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Ahsan M, Ashkin A, Lindner DH, Patel VP, Lipman A. Sarcoid-like reaction in malignant melanoma exacerbated with pembrolizumab therapy case report. Heliyon 2024; 10:e24375. [PMID: 38304765 PMCID: PMC10830524 DOI: 10.1016/j.heliyon.2024.e24375] [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: 07/27/2023] [Revised: 12/24/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
Sarcoid Like Reaction (SLR) is a localized non-caseating epithelioid granulomatous reaction seen secondary to certain immunotherapies and malignancies. Invasive melanoma, while being associated with onset of sarcoidosis, has not shown to directly induce SLR in the literature. We present the case of a 68-year-old male with malignant melanoma, who was found to have SLR prior to starting immunotherapy, which worsened while on pembrolizumab. This case highlights the challenge of distinguishing between drug-induced SLR and melanoma-induced SLR, and the implications in terms of management.
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Affiliation(s)
- Mohammed Ahsan
- Naples Community Hospital, 311 9th St. N. Suite 300, Naples, FL, 34102-5804, USA
| | - Alex Ashkin
- Naples Community Hospital, 311 9th St. N. Suite 300, Naples, FL, 34102-5804, USA
| | - David H. Lindner
- Naples Community Hospital, 311 9th St N #304, Naples, FL 34102 Naples, FL, 34102-5804, USA
- Instructor Mayo Clinic College of Medicine and Science
- Associate Professor of Medicine University Central Florida
- Adjunct Professor of Medicine NOVA Southeastern
- Medical Director NCH Healthcare Intensive Care Units and Respiratory Care
- Associate Pulmonary Program Director NCH Healthcare System
| | - Vishal P. Patel
- Naples Community Hospital, 1285 Creekside Blvd E, Naples, FL, 34109, USA
| | - Andrew Lipman
- Medical Oncology and Hematology, Florida Cancer Specialists & Research Institute, Naples West: 681 4th Avenue N, Naples, FL, 34102, USA
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2
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Salman AR, Smith WM, Olsen TW, Dalvin LA. Intraocular sarcoid-like reaction in patients with chronic lymphocytic leukemia. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023:S0008-4182(23)00376-9. [PMID: 38163644 PMCID: PMC11213828 DOI: 10.1016/j.jcjo.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/08/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To investigate the frequency and clinical features of intraocular paraneoplastic sarcoid-like reaction (SLR) in patients with chronic lymphocytic leukemia (CLL). METHODS Retrospective review of patients with CLL from January 1, 1980, to December 31, 2020. Eye examinations were searched for 22 keywords suggestive of SLR, and charts were manually reviewed. RESULTS Of 4209 unique patients with CLL, 1021 (24%) had at least 1 eye examination on record, and 324 (8%) had 1 or more keyword eye examination findings. After manual review, 12 patients (<1%) were identified as having probable SLR with characteristic features (n = 7), possible but not classic (n = 1), or suspect but less likely (n = 4). All patients (n = 8) with probable or possible SLR were White, and half (n = 4) were male. Intraocular SLR was diagnosed a mean of 49.7 months after the CLL diagnosis (n = 7) or preceded the CLL diagnosis by 1 month (n = 1). Involvement was bilateral in 5 patients, with 13 total affected eyes and mean presenting Snellen visual acuity of 20/50. Common characteristic features on initial examination included vitreous cell (n = 13), anterior-chamber cell (n = 10), keratic precipitates (n = 9), posterior synechiae (n = 6), chorioretinal lesions (n = 5), and vitreous haze (n = 5). Treatment included topical corticosteroids alone (n = 5), with sub-Tenon corticosteroids (n = 1), or with steroid-sparing immunosuppressive agents (n = 1) or oral corticosteroids alone (n = 1). After a mean follow-up of 19.8 months, final mean visual acuity was 20/30. CONCLUSION Intraocular SLRs affect fewer than 1% of patients with CLL. SLR should be on the differential diagnosis list for any CLL patient with ocular complaints, and most patients can be managed successfully with corticosteroids.
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Affiliation(s)
- Ali R Salman
- Department of Ophthalmology, Mayo Clinic, Rochester, MN
| | - Wendy M Smith
- Department of Ophthalmology, Mayo Clinic, Rochester, MN
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3
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Maccio U, Gianolio A, Rets AV. Granulomas in bone marrow biopsies: clinicopathological significance and new perspectives. J Clin Pathol 2023; 77:8-15. [PMID: 37640519 DOI: 10.1136/jcp-2023-209104] [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: 08/01/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
Bone marrow granulomas in trephine biopsies are a rare and usually incidental finding. Possible causes include infectious (especially tuberculous and rarer non-tuberculous mycobacteria, but also many other bacterial, viral, fungal and parasitic agents) and non-infectious causes (especially medications, autoimmune disease, sarcoidosis, haematological and non-haematological malignancy). Necrotising granulomas are generally suggestive of an infectious aetiology (tuberculosis being the most common), whereas fibrin ring granulomas are associated with Q-fever and Epstein Barr Virus, although exceptions are possible. Every case suspicious for infectious aetiology should undergo further analysis like special staining (Ziehl-Neelsen for acid-fast rods) or molecular studies. The histomorphology should always be clinically correlated. In cases in which no infectious cause can be identified, untargeted metagenomics may represent a valid diagnostic tool that may become standard in the near future for bone marrow diagnostics. In this review, we have analysed the published data from 1956 up to today, and we report aspects of epidemiology, aetiology, diagnostic algorithms, differential diagnosis and the role of metagenomics in bone marrow biopsies with granulomas.
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Affiliation(s)
- Umberto Maccio
- Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - Alessandra Gianolio
- Department of Medical Sciences, University of Turin, Torino, Piemonte, Italy
| | - Anton V Rets
- Department of Hematopathology, ARUP Laboratories Inc, Salt Lake City, Utah, USA
- Pathology, The University of Utah School of Medicine, Salt Lake City, Utah, USA
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4
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Hogeboom A, Garrido-Ruíz MC, Rodríguez-Peralto JL. Acute sarcoidosis as a harbinger for pancreatic adenocarcinoma. Pathology 2023; 55:1024-1026. [PMID: 37468381 DOI: 10.1016/j.pathol.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/06/2023] [Accepted: 04/30/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Adriana Hogeboom
- Department of Pathology, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain.
| | - María C Garrido-Ruíz
- Department of Pathology, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Jose L Rodríguez-Peralto
- Department of Pathology, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
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5
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Rabei O, Al-Rasheed U, Alrammahi M, Al-Ibraheem A. Differentiating Hodgkin Lymphoma and Sarcoid Reaction in Subsequent FDG-PET/CT: A Case Report and Literature Review. World J Nucl Med 2023; 22:306-309. [PMID: 38152107 PMCID: PMC10751130 DOI: 10.1055/s-0043-1777694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Sarcoidosis is frequently associated with various hematological and solid tumors; it can be discovered by chance during tumor evaluations. Sarcoidosis can occur before some cancers, coexist with others, or be diagnosed 1 to 2 years later. Sarcoid reaction affecting hilar and mediastinal lymph nodes can pose a diagnostic challenge in patients with histopathological confirmation of Hodgkin lymphoma who are being evaluated using fluorodeoxyglucose-positron emission tomography computed tomography (FDG-PET/CT) scan because it cannot be easily distinguished from lymphoma infiltration. The presence of an increase or persistence of a prominent activity on a follow-up FDG-PET/CT scan after chemotherapy treatment for lymphoma that is associated with a complete metabolic response in the site of the primarily diagnosed lymphomatous disease is highly suggestive of concurrent sarcoidosis and necessitates careful assessment to avoid unnecessary therapy.
