The diagnostic challenge of coexistent sarcoidosis and thyroid cancer – a retrospective study

Abstract

Background Sarcoid lesions may mimic metastatic disease or recurrence in thyroid cancer (TC) patients as both diseases may affect the lungs and lymph nodes. We present the first study to systematically evaluate the clinical course of patients with (TC) after adjuvant radioactive iodine therapy (RIT) and concomitant sarcoidosis of the lung or the lymph nodes. Methods We screened 3285 patients and retrospectively identified 16 patients with TC (11 papillary thyroid cancer (PTC), 3 follicular thyroid cancer (FTC), 1 oncocytic PTC, 1 oncocytic FTC) and coexisting sarcoidosis of the lung and/or the lymph nodes treated at our institute. All patients had undergone thyroidectomy and initial adjuvant RIT. Challenges in diagnosing and the management of these patients were evaluated during long term follow-up (median 4.9 years (0.8–15.0 years)). Results Median age at first diagnosis of TC was 50.1 years (33.0–71.5 years) and of sarcoidosis 39.4 years (18.0–63.9 years). During follow-up, physicians were able to differentiate between SA and persistent or recurrent TC in 10 of 16 patients (63%). Diagnosis was complicated by initial negative thyroglobulin (Tg), positive Tg antibodies and non-specific imaging findings. Histopathology can reliably distinguish between SA and TC in patients with one suspicious lesion. Conclusion Physicians should be aware of the rare coexistence of sarcoidosis and TC. Lymphadenopathy and pulmonary lesions could be metastases, sarcoidosis or even a mix of both. Therefore, this rare patient group should receive a thorough work up including histopathological clarification and, if necessary, separately for each lesion.

Hürthle Cell Carcinoma of the Thyroid Gland: Systematic Review and Meta-analysis

“…Our search criteria identified 1,206 publications. After removal of duplicates and those that did not meet our inclusion criteria, 27 articles were selected (Figure 1) for data review as summarized in Table 1 [13,14,[23][24][25][26][27][28][29][30][31][32]15,[33][34][35][36][37][38][39][16][17][18][19][20][21][22]. Most papers were excluded because they analyzed HCC patients together with other histologies.…”

“…HCC are generally regarded as more aggressive than conventional follicular carcinoma of the thyroid gland [27,39], although this is unclear [15,28]. Their biological behavior is to some degree disputed in the literature perhaps in part due to their infrequent incidence.…”

“…In our review, the mean size of the HCCs was 30 mm. In 11 of the 20 articles (55%) in which data on tumor size were provided, the mean size was less than 4 cm [13,16,17,22,[25][26][27]29,31,36,39]. The study by Maxwell et al [17] reported the smallest average tumor size with a mean of 25 mm, although the range varied from 5 to 80 mm, with one third (15/45) having multifocal tumors.…”

Sarcoidosis Mimicking a Malignant Metastatic Disease

“…Sarcoidosis can co-exist and/or mimic metastatic malignancy. For example, sarcoidosis can rarely co-exist with thyroid cancer 12 and oropharyngeal cancer. 13 Interestingly, sarcoidosis has been rarely reported to mimic a pattern of metastatic breast cancer, 14 and head and neck cancer.…”

Thyroid sarcoidosis: a rare entity in the differential diagnosis of thyroid cancer

“…In addition to bioptical evaluation of suspicious lymph nodes, the authors suggested the use of F18-labeled 3'-deoxy-3'-fluorothymidine-PET scan as a helpful tool to discriminate between inflammatory lymphadenitis and metastatic lesions, thus achieving avoidance of unnecessary surgery or insufficient treatments, although more research is needed in this regard ( 9 ). More recently, Wenter et al extensively discussed the challenges of differentially diagnosing lesions in 16 patients with concomitant thyroid carcinoma and sarcoidosis, with cytology or histology needed for a definitive diagnosis in most cases ( 10 ).…”