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The increased cancer incidence may result from immunological deficiencies in patients with sarcoidosis.

(1) No increase in the incidence of GI NHL was found over a 9-year observation period; (2) nonrandom spatial distribution of new GI NHL cases was observed; (3) factors that significantly increased the risk of death in gastric cases were presence of B symptoms (RR = 3.3), clinical stage is more than II1 (RR = 3.0), age more than 72 years (RR = 2.4), and elevated serum lactate dehydrogenase (s-LDH) level (RR = 2.0); and factors that increased the risk of death in intestinal cases were presence of B symptoms (RR = 3.2), age more than 58 years (RR = 2.8), and clinical stage more than I (RR = 2.1); (4) factors that significantly increased the risk of relapse in gastric cases were male sex and no radiotherapy in primary treatment; and in intestinal cases were T-cell phenotype and no surgery in primary treatment; (5) surgical staging, as opposed to thorough noninvasive staging, did not improve staging accuracy and final outcome in localized gastric NHL.

Analysis of 17 cases of coexistent sarcoidosis and malignant lymphoproliferative disease, supplemented with 29 similar cases reported in the literature indicates that this association is not fortuitous. In addition, significantly more malignancies other than lymphoma were found in this group of patients. A sarcoidosis-lymphoma syndrome appears to exist in which malignant lympho-proliferative disease develops at least 5.5 times more often than expected in middle-aged patients with chronic active sarcoidosis, possibly as a consequence of the immunologic abnormalities observed in the latter disease.

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Nineteen cases of malignant lymphomata were selected for study from a group of about 1500 collected cases of malignant lymphomata because they showed histological evidence of non-infectious epithelioid-cell granulomata in one or more tissues. In the 19 cases selected, 5 cases of systemic sarcoidosis, 4 cases of an associated malignancy, 1 pre-malignant condition, and 1 case of an auto-immune disease were found. This remarkable association of sarcoid reactions or sarcoidosis with malignant lymphomata and associated malignancies seems to justify speculation on the possibility of a common aetiological factor, e.g. in the form of an altered immune reaction.

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