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Affiliation(s)
- Obayda Rabei
- Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), 202 Queen Rania St., P.O. Box 1269, Amman, Jordan
| | - Ula Al-Rasheed
- Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), 202 Queen Rania St., P.O. Box 1269, Amman, Jordan
| | - Mohammed Alrammahi
- Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), 202 Queen Rania St., P.O. Box 1269, Amman, Jordan
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), 202 Queen Rania St., P.O. Box 1269, Amman, Jordan
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6
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Schmidt CM, Toma M, Hein R, Sirokay JD. Pitfalls in evaluating FDG-PET/CT results in melanoma patients - A case series. J Dtsch Dermatol Ges 2023; 21:904-906. [PMID: 37125485 DOI: 10.1111/ddg.15073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/25/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Christiane M Schmidt
- Department of Dermatology and Allergy, Biederstein, Technical University of Munich, Munich, Germany
- Department of Dermatology, Artemed Fachklinik, Munich, Germany
| | - Marieta Toma
- Department of Pathology University, Hospital Bonn, Bonn, Germany
| | - Rüdiger Hein
- Department of Dermatology and Allergy, Biederstein, Technical University of Munich, Munich, Germany
| | - Judith D Sirokay
- Department of Dermatology and Allergy University, Hospital Bonn, Bonn, Germany
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7
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Schmidt CM, Toma M, Hein R, Sirokay JD. Fallstricke bei der Einordnung von FDG-PET/CT-Befunden bei Melanompatienten - eine Fallserie. J Dtsch Dermatol Ges 2023; 21:904-906. [PMID: 37574690 DOI: 10.1111/ddg.15073_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/25/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Christiane M Schmidt
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München
- Abteilung für Dermatologie, Artemed Fachklinik, München
| | - Marieta Toma
- Institut für Pathologie, Universitätsklinikum Bonn
| | - Rüdiger Hein
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München
| | - Judith D Sirokay
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn
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Müller ML, Poller W, Skurk C, Poddubnyy D, Siegmund B, Schneider T, Landmesser U, Heidecker B. Cardiac sarcoidosis presenting with complex conduction abnormalities as the first manifestation of widespread systemic sarcoidosis: a case report. Eur Heart J Case Rep 2023; 7:ytad017. [PMID: 36733684 PMCID: PMC9887667 DOI: 10.1093/ehjcr/ytad017] [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: 05/30/2022] [Revised: 08/11/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Background Sarcoidosis is a granulomatous multi-organ disease of unknown aetiology. Despite being relatively rare, cardiac sarcoidosis constitutes a very important manifestation of sarcoidosis, as its symptoms regularly precede or occur in isolation of more prevalent ones, and as it is the main driver of mortality in systemic sarcoidosis. Case summary We present the case of a 37-year-old woman, in which clinically isolated cardiac sarcoidosis revealed widespread systemic sarcoidosis. Apart from constitutional symptoms and strong recurrent dizziness (i.e. near-syncopes), which persisted for multiple years already, our patient initially presented with complex conduction abnormalities, including a right bundle branch block, left anterior hemi-block, and atrioventricular block °1. Following inconclusive endomyocardial biopsies, performed due to detection of focal septal scarring on cardiac magnetic resonance imaging, an 18F-FDG-PET-CT, performed upon admission to our clinic, showed distinct hypermetabolic lesions indicative of active inflammation in various organs and raised suspicion of systemic sarcoidosis. Eventually, histopathological evidence of non-caseating granulomas in affected lymph nodes, extracted by bronchoscopy, confirmed the diagnosis of systemic sarcoidosis after reasonable exclusion of other granulomatous diseases. Immediate initiation of long-term immunosuppressive therapy led to almost complete remission, as monitored by consequential 18F-FDG-PET-CT scans. Discussion Unexplained complex conduction abnormalities in young patients may be a sign of sarcoidosis, even in isolation of more prevalent symptoms. Correct interpretation and prompt initiation of a structured interdisciplinary diagnostic workup, including 18F-FDG-PET-CT as the imaging modality of choice, are essential to initiate specific treatment and obviate the major risk of mortality resulting from cardiac sarcoidosis.
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Affiliation(s)
- Maximilian L Müller
- Department of Cardiology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Wolfgang Poller
- Department of Cardiology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Britta Siegmund
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Thomas Schneider
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Bettina Heidecker
- Corresponding author. Tel: +49 30 450 513 756, Fax: +49 30 450 7 513 984,
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Prakash S, Damle NA, Madan K, Ramteke P. Malignancy-Associated Sarcoid-Like Reaction in a Case of Triple-Negative Breast Cancer on F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography. Indian J Nucl Med 2023; 38:79-80. [PMID: 37180186 PMCID: PMC10171751 DOI: 10.4103/ijnm.ijnm_130_22] [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: 07/28/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 02/25/2023] Open
Abstract
We describe the case of a 54-year-old woman with triple-negative breast cancer whose baseline F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) showed hypermetabolic left breast primary, ipsilateral axillary lymphadenopathy, lung nodules, and mediastinal lymph nodes. Histopathological examination of tissue from mediastinal lymph nodes confirmed a diagnosis of sarcoid-like reaction. Chemotherapy may induce or cause a flare-up of malignancy-associated sarcoid-like reaction. However, in our patient's post-chemotherapy F-18 FDG PET/CT, there was reduction in size and uptake of the mediastinal lymph nodes along with partial response shown by the other lesions. We aim to describe this rare course of malignancy-associated sarcoid-like reaction and highlight the role of F-18 FDG PET-CT in such cases.
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Affiliation(s)
- Sneha Prakash
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Karan Madan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Ramteke
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Vaccaro M, Borgia F, Lentini M, Gaeta M, MarafiotI I. Systemic sarcoidosis during pazopanib treatment for clear cell renal cell carcinoma. Indian J Dermatol Venereol Leprol 2022; 89:444-446. [PMID: 36688889 DOI: 10.25259/ijdvl_599_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/01/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Mario Vaccaro
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Francesco Borgia
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Maria Lentini
- Human Pathology, University of Messina, Messina, Italy
| | - Michele Gaeta
- Department of Biomedical, Dental Science and Morphological and Functional Images, Radiology Unit, University of Messina, Messina, Italy
| | - Ilenia MarafiotI
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
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11
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Huh JY, Moon DS, Song JW. Sarcoid-like reaction in patients with malignant tumors: Long-term clinical course and outcomes. Front Med (Lausanne) 2022; 9:884386. [PMID: 36059841 PMCID: PMC9433121 DOI: 10.3389/fmed.2022.884386] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background The 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. Methods Clinical 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. Results Among 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. Conclusions During 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.
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Melin A, Routier É, Roy S, Pradere P, Le Pavec J, Pierre T, Chanson N, Scoazec JY, Lambotte O, Robert C. Sarcoid-like Granulomatosis Associated with Immune Checkpoint Inhibitors in Melanoma. Cancers (Basel) 2022; 14:cancers14122937. [PMID: 35740604 PMCID: PMC9221061 DOI: 10.3390/cancers14122937] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 02/05/2023] Open
Abstract
We aimed to review the clinical and biological presentation of granulomatosis associated with immune-checkpoint inhibitors (ICI) in patients with melanoma and to explore its association with classical sarcoidosis as well as with cancer response to ICI. To this end, a retrospective study on 18 melanoma patients with histologically proven ICI-induced granulomatosis over a 12-year period in a single center, as well as on 67 similar cases reported in the literature, was conducted. Results indicate ICI-induced granulomatosis is an early side effect (median time to onset: 2 months). Its clinical presentation, with predominant (90%) thoracic involvement, histopathological appearance and supposed underlying biology (involving the mTOR pathway in immune cells, Th17 polarization and TReg dysfunction) are indistinguishable from those of sarcoidosis. Moreover, it appears to be associated with ICI benefit (>65% objective response rate). Evolution is generally favorable, and symptomatic steroid treatment and/or ICI discontinuation are rarely necessary. ICI-associated granulomatosis is critical to explore for several reasons. Practically, it is essential to differentiate it from cancer progression. Secondly, this “experimental” sarcoidosis brings new elements that may help to address sarcoidosis origin and pathophysiology. Its association with ICI efficacy must be confirmed on a larger scale but could have significant impacts on patient management and biomarker definition.
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Affiliation(s)
- Audrey Melin
- Department of Dermatology, Gustave Roussy, 114 rue Edouard-Vaillant, 94800 Villejuif, France; (É.R.); (S.R.)
- Correspondence: (A.M.); (C.R.)
| | - Émilie Routier
- Department of Dermatology, Gustave Roussy, 114 rue Edouard-Vaillant, 94800 Villejuif, France; (É.R.); (S.R.)
| | - Séverine Roy
- Department of Dermatology, Gustave Roussy, 114 rue Edouard-Vaillant, 94800 Villejuif, France; (É.R.); (S.R.)
| | - Pauline Pradere
- Service de Pneumologie et Transplantation Pulmonaire, Hôpital Marie-Lannelongue, Groupe Hospitalier Paris-Saint Joseph, 133 Av. de la Résistance, 92350 Le Plessis-Robinson, France; (P.P.); (J.L.P.)
| | - Jerome Le Pavec
- Service de Pneumologie et Transplantation Pulmonaire, Hôpital Marie-Lannelongue, Groupe Hospitalier Paris-Saint Joseph, 133 Av. de la Résistance, 92350 Le Plessis-Robinson, France; (P.P.); (J.L.P.)
| | - Thibaut Pierre
- Department of Medical Imaging, Gustave Roussy, 114 rue Edouard-Vaillant, 94800 Villejuif, France;
| | - Noémie Chanson
- Department of Internal Medicine, Kremlin Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; (N.C.); (O.L.)
| | - Jean-Yves Scoazec
- Université Paris Saclay, AP-HP, 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France;
- Department of Pathology, Gustave Roussy, 114 rue Edouard-Vaillant, 94800 Villejuif, France
| | - Olivier Lambotte
- Department of Internal Medicine, Kremlin Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; (N.C.); (O.L.)
- Université Paris Saclay, AP-HP, 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France;
| | - Caroline Robert
- Department of Dermatology, Gustave Roussy, 114 rue Edouard-Vaillant, 94800 Villejuif, France; (É.R.); (S.R.)
- Université Paris Saclay, AP-HP, 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France;
- Correspondence: (A.M.); (C.R.)
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Peculiar encounter of sarcoidosis and solid pseudopapillary tumor of the pancreas. ROMANIAN JOURNAL OF INTERNAL MEDICINE 2022; 60:132-137. [DOI: 10.2478/rjim-2022-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective: Current literature indicates a connection between sarcoidosis and malignancy, prompting advanced screening in uncertain cases. Solid pseudopapillary tumors (SPT) of the pancreas are rare entities that can be confirmed by adding imaging results to immunohistochemistry staining. The aim of this article is to describe a rare association of sarcoidosis and SPT.
