Sarcoid-like reaction in patients with malignant tumors: Long-term clinical course and outcomes

Abstract

BackgroundThe development of non-caseating epithelioid cell granulomas in cancer patients who do not fulfill the systemic sarcoidosis criteria is termed sarcoid-like reaction (SLR). Little is known about this condition's natural course and impact on the prognosis of malignancy. We aimed to investigate the natural course and prognostic value of cancer-associated SLR.MethodsClinical data were retrospectively analyzed in 32 patients with biopsy-proven cancer-associated SLR. Among patients with non-small cell lung cancer (NSCLC), SLR cases (n = 8) were matched with non-SLR cases (n = 78) for survival analysis.ResultsAmong the included patients, the mean age was 59.7 years, and 68.8% were female. The median follow-up period was 35.6 months [interquartile range (IQR): 14.0–61.4 months]. Of all the included malignancies (n = 32), breast cancer (25.0%) and NSCLC (25.0%) were the most common, with stage I being the most frequent tumor stage (59.4%). During follow-up, SLR progression to overt sarcoidosis was not observed. In the 28 patients with available follow-up computed tomography images (median interval: 24.9 months; IQR: 14.4–41.7), 4 patients received corticosteroids (n = 4), resulting to a decrease of SLR lesions. Meanwhile, among those who did not receive treatment (n = 24), the extent of SLR decreased or did not change in 85.7% of them, whereas 3.6% had increased SLR extent. Furthermore, among patients with NSCLC, SLR was not associated with overall survival [hazard ratio (HR) = 1.28, 95% confidence interval (CI): 0.02–67.71, P = 0.882] and recurrence of malignancy (HR = 1.27, 95% CI 0.21–7.51, P = 0.793) in the Cox proportional hazard regression model.ConclusionsDuring the follow-up of cancer-related SLR, we found no further evidence for systemic sarcoidosis, and most of the lesions decreased or did not change. Development of SLR was also not associated with overall survival or disease-free survival in patients with NSCLC.

Sarcoid-Like Reactive Lymphadenopathy in Metastatic Synovial Sarcoma

“…Overall, the results were not significantly different. But there are other studies that reported sarcoid-like reactions associated with non-small cell lung cancer were associated with better outcomes in terms of survival [9].…”

Splenic sarcoid reaction mimicking metastases in patients after uterine cancer surgery: a report of two cases

“…Sarcoid reactions may not be initially considered when preoperative diagnosis of the tumor or sarcoid reaction using imaging is difficult; however, a review of the initial specimen for the presence of granuloma formation may help with their identification. The sarcoid reaction is thought to be involved in the T cell-type immune response [ 4 ] and is not associated with overall or recurrence-free survival [ 3 ]. There have been no reports of sarcoid reactions leading to sarcoidosis.…”

“…Sarcoid or sarcoid-like reactions are histologic changes characterized by non-caseating epithelioid cell granulomas in patients without systemic sarcoidosis [ 1 , 2 ]. Sarcoid reactions have been associated with various tumors [ 1 , 3 , 4 ], including lymphoma, lung cancer [ 5 – 9 ], breast cancer [ 10 – 12 ], esophageal cancer [ 13 ], gastric cancer [ 14 ], colorectal cancer [ 15 – 19 ], biliary cancer [ 20 , 21 ], pancreatic cancer [ 22 ], melanoma [ 23 , 24 ], renal cell carcinoma [ 25 – 30 ], and bone cancer [ 31 ]. Sarcoidosis-like granulomas are predominantly found in the lymph nodes and stroma adjacent to tumors; however, involvement in the organs, such as the bone, skin, and spleen, is infrequent.…”

Sarcoid-like reaction in malignant melanoma exacerbated with pembrolizumab therapy case report

“…Sarcoid like reactions (SLR) consists of a localized reaction with histopathological finding of noncaseating epithelioid cell granulomas. While the exact pathophysiology underlying SLR is unclear, studies suggest that it is attributed to diverse antigens that are coupled with genetic susceptibility, thus triggering T cell mediated immune responses and leading to the formation of noncaseating epithelioid cell granulomas [ 1 ].…”