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Brito-Zerón P, Flores-Chávez A, González-de-Paz L, Feijoo-Massó C, de Escalante B, González-García A, Gómez-de-la-Torre R, Policarpo-Torres G, Alguacil A, García-Morillo JS, López-Dupla M, Robles Á, Bonet M, Gómez-Lozano A, Toledo N, Chamorro A, Morcillo C, Cruz-Caparrós G, de Miguel-Campo B, Akasbi M, Fonseca-Aizpuru E, Gómez-Cerezo JF, Mas-Maresma L, Vallejo-Grijalba J, Starita-Fajardo G, Sánchez-Niño R, Ramos-Casals M. Temporal relationship between sarcoidosis and malignancies in a nationwide cohort of 1942 patients. Postgrad Med J 2024:qgae045. [PMID: 38972066 DOI: 10.1093/postmj/qgae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/22/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE To investigate the phenotype of sarcoidosis according to the time when a malignancy is diagnosed (preexisting to the diagnosis of sarcoidosis, concomitant, or sequential) and to identify prognostic factors associated with malignancies in a large cohort of patients with sarcoidosis. METHODS We searched for malignancies in the SARCOGEAS cohort, a multicenter nationwide database of consecutive patients diagnosed with sarcoidosis according to the ATS/ESC/WASOG criteria. Solid malignancies were classified using the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) nomenclature, and hematological malignancies using the 2016 WHO classification. We excluded patients with a biopsy-proven diagnosis of sarcoidosis based exclusively on demonstrating granulomas in tissues also involved by malignant cells. RESULTS Out of 1942 patients with sarcoidosis, 233 (12%) developed 250 malignancies, including solid (n = 173), hematological (n = 57), and both types of malignancies (n = 3). Concerning the time interval between the diagnoses of both conditions, 83 (36%) patients were diagnosed with malignancy at least 1 year before sarcoidosis diagnosis, 22 (9%) had s synchronous diagnosis of both diseases, and 118 (51%) developed malignancies at least 1 year after the diagnosis of sarcoidosis (the remaining cases developed malignancies in different time intervals). The multivariate-adjusted model showed that individuals with sarcoidosis who developed a malignancy had an hazard ratio (HR) of 2.27 [95% confidence interval (CI), 1.62-3.17] for having an asymptomatic clinical phenotype at diagnosis of sarcoidosis and that spleen (presence vs. absence: HR = 2.06; 95% CI, 1.21-3.51) and bone marrow (presence vs. absence: HR = 3.04; 95% CI, 1.77-5.24) involvements were independent predictors for the development of all-type malignancies. No predictive factors were identified when the analysis was restricted to the development of solid malignancies. The analysis limited to the development of hematological malignancies confirmed the presence of involvement in the spleen (HR = 3.73; 95% CI, 1.38-10.06) and bone marrow (presence vs. absence: HR = 8.00; 95% CI, 3.15-20.35) at the time of sarcoidosis diagnosis as predictive factors. CONCLUSION It is essential to consider the synchronous or metachronous timing of the diagnosis of malignancies in people with sarcoidosis. We found that half of the malignancies were diagnosed after a diagnosis of sarcoidosis, with spleen and bone marrow involvement associated with a four to eight times higher risk of developing hematological malignancies. Key messages What is already known on this topic Malignancies are one of the comorbidities more frequently encountered in people with sarcoidosis What this study adds Malignancies occur in 12% of patients with sarcoidosis Malignancy may precede, coincide with, or follow the diagnosis of sarcoidosis One-third were identified before sarcoidosis, and half were diagnosed after Spleen and bone marrow involvement are risk factors for developing hematological malignancies How this study might affect research, practice or policy Patients with sarcoidosis should be regularly monitored for neoplasms, informed of the increased risk, and educated on early detection. Those with spleen or bone marrow involvement must be closely followed.
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Affiliation(s)
- Pilar Brito-Zerón
- Department of Internal Medicine, Research and Innovation Group in Autoimmune Diseases, Hospital-CIMA-Sanitas, Barcelona, 08034, Spain
| | | | - Lluís González-de-Paz
- Primary Care Center Les Corts, CAPSBE, Primary Healthcare Transversal Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Carles Feijoo-Massó
- Department of Internal Medicine, Hospital Parc Tauli, Sabadell, 08208, Spain
| | | | | | - Ricardo Gómez-de-la-Torre
- Department of Internal Medicine, Hospital Universitario Central de Asturias (HUCA), Oviedo, 33011, Spain
| | | | - Ana Alguacil
- Department of Internal Medicine, Hospital Virgen de la Salud, Toledo, 45071, Spain
| | | | - Miguel López-Dupla
- Department of Internal Medicine, Hospital Joan XXIII, Tarragona, 43007, Spain
| | - Ángel Robles
- Department of Internal Medicine, Hospital La Paz, Madrid, 28046, Spain
| | - Mariona Bonet
- Department of Internal Medicine, Althaia, Xarxa Assistencial de Manresa, Manresa, 08243, Spain
| | - Albert Gómez-Lozano
- Department of Internal Medicine, Hospital Santa Caterina, Girona, 17190, Spain
| | - Neera Toledo
- Department of Internal Medicine, Hospital Gregorio Marañón, Madrid, 28007, Spain
| | - Antonio Chamorro
- Department of Internal Medicine, Hospital Universitario de Salamanca, Salamanca, 37007, Spain
| | - César Morcillo
- Department of Internal Medicine, Hospital CIMA-Sanitas, Barcelona, 08034, Spain
| | | | | | - Miriam Akasbi
- Department of Internal Medicine, Hospital de Cabueñes, Gijón, 33394, Spain
| | - Eva Fonseca-Aizpuru
- Department of Internal Medicine, Hospital Infanta Leonor, Madrid, 28046, Spain
| | | | - Laia Mas-Maresma
- Department of Internal Medicine, Hospital Parc Tauli, Sabadell, 08208, Spain
| | | | | | - Raúl Sánchez-Niño