Materials and methods: Case report.
Results: A young female patient with no prior medical history presents with shortness of breath and fatigue. The diagnosis of pulmonary and hepatic sarcoidosis is placed upon laboratory and radiographic changes. Intermittent abdominal pain prompts an MRI that shows the presence of a tumoral mass in the tail of the pancreas. Surgical resection of the mass is performed and histological examination indicates a SPT, subsequently confirmed by immunohistochemistry.
Conclusion: This is the third reported case of concomitant sarcoidosis and solid pseudopapillary tumor of the pancreas.
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Kawabata A, Nakamura T, Suzuki H, Yoshida M, Otsuki Y, Mori N. Coincidence of Sarcoidosis and a COVID-19 vaccine-associated hypermetabolic lymphadenopathy in a patient with a history of invasive breast cancer: A case report. Int J Surg Case Rep 2022; 94:107098. [PMID: 35464072 PMCID: PMC9017090 DOI: 10.1016/j.ijscr.2022.107098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 01/16/2023] Open
Abstract
Introduction and importance Vaccine-associated hypermetabolic lymphadenopathy (VAHL) after a COVID 19 vaccination is a common adverse event and also a diagnostic challenge especially in patients with a history of a malignancy. Case presentations A 47-year-old woman presented with enlarged lymph nodes in the right hilar, subcarinal, and right supraclavicular regions detected by computed tomography as a postoperative follow-up study of thyroid cancer. Fluorine-18 fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) performed 3 weeks later revealed an FDG uptake in those swollen lymph nodes and in the novel lymphadenopathy in the left axilla and left subclavicular regions. Both biopsy specimens from the right supraclavicular and hilar lymph nodes revealed only multiple small granulomas with multinucleated giant cells without malignancy, consistent with sarcoidosis. The left axilla and subclavicular lymphadenopathy detected by the FDG-PET subsequently spontaneously regressed. Clinical discussion The coincidental occurrence of VAHL and lymphadenopathy in sarcoidosis patients could cause diagnostic confusion especially in those with breast cancer. Conclusion Sufficient attention should be paid both to the injection site and the time interval between the vaccination and imaging test in the era of nationwide mass vaccinations against COVID 19.
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Affiliation(s)
- Asuka Kawabata
- Department of Breast Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Toru Nakamura
- Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Hanae Suzuki
- Department of Breast Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Masayuki Yoshida
- Department of Breast Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Natsuko Mori
- Department of Breast Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu-city, Shizuoka 430-8558, Japan.
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A 43-Year-Old Woman With Fatigue, Pancytopenia, and Mediastinal Adenopathy. Chest 2022; 161:e293-e297. [DOI: 10.1016/j.chest.2021.12.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
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16
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Hyakutake Y, Shibahara I, Inukai M, Koizumi H, Hide T, Morota N, Yoshida T, Sasaki J, Kumabe T. A Case of Synchronous Occurrence of Intracranial Germinoma and Systemic Sarcoidosis. NMC Case Rep J 2022; 8:645-650. [PMID: 35079529 PMCID: PMC8769452 DOI: 10.2176/nmccrj.cr.2021-0078] [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: 03/13/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022] Open
Abstract
Although the synchronous occurrence of testicular seminoma and systemic sarcoidosis has been reported, that of intracranial germinoma and systemic sarcoidosis is unknown. A 26-year-old man presented with symptoms of panhypopituitarism and consciousness disturbance. Imaging demonstrated a large nodule in the upper right lung field and swelling of multiple bilateral pulmonary and mediastinal lymph nodes in addition to the bifocal pineal and suprasellar tumors with obstructive hydrocephalus. The pathological diagnosis of the intracranial bifocal tumors was pure germinoma, whereas that of the mediastinal lymph nodes was epithelioid granuloma. Three courses of chemotherapy using carboplatin and etoposide were administered, followed by whole ventricle irradiation. The intracranial tumors completely disappeared, but the lung nodule and mediastinal lymph nodes progressed. Whole-body fluorine-18-fluorodeoxyglucose positron emission tomography demonstrated accumulation in the mediastinal lymphadenopathy, lung masses, and multiple lymph nodes of the whole body. Transbronchial lung biopsy revealed epithelioid granuloma with multinucleated giant cells. In conjunction with the high blood concentration of angiotensin-converting enzyme and soluble interleukin-2 receptor, these findings established a diagnosis of sarcoidosis. This is the first report of synchronous occurrence of intracranial germinoma and sarcoidosis. Such coexistence is extremely rare, but we should mind that sarcoidosis can occur with intracranial germinoma.
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Affiliation(s)
- Yuri Hyakutake
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Ichiyo Shibahara
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Madoka Inukai
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hiroyuki Koizumi
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Takuichiro Hide
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Nobuhito Morota
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Tsutomu Yoshida
- Department of Pathology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Jiichiro Sasaki
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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17
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Mannan S, Lara B. Incidence of cancer in sarcoidosis patients in a tertiary care hospital in the UK. OPEN RESPIRATORY ARCHIVES 2022. [PMID: 37497322 PMCID: PMC10369624 DOI: 10.1016/j.opresp.2022.100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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Jeong YJ, Lim ST, Jeong HJ, Park HS, Lee SY, Han YH. Atypical sarcoid reaction mimicking recurrence on F-18 FDG PET/CT in a patient with breast malignancy. Radiol Case Rep 2021; 16:3834-3837. [PMID: 34745400 PMCID: PMC8551536 DOI: 10.1016/j.radcr.2021.09.032] [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: 08/18/2021] [Revised: 09/11/2021] [Accepted: 09/16/2021] [Indexed: 11/26/2022] Open
Abstract
Malignancy may lead to sarcoidosis, which is referred to as sarcoid reaction. This reaction is believed to be a host immune response to the release of soluble antigens from cancer cells. Studies have shown strong 2'-deoxy-2'-[F-18]fluoro-D-glucose (F-18 FDG) uptake in sarcoid reaction and in true sarcoidosis. Therefore, in patients with malignancy, sarcoid reactions can mimic metastasis or recurrence on F-18 FDG positron emission tomography/computed tomography (PET/CT). Herein, we report the case of a 58-year-old woman with a history of left breast cancer whose FDG PET/CT evaluated at 3 months after adjuvant chemotherapy presented hypermetabolic lymphadenopathy in the right supraclavicular and right mediastinal areas. We interpreted these as metastases because the involved lymph nodes were intensely hypermetabolic and appeared newly. Pathologic evaluation of the excised lymph node revealed noncaseating chronic granulomas without malignant cells, indicating a sarcoid reaction. After appropriate steroid therapy, both the size and metabolic activity of the lymphadenopathy substantially decreased. Most sarcoid reactions present as bilateral hilar and peribronchial lymphadenopathies. Our patient presents an atypical example that a sarcoid reaction can also present in a unilateral pattern, making its diagnosis challenging. When interpreting FDG PET/CT images, considering that the sarcoid reaction pattern can vary is crucial.
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Affiliation(s)
- Young Jin Jeong
- Department of Nuclear Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Seok Tae Lim
- Department of Nuclear Medicine, Molecular Imaging & Therapeutic Medicine Research Center, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, 20, Geonjiro, Jeonju, Jeonbuk 54907, Republic of Korea
| | - Hwan-Jeong Jeong
- Department of Nuclear Medicine, Molecular Imaging & Therapeutic Medicine Research Center, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, 20, Geonjiro, Jeonju, Jeonbuk 54907, Republic of Korea
| | - Ho Sung Park
- Department of Pathology, Jeonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, Republic of Korea
| | - Sun Young Lee
- Department of Radiation Oncology, Jeonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, Republic of Korea
| | - Yeon-Hee Han
- Department of Nuclear Medicine, Molecular Imaging & Therapeutic Medicine Research Center, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, 20, Geonjiro, Jeonju, Jeonbuk 54907, Republic of Korea
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19
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Murakami K, Koh J, Taruya J, Ito H. Neurosarcoidosis Mimicking the Recurrence of Malignant Lymphoma. Case Rep Neurol 2021; 13:605-612. [PMID: 34703450 PMCID: PMC8460933 DOI: 10.1159/000518378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/02/2021] [Indexed: 11/19/2022] Open
Abstract
A 67-year-old woman with a recurrent history of malignant lymphoma (ML) presented with muscle weakness and paresthesia of the fingertips and feet. Due to the elevated level of serum soluble interleukin-2 receptor and increased 18F-fluorodeoxyglucose uptake in a mediastinal lymph node, neurolymphomatosis was initially suspected. Neurological and electrophysiological examinations were consistent with mononeuropathy multiplex. A diagnosis of neurosarcoidosis was made based on the presence of noncaseating epithelioid granulomas in the mediastinal lymph node, along with the presence of the uveitis, cardiac inflammation, and mononeuropathy multiplex. She was treated with glucocorticoids and azathioprine, and her symptoms disappeared. Sarcoidosis following ML is rare, and since biopsy of nervous systems is often improbable, differentiating neurosarcoidosis and neurolymphomatosis can be difficult as their clinical symptoms can be similar. Clinicians should consider systemic pathological investigations based on 18F-fluorodeoxyglucose positron emission tomography examination in addition to comprehensive evaluation to accurately diagnose neurosarcoidosis.
