Suspected anal malignancy turned out to be sarcoidosis; a case report.

Introduction and importance: Sarcoidosis rarely presents in the anorectal region. It most commonly affects the lungs, lymphatic system, eyes, and skin, but can occur in other organs. Anal or rectal manifestations are exceptionally uncommon and may mimic malignancy both clinically and radiologically, posing a diagnostic challenge. Case presentation: A 66-year-old patient presented to the primary health center with a 9-month history of a mass in the anal region. The patient was referred to the surgical department for further evaluation. Clinical examination and radiological imaging suggested a malignant process. Repeated biopsies were performed, and histopathological analysis ultimately confirmed sarcoidosis. Clinical discussion: The case illustrates how anorectal sarcoidosis can closely resemble malignancy in both presentation and radiological appearance. Initial management with corticosteroid therapy led to regression of the lesion. Given the rarity of this localization and its mimicry of cancer, vigilant follow-up is essential. Imaging and a low threshold for repeat biopsy are crucial, especially if the lesion shows signs of regrowth or insufficient response to treatment. Conclusion: Anorectal sarcoidosis is extremely rare and can be mistaken for malignancy. Accurate diagnosis relies on histopathology from repeated biopsies when imaging and clinical findings are inconclusive. Corticosteroids may be effective, but individualized monitoring with renewed imaging and prompt re-biopsy is recommended to detect recurrence or alternative diagnoses.