- Department of Internal Medicine, Hospital Universitario Central de Asturias (HUCA), Oviedo, 33011, Spain
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clinic, Barcelona, 08036, Spain
- Department of Medicine, Universitat de Barcelona, Barcelona, 08036, Spain
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Brito-Zerón P, Lower EE, Ramos-Casals M, Baughman RP. Hematological involvement in sarcoidosis: from cytopenias to lymphoma. Expert Rev Clin Immunol 2024; 20:59-70. [PMID: 37878359 DOI: 10.1080/1744666x.2023.2274363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION We present an updated overview of the hematological involvementassociated with sarcoidosis, including a management approach forcytopenias and revisiting the association with hematologicalmalignancies. AREAS COVERED Theetiology of cytopenias in sarcoidosis can be attributed to two majoretiopathogenic mechanisms: infiltration of hematopoietic organs suchas the spleen and bone marrow, and autoimmune-mediated cytopenias.With respect to the association with hematological malignancies, itrequires careful evaluation of patients from a chronologicalperspective. Patients must be classified into one of three pathogenicscenarios, including preexisting hematological malignancies,synchronous development of malignancy and sarcoidosis due to commonpredisposing factors, or sarcoidosis as a predisposing factor formalignancies. EXPERT OPINION The association between sarcoidosis and hematologic involvement isbest understood as a pathogenic continuum, with cytopenias andhematologic neoplasms intertwined due to various etiopathogenicmechanisms. These mechanisms include sarcoid infiltration ofhematopoietic organs, common predisposing immunogenetics for thedevelopment of autoimmune cytopenias and malignancies, and anincreased risk of neoplasm development in patients with autoimmunecytopenias. Collaboration among the main specialties involved in theclinical management of these patients is crucial for an earlymonitoring and management.
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Affiliation(s)
- Pilar Brito-Zerón
- Autoimmune Diseases Unit, Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Milenium Balmes Sanitas, Barcelona, Spain
- SarcoGEAS Study Group ("Grupo de Estudio de Enfermedades Autoinmunes -GEAS-, Sociedad Española de Medicina Interna -SEMI-), Spain
| | - Elyse E Lower
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Manuel Ramos-Casals
- SarcoGEAS Study Group ("Grupo de Estudio de Enfermedades Autoinmunes -GEAS-, Sociedad Española de Medicina Interna -SEMI-), Spain
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Robert P Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
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Clinical Characteristics of Sarcoidosis Patients with Self-Reported Lymphoma: A US Nationwide Registry Study. Lung 2021; 199:611-618. [PMID: 34665319 DOI: 10.1007/s00408-021-00485-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Little is known about the association between sarcoidosis and lymphoma. We aim to determine the prevalence of lymphoma in US sarcoidosis patients and compare the clinical characteristics of patients with and without lymphoma. METHODS Using a national registry-based study investigating 3560 respondents to the Foundation for Sarcoidosis Research Sarcoidosis Advanced Registry for Cures Questionnaire (FSR-SARC) completed between June 2014 and August 2019, we identified patients who reported the diagnosis of lymphoma following sarcoidosis and randomly selected a computer-generated control sample of sarcoidosis patients with no reported lymphoma with a 2:1 ratio. RESULTS Among 3560 patients with sarcoidosis, 43 (1.2%) reported developing lymphoma following their sarcoidosis diagnosis. Patients with lymphoma were more likely to be diagnosed with sarcoidosis at a younger age (median, IQR) 40 (27-50) vs 45 (34.8-56, p = 0.017) years, were more likely to be African-Americans OR 95% CI 3.9 (1.6-9.6, p = 0.002), and have low annual income (OR 2.7, 1.1-6.4 p = 0.026). The sarcoidosis-lymphoma group were more likely to have salivary gland (16% vs 5%, p = 0.026) (OR 4; 1.1-14.5) and cutaneous (46% vs 23%, p = 0.023) (OR 2.9; 1.1-7.3) sarcoidosis. They also reported more chronic fatigue (42% vs 23%, p = 0.029), chronic pain (37% vs 13%, p = 0.001), and depression (42% vs 22%, p = 0.019). CONCLUSION The prevalence of lymphoma reported in sarcoidosis patients is higher than the general population which further supports the possible increased risk of lymphoma in sarcoidosis. Diagnosis of sarcoidosis at a younger age, African-American race, cutaneous, and salivary glands sarcoidosis were associated with lymphoma. Sarcoidosis patients who developed lymphoma reported higher disease burden and more non-organ-specific manifestations.
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Tanaka Y, Tokubayashi Y, Kikuchi M, Fujii S, Kusaka T, Shibuya S, Kokuryu H. Gastric Cancer with Multiple Lymph Node Enlargement at the Time of the Sarcoidosis Diagnosis. Intern Med 2021; 60:3225-3229. [PMID: 33967139 PMCID: PMC8580756 DOI: 10.2169/internalmedicine.7218-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
An 80-year-old woman was found to have a 40-mm depressed-type gastric cancer. Computed tomography showed multiple lymph node enlargement, including paraaortic lymph nodes. The extent of lymph node enlargement was significant compared with the depth of the primary lesion. We conducted distal gastrectomy, D2 lymph node dissection, and a paraaortic lymph node biopsy. Microscopically, the tumor was diagnosed as mucosal cancer. In the dissected lymph nodes, noncaseating granuloma was found without metastasis of adenocarcinoma. Immunohistochemical staining using Propionibacterium acnes-specific antibodies showed a large number of P. acnes-positive cells in the granulomas. Finally, the tumor was diagnosed as early-stage gastric cancer and sarcoidosis.
