A case report of gastric cancer associated with sarcoid reactions in the regional lymph nodes and liver

Abstract

Epithelioid cell granulomas identical to those of systemic sarcoidosis are occasionally observed within malignant neoplasms, particularly in the lymphatics draining a primary tumor. These histologic changes have been termed sarcoid reactions and are easily confused with systemic sarcoidosis. This report describes an extremely rare case of gastric cancer accompanied by sarcoid reactions in the regional lymph nodes and liver parenchyma near a tumor metastasis. A 63-year-old woman with advanced gastric cancer was treated by subtotal gastrectomy with dissection of the regional lymph nodes and local excision of the liver tissue involved by metastasis. Microscopic examination of the resected lymph nodes and liver disclosed the presence of sarcoid-like granulomas. The absence of any clinical manifestations and the negative results of the Kveim test, chest radiograph, and laboratory tests, including that for the serum angiotensin converting enzyme excluded the possibility of systemic sarcoidosis. The presence of a sarcoid reaction in the liver parenchyma adjacent to a metastasis has never been reported previously.

Paraneoplastic Sarcoid-Like Reactions and the Eye

“…6,8,9,13-15,21,23,33,45-56 , 5,7,10-12,16-20,22,24,25,27-32,34-44,59 Most often, these reactions are observed in lymph nodes draining the malignancy but can also occur in distant organs or the tumor-affected organ itself. [5][6][7][10][11][12][16][17][18][19][20]22,24,25,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]46,47,59 The mechanism for sarcoidlike reactions remains unknown. 46 Some authors have suggested a T-cell-mediated host response to soluble tumor antigens and others a reaction to tumor cell metabolites.…”

Multiple early gastric cancer associated with sarcoid-like reaction in the regional lymph nodes

“…To the best of our knowledge, 20 cases of gastric cancer associated with sarcoid-like reactions have had their clinical, surgical, and pathological findings documented in detail; [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] ours was the twenty-first case report. In 15 [21][22][23][24]26,[28][29][30][31]33,34,[36][37][38] of the 21 patients, intraabdominal lymphadenopathy was detected during surgery. And, in 11 21,22,[28][29][30]33,34,[36][37][38] of the 15 patients, this was regarded as tumor metastasis because of the abnormal firmness of lymph nodes.…”

“…In 15 [21][22][23][24]26,[28][29][30][31]33,34,[36][37][38] of the 21 patients, intraabdominal lymphadenopathy was detected during surgery. And, in 11 21,22,[28][29][30]33,34,[36][37][38] of the 15 patients, this was regarded as tumor metastasis because of the abnormal firmness of lymph nodes. Namely, lymph nodes with the sarcoidlike reaction associated with gastric cancer were often enlarged and firm, and signaled tumor metastasis in the lymph node.…”

“…Four 25,31,33 of the 16 patients had multiple early gastric cancers. As for early gastric cancer, in 10 21,22,24,26,29-31,33,36 of the 16 patients, intraabdominal lymphadenopathy was detected during surgery, and in 7 21,22,29,30,34,36 of these 10, this was regarded as tumor metastasis. Furthermore, the 3 29,30,36 cases of mucosal cancer were thought to be N 2 stage and more extensive, 3 and the submucosal cancer in our patient was thought to be N 3 stage.…”

Adenocarcinoma of Ascending Colon Associated with Sarcoid Reaction in Regional Lymph Nodes

“…Granulomatous reactions occurring within lymph nodes draining carcinomas are a well-known but uncommon occurrence [1,2,3]. These histologic changes have been termed sarcoid reactions, and such changes have been described in association with lymphoma and other solid tumors [4,5,6,7,8,9]. However, the presence of this response in colorectal cancer has been considered to be quite rare, and only a few reports have mentioned the presence of granulomatous reactions in colorectal cancer [10,11,12].…”