Sarcoidosis and maligancy: the chicken and the egg?

Abstract

Purpose of reviewThere is a complex interaction between sarcoidosis and malignancy. Since tumors can elicit a granulomatous reaction, the presence of granulomas alone is insufficient to diagnose sarcoidosis in a patient with cancer. In addition, check point inhibitors can also lead to a granulomatous reaction which can be misdiagnosed as sarcoidosis. These issues need to be considered when exploring the relationship between sarcoidosis and malignancy. Despite these limitations, a growing amount of evidence supports the potential interaction of sarcoidosis and malignancy.Recent findingsSeveral large epidemiologic studies of patients from Europe, the USA, and Japan reveal an increased relative risk for cancer in sarcoidosis patients. The highest relative risks are seen in patients with lymphoma and breast cancer. New criteria have been developed to standardize the diagnosis of sarcoidosis, which should further clarify the association.SummaryThe diagnosis of sarcoidosis may precede or occur after malignancy. In a sarcoidosis patient with an atypical lesion, such as a breast mass, a biopsy should be considered.

Autoimmune diseases and risk of non-Hodgkin lymphoma: A Mendelian randomisation study

“…52 Moreover, it remains unclear if sarcoidosis precedes or follows NHL, as several observational studies reported occurrence of sarcoidosis among NHL patients after treatment of NHL or concomitant occurrence of two diseases. 19–22…”

“…Although we also observed a negative association between genetically predicted susceptibility to sarcoidosis and NHL, the association was no longer significant after accounting for multiple testing. While no previous epidemiologic studies have reported statistically significant negative associations for either T1D or sarcoidosis with NHL, 8,9,13,22,51 it has been suggested that the pathways involved in autoimmune disease and cancer development may work in opposite directions. 52 Moreover, it remains unclear if sarcoidosis precedes or follows NHL, as several observational studies reported occurrence of sarcoidosis among NHL patients after treatment of NHL or concomitant occurrence of two diseases.…”

“…[12][13][14][15][16][17][18] For some autoimmune diseases, such as sarcoidosis, it is often unclear if the autoimmune disease precedes or develops after NHL. [19][20][21][22][23][24] One way of addressing the issue of residual confounding and reverse causation is through instrumental variable analyses with genetic instruments, often called Mendelian randomisation (MR) analyses. 25 Because genetic variants are randomly assigned at conception and are not affected by external factors such as chronic diseases and lifestyle factors, MR analyses mimic randomized experiments and are less susceptible to confounding and reverse causation compared with conventional observational studies.…”

Malignancy and sarcoidosis: A single center experience from Turkey

“…Yet it is still not very clear the cut off criteria for the differentiation of the sarcoidosis and the sarcoid-like reactions in patients with malignancy which might be a subject of changes in evaluation of the entities in the future. Bonifazi et al proposed a diagnostic work-up for cancer patients with an identification of granuloma on biopsy and stated that elevated ACE, granulomas in areas remote from cancer, previous diagnosis of sarcoidosis, atypical involvement for cancer ( ocular, skin, parenchymal lung disease and cardiac) and hypercalcemia with high vitamin D1,25 and low vitamin D25 and PTH are features that favor sarcoidosis rather than a relapse of the malignancy [30].…”

Safety of corticosteroid therapy in sarcoidosis treatment

“…Other conditions, such as infectious disorders and cancer, have also been shown to be associated with a granulomatous reaction, mimicking sarcoidosis. In addition, certain drugs may also induce OPEN ACCESS EDITED BY sarcoid-like reactions indistinguishable from sarcoidosis (Bonifazi et al, 2015;Bonifazi et al, 2021;Tana et al, 2022).…”