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Affiliation(s)
- Yasuyuki Tanaka
- Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Japan
| | - Yumi Tokubayashi
- Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Japan
| | - Mitsuya Kikuchi
- Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Japan
| | - Shigehiko Fujii
- Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Japan
| | - Toshihiro Kusaka
- Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Japan
| | | | - Hiroyuki Kokuryu
- Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Japan
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Abstract
PURPOSE OF REVIEW There 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 FINDINGS Several 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. SUMMARY The 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.
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Tamada T, Nara M, Murakami K, Gamo S, Aritake H, Shimizu M, Kazama I, Ichinose M, Sugiura H. The Clinical Features of Patients with Sarcoidosis and Malignant Diseases in Japan. Intern Med 2021; 60:209-216. [PMID: 33456025 PMCID: PMC7872817 DOI: 10.2169/internalmedicine.5441-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective Recent studies suggest a significant association between sarcoidosis and malignancy, although the results have remained controversial. The aim of this study is to evaluate the clinical features of patients with sarcoidosis associated with malignant diseases in Japan. Patients We conducted a medical record review of all sarcoidosis patients in Tohoku University Hospital between January 1, 1981, and May 31, 2017. Methods The clinical records and pathology reports for each patient were screened, and the clinical characteristics of malignancies as well as sarcoidosis were reviewed. Results A total of 52 (18.8%) patients with malignancy were identified among 277 patients with sarcoidosis. Among those 52 patients, we identified 62 with malignant diseases. These patients were older and more likely to be women than the remaining 225 (81.2%) sarcoidosis patients without malignancy. The most prevalent malignant disease was breast cancer (14 cases, 22.6%), followed by stomach cancer (8 cases, 12.9%) and lung cancer (7 cases, 11.3%). Among the 14 patients with both sarcoidosis and breast cancer, 8 (57.1%) were diagnosed with breast cancer before sarcoidosis. All of these eight cases had undergone surgical resection of the cancer. Conclusion This study showed a higher incidence of patients with both sarcoidosis and malignancy in Japan than in some western countries. Breast cancer is the most prevalent malignant disease. The high frequency of sarcoidosis after surgical resection of breast cancer may suggest a causative association between malignancy and the development of sarcoidosis.
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Affiliation(s)
- Tsutomu Tamada
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Masayuki Nara
- National Hospital Organization Akita National Hospital, Japan
| | - Koji Murakami
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Shunichi Gamo
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Hidemi Aritake
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Megumi Shimizu
- Department of Gerontological and Home Healthcare Nursing, Course of Nursing, Tohoku University Graduate School of Medicine, Japan
| | | | - Masakazu Ichinose
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Hisatoshi Sugiura
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Japan
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El Jammal T, Pavic M, Gerfaud-Valentin M, Jamilloux Y, Sève P. Sarcoidosis and Cancer: A Complex Relationship. Front Med (Lausanne) 2020; 7:594118. [PMID: 33330555 PMCID: PMC7732692 DOI: 10.3389/fmed.2020.594118] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/30/2020] [Indexed: 12/19/2022] Open
Abstract
Sarcoidosis is a systemic disease of unknown etiology, characterized by the presence of non-caseating granulomas in various organs, mainly the lungs, and the lymphatic system. Since the individualization of sarcoidosis-lymphoma association by Brincker et al., the relationship between sarcoidosis or granulomatous syndromes and malignancies has been clarified through observational studies worldwide. Two recent meta-analyses showed an increased risk of neoplasia in sarcoidosis. The granulomatosis can also reveal malignancy, either solid or hematological, defining paraneoplastic sarcoidosis. Recent cancer immunotherapies, including immune checkpoint inhibitors (targeting PD-1, PD-L1, or CTLA-4) and BRAF or MEK inhibitors were also reported as possible inducers of sarcoidosis-like reactions. Sarcoidosis and neoplasia, especially lymphoma, can show overlapping presentations, thus making the diagnosis and treatment harder to deal with. There are currently no formal recommendations to guide the differential diagnosis workup between the evolution of lymphoma or a solid cancer and a granulomatous reaction associated with neoplasia. Thus, in atypical presentations (e.g., deeply impaired condition, compressive lymphadenopathy, atypical localization, unexplained worsening lymphadenopathy, or splenomegaly), and treatment-resistant disease, targeted biopsies on suspect localizations with histological examination could help the clinician to differentiate neoplasia from sarcoidosis. Pathological diagnosis could sometimes be challenging since very few tumor cells may be surrounded by massive granulomatous reaction. The sensitization of currently available diagnostic tools should improve the diagnostic accuracy, such as the use of more “cancer-specific” radioactive tracers coupled with Positron Emission Tomography scan.