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Affiliation(s)
- Keishu Murakami
- Department of Neurology, Wakayama Medical University, Wakayama, Japan
| | - Jinsoo Koh
- Department of Neurology, Wakayama Medical University, Wakayama, Japan.,Department of Neurology, Social Insurance Kinan Hospital, Tanabe, Japan
| | - Junko Taruya
- Department of Neurology, Wakayama Medical University, Wakayama, Japan
| | - Hidefumi Ito
- Department of Neurology, Wakayama Medical University, Wakayama, Japan
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20
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Tumor-Associated Granulomas Preceding a Diagnosis of Thoracic Sarcoidosis: A Retrospective, Single-Center Cohort Study. J Clin Med 2021; 10:jcm10184151. [PMID: 34575262 PMCID: PMC8465305 DOI: 10.3390/jcm10184151] [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: 07/10/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 11/18/2022] Open
Abstract
There is a relationship between systemic sarcoidosis (SS) and malignancy. Sarcoidosis results from an exaggerated immune response in genetically susceptible individuals. In oncologic patients with sarcoidosis, tumoral antigens and antineoplastic treatment are considered potential triggering factors. The observation of a patient with granulomas in a parotid carcinoma who later developed SS led us to review the previous tumors of patients with SS. The aim of the study is to see whether granulomas were already present in the tumors that preceded sarcoidosis. We identified 196 sarcoidosis patients, 47 of whom had previously had a tumor. We were able to review 29 cases, 12 of which showed tumor-associated granulomas (TAGs) (41.4%). This ratio is much higher than that of the normal population (4.4–13.8). We analyzed five control patients without sarcoidosis for each tumor. In conclusion, we observed an increased number of TAGs in patients who later developed SS. This finding reinforces a pathogenic relationship between SS and neoplasia. The histology of tumors in patients with SS should be reviewed in an attempt to identify granulomas.
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21
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Sarcoidosis vs. Colon Cancer Metastasis: Diagnostic Dilemma and the Role of PET Scan in Monitoring Disease Activity. Case Rep Rheumatol 2021; 2021:5529523. [PMID: 34258100 PMCID: PMC8244180 DOI: 10.1155/2021/5529523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/31/2021] [Accepted: 04/12/2021] [Indexed: 11/18/2022] Open
Abstract
Sarcoidosis is a systemic inflammatory disorder characterized by “noncaseating granulomas.” It primarily affects the lungs, but multiple other organs can be involved. Sarcoidosis has been increasingly reported in association with cancer. It can precede, follow or occur at the same time as the diagnosis of cancer. We report a case of sarcoidosis that was diagnosed concomitantly with colon cancer, highlighting the diagnostic dilemma of sarcoidosis vs. cancer metastasis, the relationship between the two, and the value of PET scan in follow-up and monitoring of disease activity.
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22
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Taha M, Samavati L. Sarcoidosis and neuroendocrine tumours: case report and literature review. Respirol Case Rep 2021; 9:e00784. [PMID: 34094569 PMCID: PMC8155788 DOI: 10.1002/rcr2.784] [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: 12/03/2020] [Revised: 04/04/2021] [Accepted: 04/25/2021] [Indexed: 11/11/2022] Open
Abstract
Rare cases of co-existing sarcoidosis and carcinoid tumour have been previously reported in the literature. Both diseases may have vague and overlapping clinical presentations that can lead to delayed or missed diagnosis. To avoid this diagnostic pitfall, we discuss and compare the clinical presentations of all reported cases in the literature including our case. We also provide hypothesis to explain the relationship between the two diseases.
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Affiliation(s)
- Muhanad Taha
- Department of Pulmonary Critical Care & Sleep DivisionWayne State UniversityDetroitMIUSA
| | - Lobelia Samavati
- Department of Pulmonary Critical Care & Sleep DivisionWayne State UniversityDetroitMIUSA
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23
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Rana GD, d'Alessandro M, Rizzi L, Bergantini L, Cameli P, Vozza A, Sestini P, Suppressa P, Bargagli E. Clinical phenotyping in sarcoidosis management. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2021; 38:e2021007. [PMID: 34316252 PMCID: PMC8288209 DOI: 10.36141/svdld.v38i2.10423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 06/18/2021] [Indexed: 11/05/2022]
Abstract
Sarcoidosis is a heterogeneous granulomatous disease. Biological markers and clinical features could allow specific phenotypes to be associated with different prognosis, severity and treatment responses. This retrospective multicentre study aims to analyse the clinical and immunological features of sarcoidosis and to identify a routine non-invasive biomarker useful in clinical practice.
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Affiliation(s)
- Giuseppe Domenico Rana
- Internal Medicine Unit "C. Frugoni", Centre for rare diseases, University Hospital Bari, Bari, Italy
| | - Miriana d'Alessandro
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, Siena, Italy
| | - Luigi Rizzi
- Internal Medicine Unit "C. Frugoni", Centre for rare diseases, University Hospital Bari, Bari, Italy
| | - Laura Bergantini
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, Siena, Italy
| | - Paolo Cameli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, Siena, Italy
| | - Alfredo Vozza
- Internal Medicine Unit "C. Frugoni", Centre for rare diseases, University Hospital Bari, Bari, Italy
| | - Piersante Sestini
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, Siena, Italy
| | - Patrizia Suppressa
- Internal Medicine Unit "C. Frugoni", Centre for rare diseases, University Hospital Bari, Bari, Italy
| | - Elena Bargagli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, Siena, Italy
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Sarcoid-like reaction in a BRAF V600E-mutated metastatic melanoma patient during treatment with BRAF/MEK-targeted therapy. Melanoma Res 2021; 31:272-276. [PMID: 33904519 DOI: 10.1097/cmr.0000000000000735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Treatment with combined BRAF and MEK inhibition is widely accepted as a first-line treatment option for patients with advanced BRAF V600E mutant melanoma. It is generally well-tolerated and has limited side-effects. However, we report a case of a sarcoid-like syndrome induced by treatment with dabrafenib/trametinib (D/T) in a patient with stage IV-M1d melanoma. Sarcoid-like syndrome is a known side-effect of immune checkpoint-inhibition therapy but has only rarely been described in BRAF/MEK inhibition. However, recognizing this side-effect is important because of potential misinterpretation as progressive disease and influence on treatment. We describe a 48-year-old female patient who initially presented with solitary brain metastasis and diffuse lung lesions. She was treated with D/T to which she had an initial response in all lesions. One year later, new hilar and mediastinal lymphadenopathies were detected. Imaging was suggestive of the sarcoid-like syndrome. An endoscopic biopsy of the enlarged lymph node showed no melanoma cells. Treatment was continued. Three months later, the patient experienced a drop in hemoglobin, which prompted further investigations into possible occult intestinal metastasis. Video capsule examination revealed a metastatic lesion in the small intestine. A treatment switch to the combination of checkpoint inhibitors nivolumab and ipilimumab successfully treated both lung and small intestine lesions. After the third dose of this combination therapy, she developed an immune-related pneumonitis. Treatment with corticosteroids resolved the pneumonitis and decreased metabolism in the sarcoid-like syndrome. The treatment was not restarted afterward. She remains free of the disease up to today, 2.5 years after diagnosis.
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25
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Khalid T, Patil A, Ahmed A, Yousif A. Sarcoid-like reaction: a unique response to immunotherapy in malignant melanoma. BMJ Case Rep 2021; 14:14/5/e243723. [PMID: 34049896 DOI: 10.1136/bcr-2021-243723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In recent years, immunotherapy has revolutionised the treatment landscape for oncology patients with improved survival rates in cancers which previously had a dismissal prognosis. These agents target specific pathways of inhibition such as programmed cell death -1 (PD-1), PD ligand-1 and cytotoxic T-lymphocyte-associated antigen 4 resulting in stimulation of T cell activity. This results in enabling an individual's own immune system to fight against cancer, a different modality of treatment when compared with traditional chemotherapy. While attacking the tumour cells, there is an increased chance of host tissue immune reactions.We report a case of a patient who received immunotherapy for metastatic malignant melanoma. During the course of the treatment, development of a sarcoid-like reaction was histologically confirmed in the mediastinal lymph nodes. The patient had no respiratory symptoms and continued on the immunotherapy treatment with good clinical and radiological response.
