Faut-il rechercher un cancer après la découverte d’une granulomatose inexpliquée ?

Sève, P.; Jamilloux, Yvan; Gerfaud‐Valentin, Mathieu; El-Jammal, Thomas; Pavic, Michel

doi:10.1016/j.revmed.2019.05.006

Cited by 5 publications

(9 citation statements)

References 38 publications

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“…Sarcoidosis and SLR can occur before, during or after cancer (31). While sarcoidosis is a well-defined condition, SLR is usually defined as non-caseating granulomatous reaction occurring under various conditions, which do not meet the diagnostic criteria for sarcoidosis (32).…”

Section: Sarcoidosis and Sarcoid-like Reactions In The Course Of Cancermentioning

confidence: 99%

“…Other red flags should alert the clinician about the atypical nature of sarcoidosis or the possibility of underlying neoplasia [e.g., impaired general condition, compressive phenomena, hemoptysis, refractory disease; (31,32,105)]. Atypical radiological manifestations should also be considered.…”

Section: When Should We Look For Neoplasia In Patients With Sarcoidosis?mentioning

confidence: 99%

“…In a patient with previously known sarcoidosis, the occurrence of atypical manifestations (e.g., peritoneal or gut involvement) or new organ involvement, and refractory disease which is defined as a disease in which a 2nd line treatment is not sufficient to achieve satisfying disease control or satisfying CS tapering, must lead to histological confirmation to rule out opportunistic infection and lymphoma, especially (31,102,108).…”

Section: When Should We Look For Neoplasia In Patients With Sarcoidosis?mentioning

confidence: 99%

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Sarcoidosis and Cancer: A Complex Relationship

et al. 2020

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Sarcoidosis is a systemic disease of unknown etiology, characterized by the presence of non-caseating granulomas in various organs, mainly the lungs, and the lymphatic system. Since the individualization of sarcoidosis-lymphoma association by Brincker et al., the relationship between sarcoidosis or granulomatous syndromes and malignancies has been clarified through observational studies worldwide. Two recent meta-analyses showed an increased risk of neoplasia in sarcoidosis. The granulomatosis can also reveal malignancy, either solid or hematological, defining paraneoplastic sarcoidosis. Recent cancer immunotherapies, including immune checkpoint inhibitors (targeting PD-1, PD-L1, or CTLA-4) and BRAF or MEK inhibitors were also reported as possible inducers of sarcoidosis-like reactions. Sarcoidosis and neoplasia, especially lymphoma, can show overlapping presentations, thus making the diagnosis and treatment harder to deal with. There are currently no formal recommendations to guide the differential diagnosis workup between the evolution of lymphoma or a solid cancer and a granulomatous reaction associated with neoplasia. Thus, in atypical presentations (e.g., deeply impaired condition, compressive lymphadenopathy, atypical localization, unexplained worsening lymphadenopathy, or splenomegaly), and treatment-resistant disease, targeted biopsies on suspect localizations with histological examination could help the clinician to differentiate neoplasia from sarcoidosis. Pathological diagnosis could sometimes be challenging since very few tumor cells may be surrounded by massive granulomatous reaction. The sensitization of currently available diagnostic tools should improve the diagnostic accuracy, such as the use of more “cancer-specific” radioactive tracers coupled with Positron Emission Tomography scan.

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Section: Sarcoidosis and Sarcoid-like Reactions In The Course Of Cancermentioning

confidence: 99%

Section: When Should We Look For Neoplasia In Patients With Sarcoidosis?mentioning

confidence: 99%

Section: When Should We Look For Neoplasia In Patients With Sarcoidosis?mentioning

confidence: 99%

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Sarcoidosis and Cancer: A Complex Relationship

et al. 2020

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“…The onset of such manifestations varies between 1 and 22 months with a mean time of onset at 6 months after initiation of treatment. 35,36…”

Section: Drug-induced Granulomatosismentioning

confidence: 99%

“…38 Of note, sarcoidosis may precede, follow, or occur concurrently with a number of cancers, especially lymphomas, thus representing a diagnostic challenge. 25,36,39 Both cancer and sarcoidosis are 18fluorodeoxyglucose (18-FDG) avid; therefore 18-FDG positron emission tomography (PET) may be useful in selecting possible biopsy sites (in priority, sites with the greatest 18-FDG uptake), but not in distinguishing between the two entities. 24 If uncertainty remains, multiple biopsies may be needed to determine whether all FDG-avid sites are involved with sarcoidosis or whether they harbor cancer cells as well.…”