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Affiliation(s)
- Thomas El Jammal
- Internal Medicine Department, La Croix-Rousse Hospital, Lyon, France
| | - Michel Pavic
- Medicine Department, Sherbrooke University, Sherbrooke, QC, Canada
| | | | - Yvan Jamilloux
- Internal Medicine Department, La Croix-Rousse Hospital, Lyon, France.,INSERM U1111, Center International de Recherche en Infectiologie/International Research Center in Infectiology (CIRI), University Claude-Bernard Lyon 1, Villeurbanne, France
| | - Pascal Sève
- Internal Medicine Department, La Croix-Rousse Hospital, Lyon, France.,Pôle IMER, Hospices Civils de Lyon, Lyon, France.,HESPER EA 7425, Lyon University, University Claude-Bernard Lyon 1, Lyon, France
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Rubasingham J, Marzouk S, Madhavan K, Sioftanos G, Liyanage SH. Pulmonary sarcoidosis masquerading as metastatic cervical cancer: a pitfall in CT scans and positron emission tomography (PET). BJR Case Rep 2020; 6:20190125. [PMID: 32922836 PMCID: PMC7465737 DOI: 10.1259/bjrcr.20190125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/10/2020] [Accepted: 04/19/2020] [Indexed: 12/29/2022] Open
Abstract
Sarcoidosis has been associated with co-existing malignancies in several organs, including the breast and thyroid gland as well as lymphomas. However, the occurrence of sarcoidosis with cervical cancer is rare with only nine previous cases reported in the published literature. We present a case of pulmonary sarcoidosis imitating mediastinal lymph node metastases on the staging CT scan and positron emission tomography imaging. The presence of thoracic lymphadenopathy without any pelvic lymphadenopathy prompted histological confirmation of sarcoidosis on endobronchial ultrasound guided biopsy. Misdiagnosing pulmonary sarcoidosis as metastases would have precluded the patient from receiving the curative treatment and likely resulted in suboptimal outcomes.
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Affiliation(s)
| | - Sherief Marzouk
- Southend University Hospital NHS Foundation Trust, England, United Kingdom
| | | | - George Sioftanos
- Southend University Hospital NHS Foundation Trust, England, United Kingdom
| | - Sidath H Liyanage
- Southend University Hospital NHS Foundation Trust, England, United Kingdom
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James WE. Overlap Syndromes in Sarcoidosis: Clinical Features and Outcomes. Semin Respir Crit Care Med 2020; 41:607-617. [PMID: 32777847 DOI: 10.1055/s-0040-1713008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Sarcoidosis is a multisystem inflammatory disease characterized by noncaseating granulomatous inflammation. While pulmonary sarcoidosis is most common, extrapulmonary involvement occurs in 50 to 74% of patients and can be the presenting abnormality in some patients. The diagnosis of sarcoidosis is based on a compatible clinical presentation in combination with granulomas on histology and exclusion of other causes. However, the absence of a diagnostic biomarker for sarcoidosis, in addition to the overlap of granulomatous inflammation and nonspecific clinical findings with other diseases, often results in a delayed diagnosis. Sarcoidosis overlap syndromes are typically described when sarcoidosis is diagnosed in the presence of another disease (concurrently or sequentially) with shared clinical and histologic features, or when sarcoidosis presents with clinical features typically observed in, but not diagnostic of, other diseases. Awareness of overlap syndromes is important for clinicians to avoid diagnostic errors and evaluate for concomitant diagnoses that may impact the management and outcome of sarcoidosis. This article is intended to provide an overview of these presentations and the most commonly associated diseases, with attention to their prevalence, clinical features, and reciprocal impacts on disease outcomes.
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Affiliation(s)
- W Ennis James
- Division of Pulmonary and Critical Care Medicine, Susan Pearlstine Sarcoidosis Center of Excellence, Medical University of South Carolina, Charleston, South Carolina
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Ozawa Y, Yamamoto H, Yasuo M, Komatsu M, Ushiki A, Hamano H, Uehara T, Kawakami S, Fujita A, Fujinaga Y, Oguchi K, Kawa S, Hanaoka M. A comparison of the features of fluorine-18 fluorodeoxyglucose-positron emission tomography (FDG-PET) between IgG4-related disease with bilateral hilar lymphadenopathy and sarcoidosis. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 82:101-111. [PMID: 32273638 PMCID: PMC7103870 DOI: 10.18999/nagjms.82.1.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We aimed to show the differentiation of the degree and distribution on Fluorine-18 fluorodeoxyglucose-positron emission tomography (FDG-PET) between patients with immunoglobulin G4-related disease (IgG4-RD) and sarcoidosis, though both diseases frequently show bilateral hilar lymphadenopathy (BHL). The clinical records were retrospectively reviewed in 25 patients with IgG4-RD with BHL and 15 patients with sarcoidosis (stage I–II) diagnosed at Shinshu University Hospital. All patients underwent FDG-PET at Aizawa Hospital from January 2004 to December 2015. The FDG accumulation pattern and maximum standardized uptake value (SUVmax) of the hilar lymph nodes were compared between the two groups. The IgG4-RD group (21 men; median age 69 years) showed a significant male predominance and older age compared with the sarcoidosis group (3 men, median age 55.4 years). The IgG4-RD group showed a significantly higher incidence of FDG accumulation in the lachrymal gland, submandibular gland, pancreas, prostate and periurethral and periarterial regions compared with the sarcoidosis group. In contrast, the sarcoidosis group showed a significantly higher incidence of FDG accumulation in the supraclavicular and abdominal lymph nodes, muscle and soft tissues compared with the IgG4-RD group. Furthermore, the SUVmax of the hilar lymph nodes was significantly higher in the sarcoidosis group (median 7.20) than in the IgG4-RD group (median 4.20, p=0.002). In conclusion, significant differences were observed in the FDG accumulation patterns and SUVmax values of the hilar lymph nodes between IgG4-RD with BHL and sarcoidosis, although both diseases develop through the lymphatic routes of the lungs and are frequently associated with BHL.
