Coexistence of sarcoidosis and metastatic lesions: A diagnostic and therapeutic dilemma (Review)

Abstract

Sarcoidosis, a chronic, inflammatory disease that affects various different organs, is characterized by noncaseating epitheloid granulomas. This systemic inflammatory process is associated with an increased risk of cancer. Several cases of sarcoidosis that mimic metastatic tumor progression in radiological findings have been reported so far. However, there are also cases that have presented a coexistence of sarcoidosis and metastasis, which have caused a diagnostic and therapeutic dilemma. Due to inadequate current therapies, a reliable differentiation between benign and malignant lesions is crucial. This review focuses on the residual risk of the coexistence of metastases within radiological suspicious lesions in patients with a history of solid tumors and sarcoidosis, as well as immunological findings, in order to explain the potential associations. Sarcoidosis has the potential to promote metastasis as it includes tumor-promoting and immune-regulating cell subsets. Notably, myeloid derived suppressor cells may serve a pivotal role in metastatic progression in patients with sarcoidosis. In addition, the present review also evaluates the potential novel diagnostic approaches, which may be able to differentiate between metastatic lesions and sarcoidosis. The risk of coexistent metastasis in sarcoidosis lesions must be considered by clinical practitioners, and a multidisciplinary approach may be required to avoid misdiagnosis and the subsequent unnecessary surgery or insufficient treatments.

Testicular seminoma with a progressing pulmonary nodule and mediastinal lymphadenopathy without retroperitoneal metastasis

“…Moreover, there are cases like ours in which sarcoidosis and malignant diseases coexist, leading to diagnostic dilemmas. 7,8 Paparel et al reviewed 64 cases in which sarcoidosis coexisted in patients with testicular cancer. 7 Seminoma was the most common histological type of testicular cancer among these patients (63%, 40/64).…”

Overlap Syndromes in Sarcoidosis: Clinical Features and Outcomes

“…72 There are numerous studies that also report an association between sarcoidosis and other solid-organ cancers, but breast cancer is the most commonly observed and accounts for 20 to 21% of cases. 72,73 Other malignancies commonly reported to occur with sarcoidosis include melanoma, cervical, and thyroid cancer. 72,73 Just less than 5% of sarcoidosis patients from a prospective cohort were identified to have cancer that occurred preceding, concurrently, or subsequent to sarcoidosis; however, the risk of subsequent cancer in patients with known sarcoidosis is debated.…”

“…72,73 Other malignancies commonly reported to occur with sarcoidosis include melanoma, cervical, and thyroid cancer. 72,73 Just less than 5% of sarcoidosis patients from a prospective cohort were identified to have cancer that occurred preceding, concurrently, or subsequent to sarcoidosis; however, the risk of subsequent cancer in patients with known sarcoidosis is debated. 74 A large registry study from Sweden and Denmark found sarcoidosis patients were more likely to develop high-grade non-Hodgkin's lymphoma (NHL) than those without a history of sarcoidosis.…”

Sarcoid Like Reaction Confounding the Diagnosis of Pulmonary Adenocarcinoma

“…First line treatment of sarcoidosis is corticosteroids with antimetabolites generally used when unresponsive to steroids [1]. Granulomatous inflammation can rarely be seen in lung cancer tumors and regional draining lymph nodes which is called 'sarcoid like reaction' as they do not fulfill the criteria for systemic sarcoidosis [2]. Sarcoid like reaction can coexist with malignancy either at the time of diagnosis or later during follow up after treatment or from oncologic immunotherapy [2,10,14].…”

“…Granulomatous inflammation can rarely be seen in lung cancer tumors and regional draining lymph nodes which is called 'sarcoid like reaction' as they do not fulfill the criteria for systemic sarcoidosis [2]. Sarcoid like reaction can coexist with malignancy either at the time of diagnosis or later during follow up after treatment or from oncologic immunotherapy [2,10,14]. It can be challenging at times in such cases when tissue biopsies only pick up sarcoid changes without revealing malignancy because of sampling areas in that particular tumor and further delaying the actual diagnosis which happened in our case.…”