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Affiliation(s)
- Taha Khalid
- Oncology, Sligo University Hospital, Sligo, Ireland
| | - Asma Patil
- Oncology, Sligo University Hospital, Sligo, Ireland
| | - Alina Ahmed
- Medicine, Kingsbridge Private Hospital, Sligo, Ireland
| | - Ala Yousif
- Oncology, Sligo University Hospital, Sligo, Ireland
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26
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Sarcoidosis or cancer? That is the question. Respir Med Case Rep 2021; 33:101426. [PMID: 34401272 PMCID: PMC8348150 DOI: 10.1016/j.rmcr.2021.101426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/08/2021] [Accepted: 05/07/2021] [Indexed: 12/03/2022] Open
Abstract
Sarcoidosis is a granulomatous inflammatory disease of unknown etiology. Sarcoid like granuloma may develop concurrently or following cancer. Detection of granuloma in mediastinal lymph nodes biopsy in patient with pulmonary nodules may be a concern for undiagnosed lung cancer. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a diagnostic modality of choice for the lung lesions. We discussed A 71-year-old man with history of chronic obstructive lung disease (COPD), who presented with a lung nodule and mediastinal lymphadenopathies. The nodule was 9.9 mm when detected and his endobronchial ultrasound-guided transbronchial fine needle aspiration (EBUS-TBNA) of lymph nodes in station 7 & 4R showed normal lymph node structure. Two years later, his surveillance chest CT scan indicated an increase in the size of the nodule to 15 mm, and PET/CT showed Fluorodeoxyglucose (FDG) avid nodule & mediastinal Lymph nodes. He complained of Shortness of breath after 2–3 climbs of stairs, without any history of cough or fever. He quit cigarette smoking recently and smoked 50 pack years before. He underwent another set of EBUS and was referred for sarcoidosis treatment due to finding non-necrotizing granuloma in 4L and 11L lymph nodes. The patient also underwent another biopsy of the nodule concerning the possibility of cancer sarcoid syndrome. A poorly differentiated lung adenocarcinoma positive for GATA3, positive for P63 and CK7, TTF-1 was reported. Concurrent lung cancer and granulomatous reaction in mediastinal lymph nodes are being reported more often. Recent studies have shown a better survival of patients with diagnosis of cancer and granulomatous findings of sarcoidosis. Performing lung biopsy from any nodular lesion in a patient with sarcoidosis is essential for the differential diagnosis and early therapeutic measures.
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27
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Berkowitz ST, Brock AL, Reichstein DA. Chorioretinal Biopsy-Proven Ocular Sarcoidosis in a Patient with a History of B-Cell Lymphoma. Case Rep Ophthalmol 2021; 12:438-445. [PMID: 34054498 PMCID: PMC8136327 DOI: 10.1159/000512694] [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: 10/06/2020] [Accepted: 10/30/2020] [Indexed: 11/19/2022] Open
Abstract
The purpose of this report is to describe biopsy-proven ocular sarcoidosis (OS) in a 67-year-old patient with a history of sarcoidosis and diffuse large B-cell lymphoma (DLBCL). Nonspecific posterior chorioretinal lesions in a patient with prior malignancy necessitated chorioretinal biopsy to rule out metastatic lymphoma. The association between sarcoidosis and malignancy remains unclear and can complicate management of similar patients with nonspecific posterior segment findings. Chorioretinal biopsy may, therefore, be required to rule out malignancy in patients with a leading history.
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Affiliation(s)
- Sean T Berkowitz
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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28
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Bhattad PB, Jain V. Diffuse Sarcoidosis Masquerading as Widespread Malignant Disease: A Rare Case Report and Literature Review. J Investig Med High Impact Case Rep 2021; 8:2324709620938942. [PMID: 32618211 PMCID: PMC7493242 DOI: 10.1177/2324709620938942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease commonly involving the lungs and mediastinal lymph nodes with the exact etiology being unclear. The simultaneous presence of malignant disease such as breast cancer and sarcoidosis has been reported. Sarcoidosis preceding a diagnosis of malignancy and that occurring years after treatment of malignant disease has been noted in the past. The presence of sarcoidosis in the setting of malignant disease carries a high risk of misdiagnosis. In this article, we report the case of a 45-year-old female with stage IA invasive ductal carcinoma of left breast that was in remission for 2 years; however, radiological imaging including magnetic resonance imaging of thoracic spine and positron emission tomography–computed tomography scanning were highly suspicious for malignant disease metastasis versus lymphoma with the widespread lymphadenopathy. Multiple tissue biopsies with histopathological evaluation allowed us to definitively exclude malignant disease metastasis and to correctly diagnose her atypical presentation of sarcoidosis.
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Affiliation(s)
| | - Vinay Jain
- James H. Quillen Veterans Affairs Medical Center, Mountain Home, TN, USA
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29
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Abstract
CONTEXT.— Because granulomas are represented in almost every disease category, the number of clinically and pathologically important granulomatous pulmonary diseases is large. Their diagnosis by pathologists is particularly challenging because of their nonspecificity. A specific diagnosis can be achieved only when a granuloma-inciting agent(s) (eg, acid-fast bacilli, fungi, foreign bodies, etc) are identified microscopically or by culture; this does not occur in most cases. Furthermore, a specific diagnosis cannot be reached in a high percentage of cases. Although sarcoidosis and infectious diseases account for approximately half of pulmonary granulomatous diseases worldwide, there is significant geographic variation in their prevalence. OBJECTIVES.— To present updated information to serve as a guide to pathologic diagnosis of pulmonary granulomatous diseases, to address some commonly held misconceptions and to stress the importance of multidisciplinary coordination. Presentation of basic aspects of granulomas is followed by discussion of specific disease entities, such as tuberculous and nontuberculous Mycobacterial infections, fungal, bacterial, and parasitic infections, sarcoidosis, necrotizing sarcoid granulomatosis, berylliosis, hypersensitivity pneumonitis, hot tub lung, rheumatoid nodule, bronchocentric granulomatosis, aspirated, inhaled, and embolized foreign bodies, drug-induced granulomas, chronic granulomatous disease, common variable immunodeficiency, and granulomatous lesions associated with various types of cancer. DATA SOURCES.— Review of pertinent medical literature using the PubMed search engine and the author's practical experience. CONCLUSIONS.— Although the diagnosis of granulomatous lung diseases continues to present significant challenges to pathologists, the information presented in this review can be helpful in overcoming them. The importance of multidisciplinary coordination in cases where morphologic diagnosis is not possible cannot be overstated.
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Affiliation(s)
- Yale Rosen
- From the Department of Pathology, SUNY Downstate Health Sciences University, Brooklyn, New York
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30
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Paydas S. Sarcoid-like reaction in cases treated by checkpoint inhibitors. Med Oncol 2021; 38:29. [PMID: 33598792 DOI: 10.1007/s12032-021-01477-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/29/2021] [Indexed: 12/30/2022]
Abstract
Sarcoidosis is a multisystem granulomatous disorder characterized by helper T cell inflammation. Sarcoid-like reaction (SLR) is a well-defined entity and may be related with several malignant disorders and/or their therapies. SLR has been reported more than 20 years ago and in recent years in cases treated by checkpoint inhibitors (CPIs). Better outcome has been reported in cases developing granulomatous reaction and/or SLRs during CPI treatments. However, these lesions clinically may be thought as disease progression and may cause to stop treatment or alterations. These therapeutic manipulations may be harmful for the patients. Clinicians should be aware of SLRs in cases treated by CPIs and tissues must be sampled and reviewed by an experienced pathologist to avoid misdiagnosis and also unnecessary CPI treatment cessations.Significance StatementClinicians should be aware of sarcoid-like reactions in cases treated by checkpoint inhibitors and tissues must be sampled and reviewed by an experienced pathologist to avoid misdiagnosis and CPI treatment stops.
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Affiliation(s)
- Semra Paydas
- Çukurova University Faculty of Medicine Department of Medical Oncology, Adana, Turkey.
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31
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Di L, Wang CP, Tang J, Macaulay R, Tran N. Sarcoidosis-Lymphoma Syndrome Presenting As Bony Vertebral Metastasis: A Case Report and Literature Review. Cureus 2021; 13:e13227. [PMID: 33728177 PMCID: PMC7946476 DOI: 10.7759/cureus.13227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Sarcoidosis preceding a diagnosis of lymphoma has been a reported phenomenon termed sarcoidosis-lymphoma syndrome. Skeletal metastasis is extremely rare. Here, we detail a case of sarcoidosis-lymphoma syndrome presenting as a lumbar vertebral metastasis with suspected associated intracranial lesions. A 72-year-old man with a history of follicular lymphoma presented with symptomatic central nervous system (CNS) lesions with concurrent lumbar vertebral metastases visualized with CT and MRI. Rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone (R-CHOP) with dexamethasone treatment resulted in significant radiographic regression of his intracranial lesions with dramatic symptomatic improvement. Out of concern for compression fracture of his lytic lumbar lesions, kyphoplasty with biopsy was performed showing lymphocytes that were positive for cluster-of-differentiation 10 (CD10), CD20, and B-cell lymphoma 2 (Bcl2). The patient was diagnosed with CNS and vertebral sarcoidosis-lymphoma syndrome and began treatment with high-dose methotrexate. Including the present case, only four occurrences of sarcoidosis-lymphoma syndrome with bony involvement have been described. We detail our own experience and summarize all previous literature. While rare, sarcoidosis-lymphoma may present with CNS and lytic bone involvement; in these cases, symptomatic severity, as well as an effective response to steroid treatment, underscore the importance of an accurate and prompt diagnosis.