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Affiliation(s)
- Yoko Ozawa
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hiroshi Yamamoto
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Masanori Yasuo
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Masamichi Komatsu
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Atsuhito Ushiki
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hideaki Hamano
- Second Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Takeshi Uehara
- Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Satoshi Kawakami
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Akira Fujita
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Kazuhiro Oguchi
- Positron Imaging Center, Aizawa Hospital, Matsumoto, Nagano, Japan
| | - Shigeyuki Kawa
- Matsumoto Dental University, Department of Internal Medicine, Shiojiri, Nagano, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Herron M, Chong SG, Gleeson L, Nicholson S, Fahy RJ. Paraneoplastic sarcoidosis: a review. QJM 2020; 113:17-19. [PMID: 31407005 DOI: 10.1093/qjmed/hcz207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/28/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sarcoidosis is occasionally seen in association with malignancy, both at the time of cancer diagnosis or during follow up. AIM The purpose of this study is to identify patients with paraneoplastic sarcoid, their associated malignancies and disease characteristics. METHODS We identified 289 patients diagnosed histologically with sarcoidosis over a 6-year period in one centre, from 2010 to 2016. Fifty of these patients had a prior or concomitant diagnosis of cancer. RESULTS 17.3% of sarcoid cases had an associated malignancy. The most common malignancies were Gastrointestinal (20%), Haematological (18%), Lung (12%), Gynaecological (12%) and Head and Neck cancer (12%). 74% of sarcoid cases had pulmonary disease with sarcoid diagnostic tissue obtained most frequently via endobronchial ultrasound fine needle aspiration (68%). Most sarcoid cases (66%) were diagnosed within the first year of their malignancy diagnosis. DISCUSSION Careful consideration needs to be given to the possibility that potential cancer recurrences suspected on imaging studies may indeed be sarcoid reactions.
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Affiliation(s)
- M Herron
- Department of Respiratory Medicine, St James's Hospital, James's Street North, Ushers, Dublin 8, Ireland
| | - S G Chong
- Department of Respiratory Medicine, St James's Hospital, James's Street North, Ushers, Dublin 8, Ireland
| | - L Gleeson
- Department of Respiratory Medicine, St James's Hospital, James's Street North, Ushers, Dublin 8, Ireland
| | - S Nicholson
- Department of Pathology, St James's Hospital, James's Street North, Ushers, Dublin 8, Ireland
- Department of Medicine, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
| | - R J Fahy
- Department of Respiratory Medicine, St James's Hospital, James's Street North, Ushers, Dublin 8, Ireland
- Department of Medicine, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
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12
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Sarcoidosis and Multiple Myeloma: A Case Report and Literature Review. Case Rep Hematol 2019; 2019:4586265. [PMID: 31781424 PMCID: PMC6875373 DOI: 10.1155/2019/4586265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/14/2019] [Indexed: 12/17/2022] Open
Abstract
The existence of a sarcoidosis-lymphoma syndrome has been previously proposed since the relation between sarcoidosis and an increased risk of lymphoproliferative disorders is well established. Multiple myeloma is a malignant multifocal proliferation of clonal plasma cells within the bone marrow, and its association with sarcoidosis has been rarely described. We present a concurrent diagnosis of sarcoidosis and multiple myeloma and make a brief analysis of the reported cases in the literature. A 65-year-old woman underwent surgery for the excision of a wrist mass that presented 3 years before. Histological analysis showed sarcoid-type epithelioid granulomas without necrosis, establishing soft tissue sarcoidosis. Further evaluation revealed marked interstitial lung parenchyma lesions and large intrathoracic adenopathies. Bronchofibroscopy with transbronchial biopsy confirmed lung sarcoidosis. In addition, blood analysis showed monoclonal IgG kappa gammopathy. A bone marrow biopsy confirmed hypercellularity with 60% plasma cells and plasmocyte infiltration. Thus, the diagnosis of systemic sarcoidosis and multiple myeloma was established simultaneously. In a brief review of the literature, we identified 33 reports of cases with both sarcoidosis and multiple myeloma. We point out the importance of a high level of suspicion for the association of sarcoidosis with malignant haematological diseases such as multiple myeloma.
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Cerri S, Fontana M, Balduzzi S, Potenza L, Faverio P, Luppi M, D'Amico R, Spagnolo P, Clini E, Luppi F. Clinical differences in sarcoidosis patients with and without lymphoma: a single-centre retrospective cohort analysis. Eur Respir J 2019; 54:13993003.02470-2018. [PMID: 31346006 DOI: 10.1183/13993003.02470-2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/09/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Stefania Cerri
- Dept of Medical and Surgical Sciences, Center for Rare Lung Diseases, Respiratory Disease Unit, University Hospital of Modena, Modena, Italy
| | - Matteo Fontana
- Dept of Medical and Surgical Sciences, Center for Rare Lung Diseases, Respiratory Disease Unit, University Hospital of Modena, Modena, Italy
| | - Sara Balduzzi
- Dept of Medical and Surgical Sciences, Statistics Unit, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Leonardo Potenza
- Dept of Medical and Surgical Sciences, Hematology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Faverio
- Cardio-Thoracic-Vascular Dept, Respiratory Unit, University of Milan Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Mario Luppi
- Dept of Medical and Surgical Sciences, Hematology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto D'Amico
- Dept of Medical and Surgical Sciences, Statistics Unit, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Spagnolo
- Dept of Cardiac, Thoracic and Vascular Sciences, Section of Respiratory Diseases, University of Padova, Padova, Italy
| | - Enrico Clini
- Dept of Medical and Surgical Sciences, Center for Rare Lung Diseases, Respiratory Disease Unit, University Hospital of Modena, Modena, Italy
| | - Fabrizio Luppi
- Cardio-Thoracic-Vascular Dept, Respiratory Unit, University of Milan Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
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Kaneko Y, Kato H, Matsuo M. Hilar and mediastinal sarcoid-like reaction after the treatment of malignant tumors: imaging features and natural course on 18F-FDG-PET/CT. Jpn J Radiol 2018; 37:88-94. [DOI: 10.1007/s11604-018-0786-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/09/2018] [Indexed: 11/29/2022]
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Sarcoid-Like Mediastinal Lymphadenopathy in Gynecologic Malignancy. Pulm Med 2018; 2018:5141575. [PMID: 29666703 PMCID: PMC5832114 DOI: 10.1155/2018/5141575] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/11/2018] [Accepted: 01/17/2018] [Indexed: 01/03/2023] Open
Abstract
Noncaseating granulomas are seen surrounding tumors with varying frequency, possibly as part of an immune response to tumor cells. However, data about the association of sarcoid with gynecologic malignancy is sparse. We performed a search of our institutional database for all EBUS-TBNA biopsies conducted within the past five years that revealed granulomatous inflammation. All adult female patients with a history of gynecologic malignancy were included. Patients with a history of sarcoidosis or fungal or mycobacterial infection were excluded. All patients with evidence of malignant cells on TBNA specimen were excluded. Our results revealed 65 patients with histologic diagnosis of a noncaseating granuloma on EBUS-TBNA. Five patients (7.69%) had a history of gynecologic malignancy. Two patients had evidence of PET-positive nodes on surveillance scans, which led directly to the examination. Our findings suggest that distant malignancies may cause granulomatous lymphadenitis, through yet undefined mechanisms. As such, patients with evidence of mediastinal lymphadenopathy could benefit from routine sampling and histologic examination to define the pathology in the correct clinical context.
