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

Fujii, Takaaki; Tabe, Yuichi; Yajima, Reina; Tsutsumi, Soichi; Asao, Takayuki; Kuwano, Hiroyuki

doi:10.1159/000275064

Cited by 11 publications

(14 citation statements)

References 21 publications

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“…We have only found two cases, one corresponding to a poorly differentiated colonic adenocarcinoma in the ascending colon and the second in the sigmoid colon (5,6).…”

Section: Discussionmentioning

confidence: 82%

“…The last possible mechanism is a simple tissue reaction to a tumor embolism in the lymphatic system or capillaries, or by the mere presence of tumor cells (6).…”

Section: Discussionmentioning

confidence: 99%

“…In most instances, granulomas appear in lymph nodes draining tumors (1-3), but sometimes they occur within the stroma of malignancies like renal, breast and hepatocellular carcinomas, or in other organs (4). We herein report a case of a colonic carcinoma with stromal granulomatous sarcoid-like reaction, from which we have only found two previous cases in a thorough literature review (5,6).…”

Section: Introductionmentioning

confidence: 92%

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Sarcoid reaction: a rare occurrence associated to colon adenocarcinoma (case report and literature review)

Arco¹,

Fernández-Aceñero²

2016

J. Gastrointest. Oncol.

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Granulomatous reactions are related to infectious and non infectious diseases, but more rarely, granulomas may occur in association to malignancies. The presence of sarcoid-like granulomas in lymph nodes draining malignant tumors is an uncommon but well known occurrence. However, their presence in the stroma of malignant tumors is much rarer. We have only found two previous cases reported in the Japanese and English literature. In this study we report a well differentiated adenocarcinoma of the right colon associated to a stromal granulomatous sarcoid-like reaction. Lymph nodes were not involved. The patient had a clinical history of tuberculosis treated 15 years ago, but there was no clinical, histomorphological, immunohistochemical or molecular evidence of disease at the moment of these findings.We have reviewed the literature to find the keys and the diagnostic challenges posed by granulomatous sarcoid-like reaction occurring in lymph nodes draining malignant neoplasms, peritumoral stroma and in other organs far from the primary tumor. The diagnosis of granulomatous sarcoid-like reactions associated to malignancies can be challenging and it can only be made after ruling out specific infectious and non infectious causes of granulomatous inflammation. The mechanisms involved in granuloma formation, their relationship with demographic and histopathological features, their possible association with autoimmune disorders, their cytokine profile and, more importantly, their prognostic significance in each type of tumor are still unclear and require studies with larger number of patients. J Gastrointest Oncol 2016;7(4):E72-E76 jgo.amegroups.com of pulmonary tuberculosis treated for 9 months 15 years before. Computed tomography (CT) revealed a mass in the right colon and he underwent colonoscopy. Colonoscopy revealed an excrescent mass in the cecum and ileocecal valve with partial stenosis of the lumen. Biopsies showed a well differentiated adenocarcinoma. A right hemicolectomy was subsequently performed. Postoperative course was complicated by fever due to a possible dehiscence of the anastomosis with air bubbles near the ileal loop, but the patient evolved well and was finally discharged and is currently being followed in the surgery outpatient clinics.The surgical specimen consisted of ileum, caecum and right colon measuring 26 cm in length. In the ascending colon there was an excrescent lesion with well defined high borders and a central concavity. It was circumferential and obliterated 90% of the colonic lumen. It measured 7 cm × 4.5 cm and infiltrated through the wall into the adjacent fat.Microscopic examination confirms an infiltrating moderately differentiated colonic carcinoma extending into the subserosal fat. It shows an infiltrative leading edge without budding or desmoplasia and a moderate intratumoral and peritumor lymphocytic response. Metastases were found in 1 of 36 lymph nodes examined. Immunohistochemistry for mismatch repair proteins showed intact nuclear positivity. There was a granulom...

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“…We have only found two cases, one corresponding to a poorly differentiated colonic adenocarcinoma in the ascending colon and the second in the sigmoid colon (5,6).…”

Section: Discussionmentioning

confidence: 82%

“…The last possible mechanism is a simple tissue reaction to a tumor embolism in the lymphatic system or capillaries, or by the mere presence of tumor cells (6).…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 92%

See 1 more Smart Citation

Sarcoid reaction: a rare occurrence associated to colon adenocarcinoma (case report and literature review)

Arco¹,

Fernández-Aceñero²

2016

J. Gastrointest. Oncol.

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“…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.…”

