectively. Northern Europe is the area with the highest incidence (5-40 cases per 100,000 inhabitants). African Americans have a worse prognosis, with higher mortality and a tendency to multi-organ involvement and chronicity