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Paone G, Di Lascio S, Azzola A, Mazzucchelli L, Pagani O. Unusual case of splenic sarcoidosis without morphological lesions detected by PET-CT in a patient with breast cancer: functional imaging between pitfalls and therapeutic guide. Ecancermedicalscience 2017; 11:766. [PMID: 28955402 PMCID: PMC5606293 DOI: 10.3332/ecancer.2017.766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Indexed: 12/05/2022] Open
Abstract
A 60-year-old woman under treatment with letrozole for metastatic breast cancer underwent 18F-FDG PET-CT for restaging. A new widespread intense splenic FDG uptake without nodular lesions and multiple FDG-avid mediastinal and abdominal nodes were observed. Based on these findings, a nodal and transbronchial lung biopsy was performed. Histological results were compatible with sarcoidosis. The patient began steroid treatment and 6 weeks after a PET-CT showed normalisation of both splenic and nodal uptake. In our case, 18F-FDG PET-CT has been useful in detecting a rare case of splenic sarcoidosis without typical nodular lesions on CT images, impacting the patient’s treatment and prognosis.
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Affiliation(s)
- Gaetano Paone
- Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Simona Di Lascio
- Department of Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Andrea Azzola
- Service of Pneumology, Department of Internal Medicine, EOC Switzerland
| | | | - Olivia Pagani
- Department of Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Kochoyan T, Akhmedov M, Shabanov A, Terekhov I. Sarcoidosis imitating breast cancer metastasis: a case report and literature review. Cancer Biol Med 2016; 13:396-398. [PMID: 27807507 PMCID: PMC5069840 DOI: 10.20892/j.issn.2095-3941.2016.0038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Sarcoidosis is a benign systematic granulomatous disorder of unknown etiology and is associated with various malignancies. However, granulomatous and metastatic lymph node lesions are difficult to distinguish even when using precise and modern diagnostic methods, such as positron emission tomography. Thus, histological verification is the only method that can be used to accurately describe the nature of this disease. In this article, we report a case of non-luminal HER-2/neu-positive breast cancer in a patient without history of sarcoidosis and suspected to have metastatic disease.
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Affiliation(s)
| | | | - Alexander Shabanov
- Department of Pathology, Russian Cancer Research Center, Moscow 115478, Russia
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Judson MA. The three tiers of screening for sarcoidosis organ involvement. Respir Med 2016; 113:42-9. [DOI: 10.1016/j.rmed.2016.02.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/22/2016] [Accepted: 02/22/2016] [Indexed: 02/08/2023]
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Kokuho N, Terasaki Y, Urushiyama H, Terasaki M, Kunugi S, Morimoto T, Azuma A, Usuda J, Gemma A, Eishi Y, Shimizu A. Pulmonary mucosa-associated lymphoid tissue lymphoma associated with pulmonary sarcoidosis: a case report and literature review. Hum Pathol 2016; 51:57-63. [PMID: 27067783 DOI: 10.1016/j.humpath.2015.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/21/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022]
Abstract
Differentiating low-grade lymphoma from preexisting sarcoidosis is difficult because of their pathological similarity. This article describes a case of pulmonary mucosa-associated lymphoid tissue lymphoma associated with pulmonary sarcoidosis. The patient, a 45-year-old Japanese man, presented with a 10-year history of pulmonary sarcoidosis and 5-year history of ocular sarcoidosis with histologic findings. Because only the right S3 lung nodule had gradually enlarged, partial resection was performed. Pathological study revealed noncaseous epithelioid granulomas with lymphoplasmacytic proliferation but also marked lymphoid cell proliferation with lymphoepithelial lesion findings that differed from findings of typical sarcoid lesions. Our lymphoepithelial lesion evaluation via immunohistochemistry and analysis of Ig heavy-chain gene rearrangements with assessment of Propionibacterium acnes-specific antibody reactions allow us to report, for the first time, this case of pulmonary mucosa-associated lymphoid tissue lymphoma associated with pulmonary sarcoidosis in exactly the same location, which may be significant for differentiating these diseases and understanding their pathogenic association.
