Hidden burden of female genital tract sarcoidosis: A systematic review

Female genital tract sarcoidosis (FGTS) is a rare manifestation of sarcoidosis that may involve any reproductive organ and the peritoneum and frequently mimics gynecological malignancies, resulting in diagnostic challenges and treatment uncertainty.

This study systematically summarizes the reported clinical characteristics, diagnostic pathways, anatomical distribution, and management of histologically confirmed FGTS. PubMed and Embase were searched from database inception to July 2026. Original reports describing women with histologically confirmed FGTS involving one or more female reproductive organ and/or the peritoneum were eligible for inclusion. Clinical presentation, anatomical involvement, diagnostic work-up, treatment modalities, follow-up, and reported outcomes were extracted descriptively. The quality of studies was evaluated using a structured tool for methodological assessment of case series and case reports.

Seventy case reports describing 77 women met the inclusion criteria. Most published cases described multisystem sarcoidosis (88.5%), whereas isolated FGTS was uncommon (9.8%). The uterus was the most frequently involved reproductive organ, while peritoneal involvement was more frequently reported among women initially investigated for suspected advanced gynecological malignancy. Corticosteroids was the most commonly reported first-line treatment. Clinical outcomes and duration of follow-up varied substantially across patients, limiting comparisons between treatments.

Published case reports suggest that FGTS most commonly presents as part of multisystem disease, posing significant diagnostic challenges and therapeutic uncertainty. Early histopathological confirmation might facilitate appropriate management and might avoid unnecessary radical surgery.