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Affiliation(s)
- Long Di
- Neurological Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Christopher P Wang
- Neurological Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Joseph Tang
- Neurological Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | | | - Nam Tran
- Neurological Surgery, Moffitt Cancer Center, Tampa, USA
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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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Frohlich M, Buhlaiga N, Wang H, Patenaude F, Sirois C, Sakr L. Systemic sarcoidosis mimicking metastatic renal cell carcinoma with subsequent cardiac involvement. Respir Med Case Rep 2020; 32:101334. [PMID: 33457201 PMCID: PMC7797905 DOI: 10.1016/j.rmcr.2020.101334] [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: 07/08/2020] [Revised: 12/23/2020] [Accepted: 12/26/2020] [Indexed: 11/23/2022] Open
Abstract
There exists a well-established association between sarcoidosis and many solid and hematologic malignancies however it is a less frequently described phenomenon in patients with renal cell carcinoma. Moreover the majority of described cases presented with local sarcoid-like reactions in close proximity to the tumor with comparatively few reports of more distant disease. Given the relatively low number of cases there remains a great deal of uncertainty surrounding the clinical behaviour of sarcoidosis in the setting of renal cell carcinoma. We report the case of a patient with surgically resected renal cell carcinoma who, several years later, developed bilateral pulmonary nodules, intra-thoracic lymphadenopathy as well as splenic, hepatic and osseous lesions. After extensive investigation, culminating in video-assisted thoracoscopic surgical resection, he was found to have sarcoidosis. He remained asymptomatic for many years before being diagnosed with cardiac sarcoidosis, which was found to be inactive and did not require any treatment. Both his sarcoidosis and underlying renal cell carcinoma have remained in remission to date. This case highlights the variable behaviour of sarcoidosis in these patients and underscores the importance of obtaining an accurate tissue diagnosis in the setting of suspected metastatic disease. Additionally, it underscores the importance of close monitoring and long-term follow up as these patients may develop significant organ involvement, even many years after diagnosis. Interestingly the patient's renal cell carcinoma remained in remission, raising questions about whether the development of sarcoidosis portends a better prognosis in patients with an underlying solid malignancy.
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Key Words
- CT, computed tomography
- Cancer
- EBUS-TBNA, endobronchial ultrasound-guided transbronchial needle aspiration
- Endobronchial ultrasound
- IFN- γ, interferon γ
- IL, interleukin
- MRI, magnetic resonance imaging
- PET, positron emission tomography
- RCC, renal cell carcinoma
- Renal cell carcinoma
- Sarcoidosis
- TTNA, transthoracic-needle aspiration
- Th1, T-helper cell type 1
- Th17, T-helper cell type 17
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Affiliation(s)
- Michael Frohlich
- Department of Medicine, Division of Pulmonary Disease, Jewish General Hospital, Pavilion G Room 203, 3755 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1E2, Canada
| | - Najwa Buhlaiga
- Department of Medicine, Hematology Service and Department of Oncology, Jewish General Hospital, Pavilion E7, 3755 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1E2, Canada
| | - Hangjun Wang
- Divisions of Pathology and Molecular Genetics, Jewish General Hospital, Pavillion G Room 108, 3755 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1E2, Canada
| | - Francois Patenaude
- Department of Medicine, Hematology Service and Department of Oncology, Jewish General Hospital, Pavilion E7, 3755 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1E2, Canada
| | - Christian Sirois
- Department of Surgery, Division Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, Pavilion L Room 8-505, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada
| | - Lama Sakr
- Department of Medicine, Division of Pulmonary Disease, Jewish General Hospital, Pavilion G Room 203, 3755 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1E2, Canada
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Abstract
Haematological malignancies induce important alterations of the immune system, which account for the high frequency of autoimmune complications observed in patients. Cutaneous immune-mediated diseases associated with haematological malignancies encompass a heterogeneous group of dermatoses, including, among others, neutrophilic and eosinophilic dermatoses, autoantibody-mediated skin diseases, vasculitis and granulomatous dermatoses. Some of these diseases, such as paraneoplastic pemphigus, are associated with an increased risk of death; others, such as eosinophilic dermatoses of haematological malignancies, run a benign clinical course but portend a significant negative impairment on a patient’s quality of life. In rare cases, the skin eruption reflects immunological alterations associated with an unfavourable prognosis of the associated haematological disorder. Therapeutic management of immune-mediated skin diseases in patients with haematological malignancies is often challenging. Systemic corticosteroids and immunosuppressive drugs are considered frontline therapies but may considerably augment the risk of serious infections. Indeed, developing a specific targeted therapeutic approach is of crucial importance for this particularly fragile patient population. This review provides an up-to-date overview on the immune-mediated skin diseases most frequently encountered by patients with onco-haematological disorders, discussing new pathogenic advances and therapeutic options on the horizon.
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Murthi M, Yoshioka K, Cho JH, Arias S, Danna E, Zaw M, Holt G, Tatsumi K, Kawasaki T, Mirsaeidi M. Presence of concurrent sarcoid-like granulomas indicates better survival in cancer patients: a retrospective cohort study. ERJ Open Res 2020; 6:00061-2020. [PMID: 33263026 PMCID: PMC7682654 DOI: 10.1183/23120541.00061-2020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction An increased risk of sarcoidosis and sarcoid-like reactions in subjects with a history of malignancy has been suggested. We assessed the incidence and clinical characteristics of cancer patients with biopsies containing sarcoid-like granulomas on cancer metastasis and patient survival. Methods This is a retrospective, multicentre, observational study involving endobronchial ultrasound transbronchial needle aspiration and a melanoma patient dataset at the University of Miami, USA, and a sarcoidosis patient database at Chiba University, Japan. Subjects with a confirmed diagnosis of cancer and who subsequently developed granulomas in different organs were enrolled. The study was registered at Clinicaltrials.gov (NCT03844698). Results 133 patients met the study's criteria. The most common primary cancer sites were the skin (22.5%), breast (20.3%) and lymph node (12.8%). 24 (18%) patients developed sarcoid-like granulomas within 1 year of cancer diagnosis, 54 (40.6%) between 1 and 5 years and 49 (36.8%) after 5 years. Imaging showed possible sarcoid-like granulomas in lymph nodes in 51 cases (38.3%) and lung tissue and mediastinal lymph nodes in 73 cases (54.9%); some parenchymal reticular opacity and fibrosis was found in 5 (3.7%) and significant parenchymal fibrosis in 2 (1.5%) subjects. According to logistic regression analysis, the frequency of metastatic cancer was significantly lower in patients with sarcoid-like granulomas than in controls. Moreover, multivariate Cox proportional hazard analysis showed a significant survival advantage in those with sarcoid-like granuloma. Conclusion Sarcoid-like granulomas are uncommon pathology findings in cancer patients. There is a significant association between the presence of granulomas and reduced metastasis and increased survival. Further study is warranted to understand the protective mechanism involved.
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Affiliation(s)
- Mukunthan Murthi
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, USA
| | - Keiichiro Yoshioka
- Dept of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jeong Hee Cho
- Dept of Pathology, University of Miami, Miami, FL, USA
| | - Sixto Arias
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, USA
| | - Elio Danna
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, USA
| | - Moe Zaw
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, USA
| | - Greg Holt
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, USA.,Section of Pulmonary, Miami VA Healthcare System, Miami, FL, USA
| | - Koichiro Tatsumi
- Dept of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeshi Kawasaki
- Dept of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mehdi Mirsaeidi
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, USA.,Section of Pulmonary, Miami VA Healthcare System, Miami, FL, USA
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Elarjani T, Altewerki M, Alsuwaidan A, Alhuthayl M, Hassounah M. Molecular Association of Medulloblastoma and Sarcoidosis: Case Report and Review of the Literature. World Neurosurg 2020; 145:290-294. [PMID: 33010513 DOI: 10.1016/j.wneu.2020.09.135] [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: 05/27/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Medulloblastoma (MB) is a malignant tumor of the central nervous system (CNS), and sarcoidosis is a chronic inflammatory disease of many organ systems, commonly affecting the lungs. No association between MB and sarcoidosis was described in the literature. MB and sarcoidosis have mutual molecular and signaling pathways that may predispose patients with sarcoidosis to develop MB. We describe a patient with sarcoidosis who developed MB. CASE DESCRIPTION The patient is a 36-year-old diagnosed with pulmonary sarcoidosis presented with ataxia, bilateral horizontal nystagmus, diplopia, and bilateral upper limb dysmetria was found to have a cerebellar mass on magnetic resonance imaging (MRI). He was initially treated with corticosteroids as a case of neurosarcoidosis. The patient's symptoms worsened, and repeat MRI showed an increase in the tumor size with hydrocephalus. External ventricular drain insertion plus midline suboccipital craniotomy and resection of the tumor was performed. Pathology revealed MB classic type, sonic hedgehog-activated. There was no cerebrospinal fluid dissemination. He received craniospinal radiation and chemotherapy. Follow-up 20 months after radiation revealed residual neurologic symptoms and no recurrence on MRI brain. CONCLUSIONS The exceedingly rare coexistence of adult MB and sarcoidosis may have a causal relationship based on specific common molecules. Leukotrienes, stimulation of astrocytes and Purkinje neurons, and the sonic hedgehog signaling pathway can be considered. Further genetic and molecular studies are merited.