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Affiliation(s)
- Nariaki Kokuho
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8602, Japan; Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8602, Japan
| | - Yasuhiro Terasaki
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8602, Japan.
| | - Hirokazu Urushiyama
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8602, Japan
| | - Mika Terasaki
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8602, Japan
| | - Shinobu Kunugi
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8602, Japan
| | - Taisuke Morimoto
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8602, Japan
| | - Arata Azuma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8602, Japan
| | - Jitsuo Usuda
- Department of Thoracic Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8602, Japan
| | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8602, Japan
| | - Yoshinobu Eishi
- Department of Human Pathology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo 113-8602, Japan
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Abstract
PURPOSE OF REVIEW Several studies have suggested an association between sarcoidosis and cancer, and between sarcoidosis and connective tissue diseases (CTDs). In this review, we discuss the evidence supporting and refuting these associations. RECENT FINDINGS In terms of a cancer risk in sarcoidosis patients, the data are somewhat conflicting but generally show a very small increased risk. The data supporting an association between sarcoidosis and CTD are not as robust as for cancer. However, it appears that scleroderma is the CTD most strongly associated with sarcoidosis. SUMMARY There are several important clinical and research-related implications of the association of sarcoidosis and CTDs. First, rigorous efforts should be made to exclude alternative causes for granulomatous inflammation before establishing a diagnosis of sarcoidosis. Second, the association between sarcoidosis and both cancer and CTDs may yield important insights into the immunopathogenesis of all three diseases. Finally, these data provide insight in answering a common question asked by sarcoidosis patients, 'Am I at an increased risk of developing cancer?' We believe that although there is an increased (relative) risk of cancer in sarcoidosis patients compared with the general population, that increased risk is quite small (low absolute risk).
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Chalayer É, Bachy E, Occelli P, Weiler L, Faurie P, Ghesquieres H, Pavic M, Broussolle C, Sève P. Sarcoidosis and lymphoma: a comparative study. QJM 2015; 108:871-8. [PMID: 25660608 DOI: 10.1093/qjmed/hcv039] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Indexed: 11/13/2022] Open
Abstract
AIM To assess the clinical features and outcome of lymphoma when associated with sarcoidosis and to determine whether this association gives lymphoma a better prognosis. DESIGN Multicentre retrospective cohort study. METHODS Retrospective chart review. RESULTS Twenty-one patients were included (9 males, 12 females). Median age at sarcoidosis diagnosis was 48 years (range: 24-68 years). In 14 cases, lymphoma occurred within a previously known sarcoidosis. Five patients received a concomitant diagnosis of sarcoidosis and lymphoma, whereas lymphoma preceded sarcoidosis in two patients. Three patients were diagnosed with Hodgkin's lymphoma and 18 patients with non-Hodgkin's lymphoma (diffuse large B-cell lymphoma (DLBCL) (n = 11), follicular lymphoma (n = 2), chronic lymphocytic leukemia/small lymphocytic lymphoma (n = 2), anaplastic large cell lymphoma ALK + (n = 1), angioimmunoblastic T-cell lymphoma (n = 1) and T-cell prolymphocytic leukemia (n = 1)). Thirteen patients were alive and in complete remission. Median age at the time of diagnosis of sarcoidosis was lower in patients with concomitant lymphoma compared with patients with sarcoidosis preceding lymphoma (34 years vs. 51 years, P = 0.01). Patients presenting with DLBCL associated with sarcoidosis were compared with DLBCL without sarcoidosis. No statistical difference was found in the risk of death or progression between the two groups (P = 0.685). CONCLUSIONS We report here the largest series of lymphoma associated sarcoidosis patients. As opposed to previous studies, we observed a predominance of patients with DLBCL. Our study confirms the concept of the sarcoidosis-lymphoma syndrome. Large B-cell lymphoma does not have a better prognosis when associated with sarcoidosis.
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Affiliation(s)
- É Chalayer
- From the Service de Médecine Interne, Hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Etienne Cedex 2, France,
| | - E Bachy
- Service d'Hématologie, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France
| | - P Occelli
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, 162 Avenue Lacassagne, 69424 Lyon Cedex 3, France
| | - L Weiler
- Service de Dermatologie, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France
| | - P Faurie
- Centre Léon Berard, 28 Promenade Léa et Napoléon Bullukian, 69008 Lyon, France
| | - H Ghesquieres
- Centre Léon Berard, 28 Promenade Léa et Napoléon Bullukian, 69008 Lyon, France
| | - M Pavic
- Service d'Hémato-oncologie, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12 Avenue Nord, Sherbooke QC J1H 5N4, Canada and
| | - C Broussolle
- Service de Médecine Interne, Groupement Hospitalier Nord, Hôpital de la Croix Rousse,103 Grande-Rue de la Croix-Rousse 69317 Lyon, France
| | - P Sève
- Service de Médecine Interne, Groupement Hospitalier Nord, Hôpital de la Croix Rousse,103 Grande-Rue de la Croix-Rousse 69317 Lyon, France
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Grados A, Ebbo M, Bernit E, Veit V, Mazodier K, Jean R, Coso D, Aurran-Schleinitz T, Broussais F, Bouabdallah R, Gravis G, Goncalves A, Giovaninni M, Sève P, Chetaille B, Gavet-Bongo F, Weitten T, Pavic M, Harlé JR, Schleinitz N. Sarcoidosis Occurring After Solid Cancer: A Nonfortuitous Association: Report of 12 Cases and Review of the Literature. Medicine (Baltimore) 2015; 94:e928. [PMID: 26181571 PMCID: PMC4617083 DOI: 10.1097/md.0000000000000928] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The association between cancer and sarcoidosis is controversial. Some epidemiological studies show an increase of the incidence of cancer in patients with sarcoidosis but only few cases of sarcoidosis following cancer treatment have been reported. We conducted a retrospective case study from internal medicine and oncology departments for patients presenting sarcoidosis after solid cancer treatment. We also performed a literature review to search for patients who developed sarcoidosis after solid cancer. We describe the clinical, biological, and radiological characteristics and outcome of these patients. Twelve patients were included in our study. Various cancers were observed with a predominance of breast cancer. Development of sarcoidosis appeared in the 3 years following cancer and was asymptomatic in half of the patients. The disease was frequently identified after a follow-up positron emission tomography computerized tomography evaluation. Various manifestations were observed but all patients presented lymph node involvement. Half of the patients required systemic therapy. With a median follow-up of 73 months, no patient developed cancer relapse. Review of the literature identified 61 other patients for which the characteristics of both solid cancer and sarcoidosis were similar to those observed in our series. This report demonstrates that sarcoidosis must be considered in the differential diagnosis of patients with a history of malignancy who have developed lymphadenopathy or other lesions on positron emission tomography computerized tomography. Histological confirmation of cancer relapse is mandatory in order to avoid unjustified treatments. This association should be consider as a protective factor against cancer relapse.
