Inflammatory cells in the formation of tumor-related sarcoid reactions

Conformational fingerprinting of the angiotensin I-converting enzyme (ACE). 1. Application in sarcoidosis

Fine epitope mapping of monoclonal antibodies (mAbs) to 16 epitopes on human angiotensin I-converting enzyme (ACE) revealed that the epitopes of all mAbs contained putative glycosylation sites. ACE glycosylation is both cell- and tissue-specific and, therefore, the local conformation of ACE produced by different cells could be also unique. The pattern of ACE binding by a set of mAbs to 16 epitopes of human ACE - "conformational fingerprint of ACE" - is the most sensitive marker of ACE conformation and could be cell- and tissue-specific. The recognition of ACEs by mAbs to ACE was estimated using an immune-capture enzymatic plate precipitation assay. Precipitation patterns of soluble recombinant ACE released from Chinese hamster ovary (CHO)-ACE cells was influenced by conditions that alter ACE glycosylation. This pattern was also strongly cell type specific. Patients with sarcoidosis exhibited conformational fingerprints of tissue ACE (lungs and lymph nodes), as well as blood ACE, which were distinct from controls. Conformational fingerprinting of ACE may detect ACE originated from the cells other than endothelial cells in the blood and when combined with elevated blood ACE levels in patients with sarcoidosis may potentially reflect extrapulmonary sarcoidosis involvement (bone marrow, spleen, liver). If proven true, this would serve as a biomarker of enormous potential clinical significance.

Sarcoidosis and lung cancer

BACKGROUND

Although sarcoidosis as well as lung cancer are frequently encountered common diseases, their metachronous or synchronous occurrence in the same patient is very rare.

METHODS

The charts of lung cancer patients, diagnosed between 1980 and 2007 in our hospital, were reviewed.

RESULTS

We found 3 cases with sarcoidosis and lung cancer. The first case had lung cancer 16 years after the diagnosis of sarcoidosis. The second case had two different metachronous lung cancers 18 and 10 years after the diagnosis of sarcoidosis. The third case detected these two diseases simultaneously. In simultaneously detected cases, it is difficult to determine whether noncaseating epithelioid cell granulomas coexisting with lung cancer represent sarcoid reaction or genuine systemic sarcoidosis.

CONCLUSIONS

Either causality or coincidence, lung cancer, a condition that can be observed in patients with sarcoidosis, should be considered in the differential diagnosis when suspicious findings of it are discovered.

Sarcoid Reactions after Chemotherapy for Hodgkin's Lymphoma

Introduction

There is a reported association between sarcoidosis and malignancy. This is particularly true for lymphomas and is known as the sarcoidosis-lymphoma syndrome.

Case report

A 49 year old Caucasian female presented with mediastinal and axillary lymphadenopathy. An excisional axillary lymph node biopsy showed classical Hodgkin’s lymphoma, nodular sclerosis subtype. She received six cycles of conventional chemotherapy achieving a complete remission with no evidence of any lymphadenopathy on restaging imaging. However, one month after completion of chemotherapy, she developed new onset of progressive mediastinal lymphadenopathy. A mediastinoscopy and biopsy was performed showing noncaseating granulomata and the patient was diagnosed with a sarcoid reaction.

Conclusion

Sarcoidosis and sarcoid reactions must be considered in the differential diagnosis when assessing patients with persistent or enlargening masses after chemotherapy treatment for Hodgkin’s lymphoma, especially since this is associated with a better prognosis. A tissue biopsy is essential prior to starting chemotherapy for presumed relapsed malignancy or persistent disease so as to avoid inappropriate treatment.

Endobronchial ultrasound-guided transbronchial needle aspiration cytology: a state of the art review

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a recently developed, accurate, safe and cost-effective technique that allows sampling of mediastinal lymph nodes and peribronchial lesions including pulmonary and mediastinal lesions. Its major indications are the nodal staging of non-small cell carcinomas of the lung, their restaging after chemotherapy and/or radiation, the diagnosis of sarcoidosis and of metastases from extrathoracic malignancies, and the diagnosis of mediastinal lymphadenopathy and masses of unknown aetiology. From our experience at the University of Minnesota and a comprehensive review of the literature, we discuss technical aspects of the procedure, its advantages and limitations in comparison with other methods of sampling mediastinal lymph nodes, focusing on the role of the cytopathologist in ensuring the effectiveness of the procedure. An algorithmic approach to the cytological diagnosis, starting with the determination of the adequacy of the sample, is also presented.

