Yu WX, Zhan FF, Hong PY, Huang MH, Chen YY, Lin YL, Zhang XB. Atypical sarcoidosis diagnosed using endobronchial ultrasound-guided mediastinal lymph node biopsy with fine biopsy forceps: Two case reports. World J Clin Cases 2025; 13(32): 111525 [DOI: 10.12998/wjcc.v13.i32.111525]
Corresponding Author of This Article
Xiao-Bin Zhang, Department of Pulmonary and Critical Care Medicine, School of Medicine, Zhongshan Hospital Xiamen University, No. 201-209 Hubinnan Road, Siming District, Xiamen 361004, Fujian Province, China. zhangxiaobincn@xmu.edu.cn
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Medicine, General & Internal
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 16, 2025 (publication date) through Nov 15, 2025
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Publication Name
World Journal of Clinical Cases
ISSN
2307-8960
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Yu WX, Zhan FF, Hong PY, Huang MH, Chen YY, Lin YL, Zhang XB. Atypical sarcoidosis diagnosed using endobronchial ultrasound-guided mediastinal lymph node biopsy with fine biopsy forceps: Two case reports. World J Clin Cases 2025; 13(32): 111525 [DOI: 10.12998/wjcc.v13.i32.111525]
Wen-Xuan Yu, Feng-Fu Zhan, Ping-Yang Hong, Mao-Hong Huang, Yi-Yuan Chen, Yi-Li Lin, Xiao-Bin Zhang, Department of Pulmonary and Critical Care Medicine, School of Medicine, Zhongshan Hospital Xiamen University, Xiamen 361004, Fujian Province, China
Wen-Xuan Yu, Feng-Fu Zhan, Ping-Yang Hong, Mao-Hong Huang, Yi-Li Lin, Xiao-Bin Zhang, The School of Clinical Medicine, Fujian Medical University, Fuzhou 350122, Fujian Province, China
Co-first authors: Wen-Xuan Yu and Feng-Fu Zhan.
Author contributions: Yu WX and Zhan FF contributed to the collection and assembly of data; they contributed equally to this manuscript and are co-first authors; Yu WX and Hong PY contributed to data analysis and interpretation; Yu WX and Zhang XB contributed to conception and design; Yu WX, Huang MH, Chen YY, Lin YL and Zhang XB contributed to manuscript writing and final approval of the manuscript.
Supported by the National Natural Science Foundation of China, No. 82170103; Natural Science Foundation of Fujian Province, No. 2024J011325; Young People Training Project from Fujian Province Health Bureau, No. 2020GGB057 and No. 2023QNB008; and Xiamen Medical and Health Guidance Project, No. 3502Z20224ZD1060, No. 3502Z20214ZD1043, and No. 3502Z20224ZD1058.
Informed consent statement: Consent to publish the identifying images or other personal or clinical details of participants has been obtained from both patients.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Bin Zhang, Department of Pulmonary and Critical Care Medicine, School of Medicine, Zhongshan Hospital Xiamen University, No. 201-209 Hubinnan Road, Siming District, Xiamen 361004, Fujian Province, China. zhangxiaobincn@xmu.edu.cn
Received: July 2, 2025 Revised: July 25, 2025 Accepted: October 14, 2025 Published online: November 16, 2025 Processing time: 133 Days and 10.2 Hours
Abstract
BACKGROUND
To evaluate the diagnostic utility of endobronchial ultrasound (EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps [i.e., EBUS-transbronchial forceps biopsy (TBFB)].
CASE SUMMARY
In this case series, two atypical sarcoidosis cases admitted in 2024 were retrospectively analyzed, both of whom lacked classical clinical manifestations. After chest computed tomography/positron emission tomography-computed tomography imaging and serum angiotensin-converting enzyme testing, EBUS-transbronchial needle aspiration was performed using a 21-G needle. Subsequently, tissue sampling was performed at the enlarged puncture site by means of a 1.2-mm fine biopsy forceps. At the same time, bronchoalveolar lavage fluid lymphocyte subset analysis was conducted.
CONCLUSION
Both cases demonstrated non-caseating granulomatous inflammation on histopathology, elevated serum angiotensin-converting enzyme levels, and markedly increased CD4/CD8 ratios in bronchoalveolar lavage fluid. Case 1 was observed after confirmation of stage II sarcoidosis, whereas case 2 required glucocorticoid therapy due to the involvement of multiple systems. EBUS-TBFB can be used to make a definitive pathological diagnosis. For radiologically atypical sarcoidosis, EBUS-TBFB improves diagnostic accuracy by obtaining larger histological samples, thereby addressing the limitations of transbronchial needle aspiration cytology. This approach significantly improves differential diagnostic efficacy and holds substantial clinical relevance for broader adoption.
Core Tip: This report highlights the diagnostic value of endobronchial ultrasound-guided transbronchial forceps biopsy (EBUS-TBFB) for atypical sarcoidosis. In two asymptomatic cases with non-specific imaging mimicking malignancy, conventional EBUS-guided fine-needle aspiration yielded inconclusive cytology. By contrast, EBUS-TBFB - using a 1.2-mm forceps via the same puncture site - obtained larger histological samples (≥ 3 mm), confirming non-caseating granulomas. This technique overcomes transbronchial needle aspiration’s limitations for benign diseases, improving diagnostic accuracy and guiding critical management decisions: Observation for localized disease (Case 1) or timely immunosuppression for systemic involvement (Case 2). EBUS-TBFB is a promising tool for radiologically ambiguous sarcoidosis.