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Affiliation(s)
- Aurélie Grados
- From the Department of Internal Medicine, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille (AG, ME, EB, VV, J-RH, NS); Department of Internal Medicine, CHU Conception, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille (KM, RJ); Department of Hematology, Paoli Calmette Institute, Marseille (DC, TA-S, FB, RB); Department of Oncology, Paoli Calmette Institute, Marseille (GG, AG, MG); Department of Internal Medicine, Croix-Rousse Hospital, Lyon (PS); Department of Pathology, Paoli Calmette Institute, Marseille (BC); Department of Internal Medicine, Alpes du Sud Hospital, Gap (FG-B, TW); and Department of Oncology, Desgenettes Hospital, Lyon (MP), France
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Jiao Y, Ning J, Zhao WDI, Li YL, Wu HY, Gu KS. Sarcoidosis in gastric cancer at the time of diagnosis: A case report. Oncol Lett 2015; 9:1159-1162. [PMID: 25663873 PMCID: PMC4315069 DOI: 10.3892/ol.2015.2850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/22/2014] [Indexed: 11/06/2022] Open
Abstract
Sarcoidosis is a multisystemic inflammatory disease that commonly affects the lungs and lymphatic system and is characterized by the formation of non-caseating granulomas. Although the association between sarcoidosis and malignant diseases has been well described, it remains controversial whether this association is merely a coincidence or the consequence of a common pathophysiological mechanism. The present study reports a rare case of sarcoidosis that was present in a patient with gastric cancer at the time of diagnosis. A 64-year-old female diagnosed with stage I gastric cancer underwent curative surgery, and the postoperative pathology of the lymph nodes revealed non-caseating granulomas. At the 4-year follow-up, the sarcoidosis remained stable, and no recurrence of cancer was identified. The present case revealed that sarcoidosis and gastric cancer may coexist simultaneously and focused on the potential advantages of histological confirmation in patients with cancer and sarcoidosis.
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Affiliation(s)
- Yang Jiao
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Jie Ning
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Wen-DI Zhao
- Department of Pathology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Yan-Li Li
- Department of Hematology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, P.R. China
| | - Hong-Yang Wu
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Kang-Sheng Gu
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
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Boshier PR, Sayers R, Hadjiminas DJ, Mackworth-Young C, Cleator S, Leff DR. Systemic inflammatory response syndrome in a patient diagnosed with high grade inflammatory triple negative breast cancer: a case report of a potentially rare paraneoplastic syndrome. Exp Hematol Oncol 2015; 5:16. [PMID: 27340609 PMCID: PMC4917943 DOI: 10.1186/s40164-016-0045-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 06/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background Inflammatory breast cancer is a complex pathological entity associated with poor outcomes. This loco-regional disease is characterised by a rapid clinical course in the presence breast erythema and infiltration of dermal lymphatics by tumours cells. Herein we describe a case of inflammatory breast cancer with a rare presentation and disease course defined by a profound systemic inflammatory response in the absence of an infective cause. Case presentation The patient presented with pyrexia and malaise following a recent tissue diagnosis of inflammatory breast cancer. At the time of admission the patient demonstrated clinical features of the systemic inflammatory response syndrome (SIRS) in the presence of a negative septic screen. Her condition deteriorated despite systemic broad spectrum intravenous antibiotics and she underwent surgical debulking of a 180 × 135 × 100 mm (821 g) primary tumour composed of oedematous, friable and haemorrhagic tissue (pT4,N1a,M0; oestrogen/progesterone/HER-2 receptor negative). Following surgery, the clinical picture dramatically improved with cessation of SIRS and normalisation of inflammatory markers. After 4 weeks the patient required readmission to hospital due to recurrent SIRS and negative septic screen. The patient received treatment with systemic chemotherapy showing transient clinical improvement and suppression of SIRS. Despite on going chemotherapy, systemic antibiotics and a trial of steroid therapy the patient died 5 months after her initial presentation to hospital. At the time of death she demonstrated persistent SIRS with elevated inflammatory markers. Conclusion This is the first case report of inflammatory breath cancer associated with SIRS in the absence of clinically confirmed infection. Important learning points highlighted by this case are: (a) recognition of the diagnostic and therapeutic uncertainties that still exist in the context of inflammatory breast cancer; (b) appreciation of the potential paraneoplastic systemic inflammatory manifestations of this disease, and finally; (c) the importance a multidisciplinary and multimodal approach to treatment.
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Affiliation(s)
- Piers R Boshier
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rosie Sayers
- Department of Breast Surgery, Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | - Dimitri J Hadjiminas
- Department of Breast Surgery, Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | - Charles Mackworth-Young
- Department of Rheumatology, Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | - Susan Cleator
- Department of Oncology, Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | - Daniel R Leff
- Department of Surgery and Cancer, Imperial College London, London, UK
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