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confidence: 99%

Paraneoplastic Sarcoid-Like Reactions and the Eye

Balasubramaniam

Salomão

Davies

et al. 2015

Retina

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“…[7][8][9][10][11][12][13][14] In terms of their pathophysiology, it has been speculated that such granulomatous responses could represent hypersensitivity reactions to certain tumor antigens or constitute innate immune reactions to tumor cell necrosis. 12,15 Ipilimumab, by unleashing T-cell-mediated immune responses, facilitates local and systemic production of cytokines.…”

Section: Discussionmentioning

confidence: 99%

Antitumor Granuloma Formation by CD4⁺ T Cells in a Patient With Rapidly Progressive Melanoma Experiencing Spiking Fevers, Neuropathy, and Other Immune-Related Toxicity After Treatment With Ipilimumab

Luke

Lezcano

Hodi

et al. 2015

JCO

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A 61-year-old woman was diagnosed in 1990 with malignant melanoma arising on the left shoulder and underwent wide local excision. No other details are available regarding the initial histology or work-up. In late 2011, the patient developed a left axillary mass. An attempted resection took place in early 2012. This procedure was aborted after the mass was deemed unresectable as a result of close proximity to essential neurovascular structures. However, a biopsy revealed metastatic melanoma with immunohistochemistry positive for Melan-A and S100. Histologically, this biopsy revealed sparse, individually disposed CD4 ϩ and CD8 ϩ T cells that were scattered throughout the tumor nodule (Figs 1A through 1C; H&E, CD4 and CD8, respectively). Mutational analysis of the tumor revealed a point mutation in codon 61 of NRAS resulting in replacement of glutamine for arginine in the product protein. Only wild-type sequences were found in BRAF. A positron-emission tomography scan revealed extensive hypermetabolic left axillary, infraclavicular, supraclavicular, and cervical lymphadenopathy as well as a hypermetabolic intraparotid lymph node.The patient was then referred to our institution, where she began receiving treatment with ipilimumab at a dose of 3 mg/kg every 3 weeks. In the 3 weeks between doses one and two, the patient was noted to have a massive increase in axillary lymphadenopathy. Before treatment, she had palpable disease within the axilla, although it did not affect her left arm. By the second dose, the mass had grown such that adduction of the patient's arm was limited in the final 45 degrees of motion. Two days after the second dose of ipilimumab, the patient began experiencing twice-daily relapsing fevers. These were consistently in the range of 38.9°C to 40°C and were associated with drenching sweats. The patient was evaluated on two occasions in emergency departments over the next 7 days, where blood cultures were negative, CBC was unremarkable, chest x-ray was clear, computed tomography (CT) of the abdomen was unremarkable, and no localizing signs of infection were observed. By day 10 of these fevers, the patient was admitted for palliative support. On physical examination, the left axillary lymphadenopathy had decreased to the size noted at her initial consultation. In the context of what seemed clinically to be an ipilimumab-induced cytokine storm, a biopsy of the left axillary tumor was obtained. This biopsy revealed focally brisk infiltration of tumor by T cells, with a marked CD4 predominance over CD8 (Figs 1D through 1F; H&E, CD4 and CD8, respectively) and multinucleated histiocytes (Fig 1D and 1H, arrows) that also stained for CD4 (Fig 1I, arrow) and formed small microgranulomas. The T cells varied from being singly disposed to aggregated at the perimeter of small tumor micronodules (Figs 1D through 1I). As opposed to the pretreatment specimen (Fig 1J), post-treatment infiltrating CD4ϩ T cells and histiocytes surrounded and obliterated small tumor nodules (Figs 1K and 1L, respectively). Correla...

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

Cited by 11 publications

References 21 publications

Sarcoid reaction: a rare occurrence associated to colon adenocarcinoma (case report and literature review)

Sarcoid reaction: a rare occurrence associated to colon adenocarcinoma (case report and literature review)

Paraneoplastic Sarcoid-Like Reactions and the Eye

Antitumor Granuloma Formation by CD4⁺ T Cells in a Patient With Rapidly Progressive Melanoma Experiencing Spiking Fevers, Neuropathy, and Other Immune-Related Toxicity After Treatment With Ipilimumab

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

Cited by 11 publications

References 21 publications

Sarcoid reaction: a rare occurrence associated to colon adenocarcinoma (case report and literature review)

Sarcoid reaction: a rare occurrence associated to colon adenocarcinoma (case report and literature review)

Paraneoplastic Sarcoid-Like Reactions and the Eye

Antitumor Granuloma Formation by CD4+ T Cells in a Patient With Rapidly Progressive Melanoma Experiencing Spiking Fevers, Neuropathy, and Other Immune-Related Toxicity After Treatment With Ipilimumab

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Antitumor Granuloma Formation by CD4⁺ T Cells in a Patient With Rapidly Progressive Melanoma Experiencing Spiking Fevers, Neuropathy, and Other Immune-Related Toxicity After Treatment With Ipilimumab