Rare coexistence of sarcoidosis and lung adenocarcinoma

Kachalia, Amit; Ochieng, Pius; Kachalia, Kinjal; Rahman, Habibur

doi:10.1016/j.rmcr.2013.12.008

Cited by 13 publications

(12 citation statements)

References 5 publications

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“…Because solitary lung masses with mediastinal lymphadenopathy are the hallmarks of lung cancer, obtaining a definitive diagnosis in cases of atypical pulmonary sarcoidosis is diagnostically challenging. Prior case reports described the need for a surgical lung biopsy to obtain sufficient tissue for a definitive diagnosis [ 4 , 6 ], which was the case in our patient. However, the presence of granulomas does not necessarily rule out a malignancy, because non-caseating granulomas have been reported in some instances of small cell lung cancer [ 7 ].…”

Section: Discussionmentioning

confidence: 79%

A rare presentation of pulmonary sarcoidosis as a solitary lung mass: a case report

Kelleher¹,

Yaggi²,

Homer³

et al. 2018

J Med Case Reports

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BackgroundSarcoidosis is a multisystem, chronic granulomatous disease of unknown etiology that predominantly affects the lungs. Pulmonary sarcoidosis classically presents with constitutional symptoms and computed tomographic scan findings of bilateral, symmetric micronodules in a peribronchovascular distribution with upper and middle lung zone predominance accompanied by bilateral, symmetric hilar lymphadenopathy. A solitary lung mass is a rare finding for pulmonary sarcoidosis, and with its associated constitutional symptoms, it strongly mimics a malignancy. We aimed to provide further insight into the broad differential diagnosis of a lung mass by describing our experiences in the care of a patient who presented with clinical and radiographic features of lung cancer who was ultimately found to have an atypical manifestation of stage II pulmonary sarcoidosis.Case presentationA 44-year-old African American woman with a history of childhood asthma and type 2 diabetes mellitus presented with shortness of breath. After being treated for a presumed asthma exacerbation with prednisone, she experienced worsening dyspnea, night sweats, and unintentional weight loss. Further evaluation revealed a large left lower lobe mass and hilar lymphadenopathy. A computed tomography-guided biopsy of the lung mass revealed a multifocal non-necrotizing granuloma with multinucleated giant cells. Although consistent with sarcoidosis, this finding could represent a sarcoid-like reaction secondary to an occult malignancy. A more extensive repeat biopsy via bronchoscopy and mediastinoscopy revealed granulomatous inflammation without evidence of malignancy or infection. These procedures confirmed the diagnosis of pulmonary sarcoidosis, and she was started on treatment with high-dose prednisone. Her treatment course was complicated by hyperglycemia necessitating insulin therapy, but after 3 months of therapy, she reported improvement in her dyspnea, and repeat imaging revealed a significant decrease in the size of the lung mass and lymphadenopathy. Given her clinical and radiographic response, she was continued on a prednisone taper.ConclusionsAtypical manifestations of pulmonary sarcoidosis are diagnostically challenging because the clinical and radiographic features of the disease mimic those of a malignancy. We aimed to illustrate a unique etiology of a lung mass and the importance of maintaining a broad differential diagnosis. Nonetheless, with the possibility of a malignancy, a high index of suspicion is necessary for timely diagnosis and optimal management.

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Section: Discussionmentioning

confidence: 79%

A rare presentation of pulmonary sarcoidosis as a solitary lung mass: a case report

Kelleher¹,

Yaggi²,

Homer³

et al. 2018

J Med Case Reports

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“…Further staging examination showed pleural, pericardial and diaphragmatic metastasis. Due to tumor progress, palliative care was initiated ( 13 ). The third case describes a 57-year-old female patient who was found to have a choroidal mass in the left eye.…”

Section: Resultsmentioning

confidence: 99%

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

Spiekermann¹,

Kuhlencord²,

Huss³

et al. 2017

Oncol Lett

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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.

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“…Spiekermann et al reviewed 59 cases with coexisting cancer and sarcoidosis including four cases of seminoma. [8][9][10][11][12] A few of these cases were actually simultaneous occurrences of sarcoidosis and metastases leading to insufficient treatment. In our case, because we did not subject every mediastinal lymph node to histological analysis, it remains possible that metastatic seminoma could also coexist in the residual mediastinal lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Introduction Testicular germ cell cancer has a relatively good prognosis even if visceral and/or lymph node metastases are present thanks to chemotherapy. Yet chemotherapy can lead to various adverse events. Therefore, it is crucial to distinguish whether a suspected metastatic disease is metastasis or not. Case presentation A 33‐year‐old male visited our hospital to receive subsequent therapy for suspected recurrent seminoma with a progressing pulmonary nodule and mediastinal lymphadenopathy after orchiectomy. The pathological diagnosis of needle aspiration and resected specimen of the several lesions was consistent with epithelioid cell granuloma without caseous necrosis. Based on these findings, the lung and mediastinal lymph node lesions were diagnosed as sarcoidosis. Conclusion In cases where the simultaneous occurrence of other benign or malignant diseases is suspected, pathological confirmation is necessary for appropriate decision‐making.

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Rare coexistence of sarcoidosis and lung adenocarcinoma

Cited by 13 publications

References 5 publications

A rare presentation of pulmonary sarcoidosis as a solitary lung mass: a case report

A rare presentation of pulmonary sarcoidosis as a solitary lung mass: a case report

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

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

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