Benefit of a second opinion: From metastatic disease to resectable lung cancer with sarcoid-like reaction

Abstract

BackgroundMediastinal lymphadenopathy in combination with lung cancer is suggestive for lymph node metastases but can also have other origins.Case reportWe describe a patient diagnosed with stage IV lung cancer presenting with parenchymal lesions and enlarged mediastinal lymph nodes. A second opinion including FDG-PET scan review and a mediastinoscopy followed by surgery revealed tumor specimens originating from a single primary tumor with a sarcoid-like reaction in the mediastinal lymph nodes, changing the diagnosis from metastasized to resectable lung cancer.DiscussionPET positive lesions are not always synonymous with metastatic disease in the presence of a malignant tumor. Conscientious review of FDG-PET scans and tissue sampling are therefore mandatory to determine definitive staging and subsequent interventions.

Deploying Team Science Principles to Optimize Interdisciplinary Lung Cancer Care Delivery: Avoiding the Long and Winding Road to Optimal Care

“…10 The need for this was not recognized in this patient who lived in a granuloma-endemic zone with high rates of histoplasmosis and sarcoidosis. 11 It is likely that early interaction with a pulmonologist or thoracic surgeon would have raised questions about the discrepancy between the patient's performance status and the radiologic severity of her disease. [11][12][13] The patient's care suffered from serial failure to activate the appropriate expertise of interdisciplinary lung cancer team members, underdeveloped coordinating mechanisms, and limited mutual performance monitoring 14,15 of specialists involved in her care.…”

“…11 It is likely that early interaction with a pulmonologist or thoracic surgeon would have raised questions about the discrepancy between the patient's performance status and the radiologic severity of her disease. [11][12][13] The patient's care suffered from serial failure to activate the appropriate expertise of interdisciplinary lung cancer team members, underdeveloped coordinating mechanisms, and limited mutual performance monitoring 14,15 of specialists involved in her care. Practice leaders must create the conditions for workgroups to be effective, including fostering real teams that are interdependent in their work 16 ; providing an appropriate team structure, reward structure, and supportive organizational context; and equipping teams with expert coaching and facilitation, when needed.…”

“…In addition, successful teams engage patients and caregivers in the decision-making process and help facilitate second opinions when desired. [11][12][13]28 Health care delivery is a service profession, and providers, rightly, expect to be paid for their services. The volume-based health care reimbursement model, which prevails in the United States, incentivizes providers to give more services, sometimes without sufficient linkage to patient benefit.…”

Sarcoid-Like Reaction Mimicking Nodal Spread of Lung Cancer in a Silica-Exposed Patient on Positron Emission Tomography/Computed Tomography: A Case Report

“…Among them, SLR poses a diagnostic challenge, mimicking metastatic nodal spread in patients with a history of malignancy (1)(2)(3). Although SLR is a well-known entity, few papers have reported its impact on patient management of lung cancer with PET/CT (4,5). Presented here is a case of a silica-exposed patient who had undergone a PET/CT study to characterize a lung mass.…”