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Affiliation(s)
- Turki Elarjani
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Malak Altewerki
- Department of Neurosciences, Division of Neurology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdullah Alsuwaidan
- Department of Pathology, Division of Neuropathology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Meshari Alhuthayl
- Department of Neurosciences, Division of Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Maher Hassounah
- Department of Neurosciences, Division of Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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Lim PN, Kirby L, Wylie G. Presentation of squamous cell carcinoma in pre-existing cutaneous sarcoidosis. BMJ Case Rep 2020; 13:13/8/e236426. [PMID: 32843386 DOI: 10.1136/bcr-2020-236426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Puo Nen Lim
- Dermatology Department, Stobhill Hospital (New), Glasgow, UK
| | - Lisa Kirby
- Dermatology Department, Stobhill Hospital (New), Glasgow, UK
| | - Grant Wylie
- Dermatology Department, Stobhill Hospital (New), Glasgow, UK
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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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Rubio-Rivas M, Moreira C, Marcoval J. Sarcoidosis related to checkpoint and BRAF/MEK inhibitors in melanoma. Autoimmun Rev 2020; 19:102587. [DOI: 10.1016/j.autrev.2020.102587] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/01/2020] [Indexed: 12/11/2022]
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40
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Chedid G, Harb JG, Noureldine HA, Tayar C, Nasser SM, Sabbah NA. Pancreatic sarcoidosis mimicking neoplasia: Case report. Int J Surg Case Rep 2020; 74:63-65. [PMID: 32795667 PMCID: PMC7426528 DOI: 10.1016/j.ijscr.2020.07.070] [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: 06/05/2020] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022] Open
Abstract
Involvement of the pancreas is exceedingly rare in sarcoidosis. Pancreatitis in a patient with pulmonary sarcoidosis can be secondary to a sarcoid inflammatory process. Pancreatic sarcoidosis can be discovered incidentally on radiography and may mimic neoplasia. Pancreatic sarcoidosis can be found concomitantly with more than one type of neoplastic lesion. Histopathologic assessment is required for definitive diagnosis.
Introduction Although sarcoidosis rarely involves the pancreas, such involvement may mimic pancreatic cancer. We herein report a case of pancreatic sarcoidosis giving rise to a cancer-mimicking retention cyst, concomitant with a neuroendocrine adenoma. Presentation of case A 47-year-old Caucasian male presented to follow-up for a benign-appearing cyst of the tail of the pancreas, detected incidentally on CT scan done for a urinary stone in 2017. He had been asymptomatic since his last presentation. The lesion was found to have increased in size from 1 cm to 3 cm in greater diameter. Yet, a CT angiography showed no evidence of invasion of surrounding organs, vessels, or lymph nodes. The patient had previous medical history of treated sarcoidosis, hypertension, recurrent nephrolithiasis, and gout. Due to the size increment a neoplastic cystic lesion was considered and distal pancreatectomy was performed. Pathologic examination revealed a retention cyst associated with chronic pancreatitis and the presence of non-caseating granulomas consistent with sarcoidosis. In addition, a neuroendocrine adenoma, and an adjacent focus of pancreatic intraepithelial neoplasia-1 and 2 were noted. Discussion Such presentations may be asymptomatic, as in this case, and a multidisciplinary workup is often required. Care must be taken to rule out pancreatic cancer. A possible relationship between pancreatic sarcoidosis and pancreatic cancer merits further study. Conclusion The diagnosis of pancreatic sarcoidosis is difficult, and conclusive diagnosis requires histopathologic assessment.
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Affiliation(s)
- Georges Chedid
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Jad Gerges Harb
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Hussein A Noureldine
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Claude Tayar
- Department of Surgery, Paris University, Paris, France; Department of General Surgery, Clemenceau Medical Center (Affiliated with Johns Hopkins International), Beirut, Lebanon
| | - Selim M Nasser
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon; Department of Pathology, Clemenceau Medical Center (Affiliated with Johns Hopkins International), Beirut, Lebanon.
| | - Nada Abbas Sabbah
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
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Berkowitz ST, Brock AL, Reichstein DA. An amelanotic choroidal melanoma arising in a young man with tattoo-associated sarcoidosis. Am J Ophthalmol Case Rep 2020; 18:100655. [PMID: 32211561 PMCID: PMC7082514 DOI: 10.1016/j.ajoc.2020.100655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/04/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose To describe a patient with an amelanotic choroidal melanoma, originally misdiagnosed as a choroidal granuloma, following his systemic diagnosis of tattoo-associated sarcoidosis. Observations The amelanotic choroidal tumor, suspected to be a granuloma, failed initial steroid treatment. Full-thickness chorioretinal biopsy demonstrated histologic presence of uveal melanoma and tumor genetics via GEP analysis demonstrated a PRAME negative, Class 1A lesion. The amelanotic choroidal melanoma was treated successfully with I-125 plaque brachytherapy. Conclusion and importance Despite a systemic diagnosis which predisposes a patient to uveal granuloma, amelanotic choroidal melanomas can still occur and should be considered. The association of uveal melanoma and sarcoidosis remains rare and of unclear significance.
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Shah I, Mehta H, Anklesaria A, Kadkhodayan K. Solid Pseudopapillary Tumor of the Pancreas in a Patient With Sarcoidosis: A Rare Combination. Cureus 2020; 12:e8340. [PMID: 32617215 PMCID: PMC7325336 DOI: 10.7759/cureus.8340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Sarcoidosis is a chronic granulomatous disease that is characterized by the formation of non-caseating granulomas, predominantly involving the lung and lymph nodes. Over the years, sarcoidosis has been associated with a high risk of malignancy. Solid pseudopapillary tumor of the pancreas is an uncommon pancreatic tumor with a 15% malignant potential. Ours is an interesting case of a 34-year-old patient who was found to have a pancreatic mass and incidental mediastinal lymphadenopathy on imaging, initially raising concern for metastatic pancreatic cancer. However, she was later diagnosed to have an isolated solid pseudopapillary tumor of the pancreas in association with concurrent sarcoidosis.
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Affiliation(s)
- Ishani Shah
- Internal Medicine, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Harsh Mehta
- Internal Medicine, Saint Barnabas Medical Center, Livingston, USA
| | - Ava Anklesaria
- Gastroenterology, Maimonides Medical Center, Brooklyn, USA
| | - Kambiz Kadkhodayan
- Gastroenterology, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, USA
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Popławska-Kita A, Wielogórska M, Poplawski Ł, Siewko K, Adamska A, Szumowski P, Myśliwiec P, Myśliwiec J, Reszeć J, Kamiński G, Dzięcioł J, Tobiaszewska D, Szelachowska M, Krętowski AJ. Thyroid carcinoma with atypical metastasis to the pituitary gland and unexpected postmortal diagnosis. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM190148. [PMID: 32168468 PMCID: PMC7077587 DOI: 10.1530/edm-19-0148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/21/2020] [Indexed: 12/19/2022] Open
Abstract
SUMMARY Papillary thyroid gland carcinoma is the most common type of malignancy of the endocrine system. Metastases to the pituitary gland have been described as a complication of papillary thyroid cancer in few reported cases since 1965. We report the case of a 68-year-old female patient with a well-differentiated form of thyroid gland cancer. Despite it being the most common malignant cancer of the endocrine system, with its papillary form being one of the two most frequently diagnosed thyroid cancers, the case we present is extremely rare. Sudden cardiac arrest during ventricular fibrillation occurred during hospitalization. Autopsy of the patient revealed papillary carcinoma of the thyroid, follicular variant, with metastasis to the sella turcica, and concomitant sarcoidosis of heart, lung, and mediastinal and hilar lymph nodes. Not only does atypical metastasis make our patient's case most remarkable, but also the postmortem diagnosis of sarcoidosis makes her case particularly unusual. LEARNING POINTS The goal of presenting this case is to raise awareness of the clinical heterogeneity of papillary cancer and promote early diagnosis of unexpected metastasis and coexisting diseases to improve clinical outcomes. Clinicians must be skeptical. They should not fall into the trap of diagnostic momentum or accept diagnostic labels at face value. Regardless of the potential mechanisms, clinicians should be aware of the possibility of the coexistence of thyroid cancer and sarcoidosis as a differential diagnosis of lymphadenopathy. This case highlights the importance of the diagnostic and therapeutic planning process and raises awareness of the fact that one uncommon disease could be masked by another extremely rare disorder.
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Affiliation(s)
| | | | | | | | | | - Piotr Szumowski
- Departments of Nuclear Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Piotr Myśliwiec
- 1st Clinic Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Janusz Myśliwiec
- Departments of Nuclear Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Joanna Reszeć
- Departments of Medical Pathomorphology, Medical University of Bialystok, Bialystok, Poland
| | - Grzegorz Kamiński
- Department of Endocrinology and Radioisotopy Therapy, Military Institute of Medicine, Warsaw, Poland
| | - Janusz Dzięcioł
- Departments of Human Anatomy, Medical University of Bialystok, Bialystok, Poland
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Bala P, Arjun P, Varghese L, Sudin SR, Pillai S, Thampy C, Palangadan S, Biji KA. A red herring, a wild-goose chase, and an unexpected diagnosis of concomitant malignancy and sarcoidosis. Lung India 2020; 37:437-440. [PMID: 32883906 PMCID: PMC7857364 DOI: 10.4103/lungindia.lungindia_378_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A 49-year-old male was evaluated in our hospital for chronic cough, cervical lymphadenopathy, and a testicular mass. As a part of the management, he underwent a cervical lymph node biopsy, which showed metastatic deposits from papillary carcinoma thyroid. Subsequently, he underwent orchidectomy for suspected testicular malignancy, but the biopsy showed discrete granulomatous inflammation consistent with sarcoidosis. This was followed by total thyroidectomy with neck node dissection. Nodal histopathological examination, this time, revealed a single node containing both malignancy and granulomas. Prior to the thyroid surgery, he underwent a mediastinoscopic sampling of the mediastinal nodes, which also showed granulomatous inflammation consistent with sarcoidosis. Sarcoidosis affecting the genitourinary system is a rare entity. The coexistence of sarcoidosis and thyroid malignancy poses a diagnostic challenge. A thorough review of the literature was done, and there are no reports from India on the above association. This is a unique case, which could possibly suggest an association between sarcoidosis and malignancy and highlights the importance of obtaining a tissue diagnosis in such cases.