Section: Neoplastic Disordersmentioning

confidence: 99%

<p>Refractory Sarcoidosis: A Review</p>

Jammal

Jamilloux

Gerfaud‐Valentin

et al. 2020

TCRM

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Sarcoidosis is a multi-system disease of unknown etiology characterized by granuloma formation in various organs (especially lung and mediastinohilar lymph nodes). In more than half of patients, the disease resolves spontaneously. When indicated, it usually responds to corticosteroids, the first-line treatment, but some patients may not respond or tolerate them. An absence of treatment response is rare and urges for verifying the absence of a diagnosis error, the good adherence of the treatment, the presence of active lesions susceptible to respond since fibrotic lesions are irreversible. That is when second-line treatments, immunosuppressants (methotrexate, leflunomide, azathioprine, mycophenolate mofetil, hydroxychloroquine), should be considered. Methotrexate is the only first-line immunosuppressant validated by a randomized controlled trial. Refractory sarcoidosis is not yet a well-defined condition, but it remains a real challenge for the physicians. Herein, we considered refractory sarcoidosis as a disease in which second-line treatments are not sufficient to achieve satisfying disease control or satisfying corticosteroids tapering. Tumor necrosis alpha inhibitors, third-line treatments, have been validated through randomized controlled trials. There are currently no guidelines or recommendations regarding refractory sarcoidosis. Moreover, criteria defining non-response to treatment need to be clearly specified. The delay to achieve response to organ involvement and drugs also should be defined. In the past ten years, the efficacy of several immunosuppressants beforehand used in other autoimmune or inflammatory diseases was reported in refractory cases series. Among them, anti-CD20 antibodies (rituximab), repository corticotrophin injection, and anti-JAK therapy anti-interleukin-6 receptor monoclonal antibody (tocilizumab) were the main reported. Unfortunately, no clinical trial is available to validate their use in the case of sarcoidosis. Currently, other immunosuppressants such as JAK inhibitors are on trial to assess their efficacy in sarcoidosis. In this review, we propose to summarize the state of the art regarding the use of immunosuppressants and their management in the case of refractory or multidrugresistant sarcoidosis.

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Metastase oder Sarkoidose – eine diagnostische Herausforderung beim metastasierten Rektumkarzinom

et al. 2022

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Zusammenfassung Hintergrund Granulomatöse Erkrankungen wie Sarkoidose können die Diagnostik bei onkologischen Erkrankungen erschweren, da Metastasen bildmorphologisch häufig nicht von Granulomen zu unterscheiden sind. Die vorliegende Kasuistik beschreibt Diagnostik und Therapie eines Patienten mit fortgeschrittener Sarkoidose und einem hepatisch metastasierten Rektumkarzinom mit schlussendlichem Erreichen eines kurativen Stadiums. Fallbeschreibung Bei einem 71-jährigen Patienten wurde im Rahmen der Abklärung ungewollten Gewichtsverlustes sowie einer Anämie ein Adenokarzinom des Rektums diagnostiziert. Die weitere Umfelddiagnostik ergab bildmorphologisch den hochgradigen Verdacht auf multiple rechtshepatische, pulmonale und splenische Metastasen. Histologisch zeigten sich nach bronchoskopischer Biopsie der mediastinalen Lymphknoten jedoch nichtverkäsende Epitheloidzellgranulome als Manifestation einer bis dato nicht bekannten Sarkoidose. Aufgrund des stenosierenden Tumors erfolgte eine Rektumresektion mit Milzextirpation bei intraoperativ hochgradigem Verdacht auf Milzmetastasen. Histologisch zeigten sich in der Milz eine Beteiligung im Rahmen der Sarkoidose. Bei bildmorphologisch weiterhin suspekten rechtshepatischen Leberläsionen erfolgte postoperativ eine Stanzbiopsie einer Läsion, die histologisch sowohl eine Metastase des bekannten Rektumkarzinoms als auch eine Sarkoidose ergab. Es erfolgte eine pseudo(neo)adjuvante Therapie mit 5-Fluorouracil, Leukovorin und Oxaliplatin (FOLFOX) und Panitumumab (Anti-EGF-Antikörper). Bildmorphologisch zeigten sich posttherapeutisch 2 Leberläsionen regredient, mehrere weitere größenstabil. Es erfolgte eine erweiterte Hemihepatektomie rechts mit histologischem Nachweis von sowohl Metastasen als auch Sarkoidose-Herden. Der zu diesem Zeitpunkt tumorfreie Patient wurde in die engmaschige Nachsorge entlassen, die sich im weiteren Verlauf (13 Monate) bildmorphologisch ohne Rezidivhinweis zeigte. Diskussion Das gleichzeitige Auftreten von metastasierten Tumorerkrankungen und Sarkoidoseherden führt zu einem diagnostischen Dilemma, da die Manifestationen bildmorphologisch kaum unterschieden werden können. Dieser Fallbereich zeigt, dass eine umfassende histologische Aufarbeitung der unterschiedlichen betroffenen Organe mit konsekutiven Resektionen schlussendlich zu einer Tumorfreiheit des Patienten führen kann.

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Faut-il rechercher un cancer après la découverte d’une granulomatose inexpliquée ?

Cited by 5 publications

References 38 publications

Sarcoidosis and Cancer: A Complex Relationship

Sarcoidosis and Cancer: A Complex Relationship

<p>Refractory Sarcoidosis: A Review</p>

Metastase oder Sarkoidose – eine diagnostische Herausforderung beim metastasierten Rektumkarzinom

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