Thomé Villar memorial lecture--the many faces of sarcoidosis

The late and great Thomé Villar established a basic understanding of sarcoidosis in Lisbon, and his successors have added scholarly contributions to this firm foundation. He recognised its worldwide distribution and prevalence, the several interwoven patterns of presentation, the importance of histological confirmation, and the value of corticosteroid therapy. His successors have clarified our understanding of extrinsic allergic alveolitis (hypersensitivity pneumonitis), shown us how to differentiate the two disorders and expanded our knowledge of immunology and markers of activity of both disorders. Although we do not know the cause, we can recognise the terrain or soil in which it flourishes; factors which includes age, sex, race, HLA affinity and hormonal status. The road which will lead us to the cause(s) is in immunology, particularly macrophages and lymphocytes and the chemical mediators which influence the development of granuloma formation and ultimate fibrosis. Professor Thomé George Villar was a Man of Lisbon in every sense of the word - by birth, education, and academic achievement. He would have rejoiced that Lisbon was chosen for an International Conference on Sarcoidosis and he would have approved of his successor's choice of four topics--granuloma formation, granuloma vasculitis, markers of activity and occupational granulomatous lung disease. These are all important growing points in our advances in knowledge.