Classic Kaposi sarcoma with sarcoid-like granulomas: a case report and literature review

The occurrence of granulomatous reactions within lymph nodes that drain carcinomas is well known but uncommon. Even more rarely, granulomas may occur within the stroma of tumors. These lesions, called sarcoid-like reactions, commonly accompany carcinomas but are very rare in sarcomas. This study presents a case of classic Kaposi sarcoma that contained sarcoid-like granulomas, with a literature review. A soft tissue lesion of the foot was excised from a 74-year-old male. Histopathological examination showed that the tumor tissue consisted of spindle cells, areas of atypical vascular proliferation, and extravasated erythrocytes surrounded by non-caseating granulomas. The patient had no clinical or laboratory findings of sarcoidosis. The case was interpreted as "Kaposi sarcoma containing sarcoid-like granulomas". The association of soft tissue sarcomas with a granulomatous reaction is very rare. A granulomatous reaction is reported to be a good prognostic indicator in several carcinoma types, although its importance in sarcomas is unclear.

The inflammatory component of Kaposi sarcoma

Kaposi sarcoma (KS) is intimately linked to several aspects of the host immune system. KS development is linked to immunodeficiency in several clinical-epidemiological settings. The development of KS at local inflammatory sites has also been documented. Inflammatory cells are almost always present within KS lesions. Depending upon the inflammatory milieu, KS lesions may progress or regress. Not surprisingly, iatrogenic manipulation of host immunity with drugs may provoke KS growth and/or flare. Given the close association between KS and the immune system, the etiologic agent Kaposi Sarcoma Herpesvirus has developed a variety of mechanisms to evade the host immune system, all of which have cleverly evolved to promote oncogenesis and viral persistence.

Is sarcoidosis frequent in patients with cancer?

PURPOSE OF REVIEW

To examine the recent advancements of the epidemiology, pathophysiology, and clinical characteristics in patients who have a history of sarcoidosis and cancer.

RECENT FINDINGS

A longitudinal study examined 1153 patients with sarcoidosis utilizing the computerized healthcare dataset available in the United Kingdom. The authors found increased incidence of cancer in patients with sarcoidosis mainly due to skin cancer (rate ratio 1.86; 95% confidence interval 1.11-3.11). Endobronchial ultrasound guided transbronchial needle aspiration for mediastinal adenopathy in patients found 11% (17 out of 153) of patients to have noncaseating granulomas. Of the 17 patients, eight had sarcoid-like lymphadenopathy, another eight had sarcoidosis, and one had nontuberculous mycobacterial infection. Another study examined the presence of granulomas in patients with testicular carcinoma, which showed either sarcoid-like reaction or sarcoidosis. Eighty percent of patients with granulomas regressed spontaneously and did not appear to affect the prognosis of cancer.

CONCLUSION

Is there a causal or accidental relationship between sarcoidosis and cancer? We do not know. However, we would like to propose the term 'sarcoid-cancer syndrome' that would encompass sarcoid-like reaction and multisystem sarcoidosis occurring in patients with cancer and various lymphomas. Further studies are needed to elucidate the precise mechanism and epidemiology, clinical features, and pathogenesis of this phenomenon.

Synchronous orofacial granulomatosis and mucoepidermoid carcinoma: paraneoplastic syndrome or coincidence?

Some malignant neoplasias induce the appearance of local or systemic manifestations at distant sites, which can act as indicators of their presence in a process named paraneoplastic syndrome. Granulomatous reactions have already been described related to malignancies. This report describes a case of synchronous orofacial granulomatosis and mucoepidermoid carcinoma and discusses the significance of this association.

Sarcoidosis and malignancy

Malignancy in patients with sarcoidosis occurs in 3 settings. The first setting relates to patients with hematologic malignancies. It includes the sarcoidosis-lymphoma syndrome, which refers to the development of lymphoma at least 1 to 2 years after the diagnosis of sarcoidosis. It also includes patients with sarcoidosis who develop other hematologic malignancies. In addition, this subset of individuals includes patients with cancer and hematologic malignancies who subsequently develop sarcoidosis. The second setting consists of patients with sarcoidosis who develop solid tumors and oncologic patients in whom sarcoidosis subsequently appears; in addition to melanoma and nonmelanoma skin cancer, the neoplasms most commonly associated involve the cervix, liver, lung, testicles, and uterus. The third setting of malignancy-related sarcoidosis occurs when sarcoidosis presents as a paraneoplastic syndrome for the associated cancer, specifically when the discovery of cancer is concurrent with or within 1 year of the diagnosis of sarcoidosis or vis-a-vis. Antineoplastic treatment of either the hematologic malignancy or the solid tumor has also been observed to either induce the initial onset or flare the activity of sarcoidosis. Malignancy can also be associated with the occurrence of sarcoid reactions that typically are restricted to the regional lymph nodes or the visceral organ of tumor origin; rarely, the sarcoid reaction can also be observed in the skin or is only limited to the skin.