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Affiliation(s)
- Ponnuthurai Bala
- Department of Respiratory Medicine, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Padmanabhan Arjun
- Department of Respiratory Medicine, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Liju Varghese
- Department of General Surgery, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - S R Sudin
- Department of Urology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Sandeep Pillai
- Department of Surgical Oncology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Cherian Thampy
- Department of Medical Oncology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - Shaji Palangadan
- Department of Cardiothoracic and Vascular Surgery, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
| | - K A Biji
- Department of Pathology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
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Ali A, Venkatram S, Niazi M, Diaz-Fuentes G. Lung mass with bilateral mediastinal hypermetabolic lymphadenopathy in a chronic smoker indicative of lung cancer? Respir Med Case Rep 2019; 29:100982. [PMID: 31890559 PMCID: PMC6928348 DOI: 10.1016/j.rmcr.2019.100982] [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: 10/15/2019] [Revised: 12/02/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022] Open
Abstract
We present the case of an asymptomatic woman, a chronic heavy smoker, who presented with an incidental lung mass and mediastinal lymphadenopathy. Bronchoscopy with transbronchial biopsy and endobronchial ultrasound-guided transbronchial needle aspiration did not show malignancy. A positron emission tomography/computed tomography scan showed increased uptake with a standardized uptake value of 26.4 in the mediastinal lymph node and an additional hypermetabolic right supraclavicular lymph node. Surgical biopsy of the supraclavicular node revealed non-necrotizing granuloma. Discussion of the clinical dilemma is provided.
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Affiliation(s)
- Asghar Ali
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System, 1650 Grand Concourse, Bronx, NY, 10457, USA
| | - Sindhaghatta Venkatram
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System, 1650 Grand Concourse, Bronx, NY, 10457, USA
| | - Masooma Niazi
- Department of Pathology, BronxCare Health System, 1650 Grand Concourse, Bronx, NY, 10457, USA
| | - Gilda Diaz-Fuentes
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System, 1650 Grand Concourse, Bronx, NY, 10457, USA
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Diamantopoulos PT, Charakopoulos E, Viniou NA, Diamantopoulou L, Gaggadi M. An unusual case report of unilateral parotid gland sarcoidosis with spontaneous remission. Medicine (Baltimore) 2019; 98:e18172. [PMID: 31804332 PMCID: PMC6919423 DOI: 10.1097/md.0000000000018172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Parotid gland sarcoidosis is a well-recognized, but uncommon disease entity. Parotidectomy is most commonly performed to establish the diagnosis and most patients are treated with corticosteroids. PATIENT CONCERNS A young female patient presented with right parotid enlargement and developed symptoms of facial nerve palsy during diagnostic investigation. DIAGNOSES A fine-needle aspiration cytology showed granulomatous inflammation. The diagnosis of sarcoidosis was eventually established based on the demonstration of the characteristic lambda and panda signs by a Gallium-67 scintigraphy. INTERVENTIONS No specific pharmacologic therapy was initiated. OUTCOMES The patient's symptoms regressed completely over a period of 3 months. Additionally, she remains asymptomatic 2 years later. LESSONS This case underlines the importance of not initiating corticosteroids in all patients with parotid gland sarcoidosis and suggests that parotidectomy can be avoided in the presence of characteristic for sarcoidosis imaging findings.
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Affiliation(s)
| | - Emmanouil Charakopoulos
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens
| | - Nora-Athina Viniou
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens
| | - Lydia Diamantopoulou
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens
| | - Maria Gaggadi
- Pulmonology Department, Laikon General Hospital, Athens, Greece
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Hepatic Sarcoidosis Complicated with Pancreatic Adenocarcinoma. Case Reports Hepatol 2019; 2019:9383019. [PMID: 31827951 PMCID: PMC6885758 DOI: 10.1155/2019/9383019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/12/2019] [Accepted: 08/27/2019] [Indexed: 12/17/2022] Open
Abstract
Sarcoidosis is a systemic noncaseous granulomatous disease. The liver is a common location but usually asymptomatic. Current literature suggests an association between sarcoidosis and cancers. However, there is a lack of definite evidence. We present a case of a 59-year-old man with jaundice and acutely elevated alkaline phosphatase. The diagnosis was confirmed by obtaining a liver biopsy and was treated with 6 months of steroids. A year later, he had a recurrence of jaundice. MRCP showed biliary dilatation and a mass in the pancreatic head, confirmed by biopsy to be adenocarcinoma. This is the first case to be reported of hepatic sarcoidosis associated with pancreatic cancer.
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Delcourt C, Yildiz H, Camboni A, Van den Neste E, Roelants V, Kozyreff A, Thissen JP, Maiter D, Furnica RM. A sarcoidosis-lymphoma syndrome revealed by hypopituitarism. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190091. [PMID: 31600729 PMCID: PMC6765315 DOI: 10.1530/edm-19-0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/03/2019] [Indexed: 12/02/2022] Open
Abstract
SUMMARY A 26-year-old woman presented with persistent headache and tiredness. Biological investigations disclosed a moderate inflammatory syndrome, low PTH-hypercalcemia and complete anterior hypopituitarism. A magnetic resonance imaging (MRI) of the pituitary gland was performed and revealed a symmetric enlargement with a heterogeneous signal. Ophthalmological examination showed an asymptomatic bilateral anterior and posterior uveitis, and a diagnosis of pituitary sarcoidosis was suspected. As the localization of lymphadenopathies on the fused whole-body FDG-PET/computerized tomography (CT) was not evoking a sarcoidosis in first instance, an excisional biopsy of a left supraclavicular adenopathy was performed showing classic nodular sclerosis Hodgkin's lymphoma (HL). A diagnostic transsphenoidal biopsy of the pituitary gland was proposed for accurate staging of the HL and surprisingly revealed typical granulomatous inflammation secondary to sarcoidosis, leading to the diagnosis of a sarcoidosis-lymphoma syndrome. The co-existence of these diseases constitutes a diagnostic challenge and we emphasize the necessity of exact staging of disease in order to prescribe adequate treatment. LEARNING POINTS The possibility of a sarcoidosis-lymphoma syndrome, although rare, should be kept in mind during evaluation for lymphadenopathies. In the case of such association, lymphoma usually occurs after sarcoidosis. However, sarcoidosis and lymphoma can be detected simultaneously and development of sarcoidosis in a patient with previous lymphoma has also been reported. An accurate diagnosis of the disease and the respective organ involvements, including biopsy, is necessary in order to prescribe adequate treatment.
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Affiliation(s)
- Charlotte Delcourt
- Departments of Endocrinology and Nutrition, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Halil Yildiz
- Internal Medicine, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Alessandra Camboni
- Pathology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Eric Van den Neste
- Hematology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Véronique Roelants
- Nuclear Medicine, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Alexandra Kozyreff
- Ophthalmology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jean Paul Thissen
- Departments of Endocrinology and Nutrition, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Dominique Maiter
- Departments of Endocrinology and Nutrition, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Raluca Maria Furnica
- Departments of Endocrinology and Nutrition, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Mitchell MA, Hogan K, Amjadi K. Atezolizumab-induced sarcoid-like granulomatous reaction in a patient with urothelial cell carcinoma. Immunotherapy 2019; 10:1189-1192. [PMID: 30326785 DOI: 10.2217/imt-2018-0035] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A 61-year-old woman with locally advanced, high-grade urothelial cell carcinoma was treated with the anti-programmed death-ligand 1 antibody atezolizumab. She initially received neoadjuvant chemotherapy and surgery that led to clinical and radiographic remission at the time of atezolizumab initiation. Within 3 months she developed new mediastinal and hilar lymphadenopathy as well as pulmonary nodules in a pattern characteristic of pulmonary sarcoidosis. Mediastinal lymph node biopsy by endobronchial ultrasound demonstrated noncaseating granulomas without evidence of malignancy or infection. Within 4 weeks of initiation of prednisone and cessation of atezolizumab there was marked reduction in intrathoracic lymphadenopathy and perilymphatic nodules. This is the first reported case of atezolizumab-induced sarcoid-like granulomatous reaction.
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Affiliation(s)
- Michael A Mitchell
- Division of Respirology, Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Kevin Hogan
- Department of Anatomical Pathology, University of Ottawa, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Kayvan Amjadi
- Division of Respirology, Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
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