1
|
Patil M, Breish MO, Madaan S, Bhattacharjee B. Resolution of multiorgan sarcoid-like reaction after treatment of renal cell carcinoma. BMJ Case Rep 2024; 17:e259370. [PMID: 38969396 DOI: 10.1136/bcr-2023-259370] [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] [Indexed: 07/07/2024] Open
Abstract
Sarcoid -like reactions (SLRs) can occur in several malignancies adjacent to primary tumour location or the draining lymph nodes. The presence of peritumoural and intratumoural SLR in patients suffering from renal cell carcinoma (RCC) has been reported in few instances. However, the association of RCC with SLR in spleen, liver and other organs in the absence of systemic sarcoidosis is very rare.We present an unusual case of a gentleman in his 30s, who presented with a lesion in the left kidney along with non-specific lesions (likely granulomatous) in liver, spleen and lungs. Partial Nnephrectomy specimen confirmed conventional/clear cell RCC. The histopathology revealed an extensive epithelioid granulomatous reaction affecting both peritumoural and intratumoural areas. Follow-up images demonstrated an almost complete resolution of lesions in the spleen, liver and lungs. Our case supports the hypothesis that non-caseating granulomas of SLR could be a manifestation of an immunologically mediated antitumour response.
Collapse
Affiliation(s)
- Monish Patil
- Urology, Dartford and Gravesham NHS Trust, Dartford, UK
| | | | - Sanjeev Madaan
- Urology & Nephrology, Darent Valley Hospital, Dartford, UK
| | | |
Collapse
|
2
|
Kitamura K, Ogura T, Miyamoto R, Ishida H, Matsudaira S, Takahashi A, Kanda H, Fukuda T. Splenic sarcoid reaction mimicking metastases in patients after uterine cancer surgery: a report of two cases. Surg Case Rep 2023; 9:167. [PMID: 37726529 PMCID: PMC10509101 DOI: 10.1186/s40792-023-01753-1] [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: 07/31/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Tumor-associated sarcoid reactions have been observed with various tumors; however, they have not been reported with uterine cancer. We present two cases of splenic sarcoid reactions that mimicked metastases a few years after uterine cancer surgery. CASE PRESENTATION Case 1 involved a 67-year-old female patient diagnosed with endometrial cancer (pT1aN0M0, pStage Ia, grade 1). The patient underwent open total abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic lymphadenectomy. Three years after the initial surgery, computed tomography (CT) and positron emission tomography CT showed multiple splenic masses with increasing numbers and sizes. Splenic metastases were diagnosed, and laparoscopic splenectomy was performed. The histopathological analysis revealed sarcoid reactions in the spleen. Case 2 involved a 47-year-old female patient diagnosed with endometrial cancer (pT1aN0M0, pStage Ia, grade 1). The patient underwent laparoscopic total abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic lymphadenectomy. Two years after the initial surgery, multiple splenic masses were observed. We performed laparoscopic splenectomy for the splenic metastases. Granuloma formations were identified in the splenic specimen and perisplenic lymph nodes that were removed simultaneously, resulting in a final diagnosis of sarcoid reaction. A review of the lymph nodes at the time of the previous uterine surgery revealed granuloma formation. Other than the presence of splenic masses, no findings suggestive of recurrence were observed in these cases. Uterine cancer and sarcoid reactions progressed without recurrence after splenectomy. CONCLUSIONS To the best of our knowledge, this is the first report of the late development of splenic sarcoid reactions after uterine cancer surgery. Sarcoid reactions and metastases are difficult to diagnose based on preoperative imaging results. However, reviewing the specimen at the time of the initial resection, the number of lesions, and the clinical findings (other than imaging findings) may aid in the determination of the correct diagnosis.
Collapse
Affiliation(s)
- Kei Kitamura
- Department of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806 Japan
| | - Toshiro Ogura
- Department of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806 Japan
| | - Ryoichi Miyamoto
- Department of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806 Japan
- Department of Gastroenterological Surgery, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Hiroyuki Ishida
- Department of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806 Japan
| | - Shinichi Matsudaira
- Department of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806 Japan
| | - Amane Takahashi
- Department of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806 Japan
| | - Hiroaki Kanda
- Department of Pathology, Saitama Cancer Center, Kita-Adachi-Gun, Saitama, Japan
| | - Takashi Fukuda
- Department of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro, Ina-Machi, Kita-Adachi-Gun, Saitama, 362-0806 Japan
| |
Collapse
|
3
|
Aoki M, Jin ZW, Ueda K, Kamimura G, Takeda-Harada A, Murakami G, Sato M. Localization of macrophages and dendritic cells in human thoracic lymph nodes: An immunohistochemical study using surgically obtained specimens. J Anat 2023; 243:504-516. [PMID: 37024113 PMCID: PMC10439373 DOI: 10.1111/joa.13870] [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: 11/29/2022] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 04/08/2023] Open
Abstract
Both dendritic cells (DCs) and macrophages are bone marrow-derived cells that perform antigen presentation. The distribution of DCs and CD68-positive macrophages were immunohistochemically examined in 103 thoracic nodes obtained from 23 lung cancer patients (50-84 years old) without metastasis. Among three antibodies tested initially-CD209/DCsign, fascin, and CD83-DCsign was chosen as the DC marker. For comparison, 137 nodes from 12 patients with cancer metastasis were also examined histologically. In patients without metastasis, DCs were found as (1) clusters along the subcapsular sinus and in a border area between the medullary sinus and cortex (mean sectional area of multiple nodes at one site, 8.4%) and, (2) rosette-like structures in the cortex (mean number in multiple nodes at one site, 20.5). Notably, DC clusters and rosettes contained no or few macrophages and were surrounded by smooth muscle actin (SMA)-positive, endothelium-like cells. The subcapsular linear cluster corresponded to 5%-85% (mean, 34.0%) of the nodal circumferential length and was shorter in older patients (p = 0.009). DC rosettes, solitary, or communicating with a cluster, were usually connected to a paracortical lymph sinus. Few differences were found between nodes with or without metastasis, but DC cluster sometimes contained abundant macrophages in cancer metastasis patients. The subcapsular DC cluster is not known in the rodent model, in which the subcapsular sinus is filled with macrophages. This quite different, even complementary, distribution suggests no, or less, cooperation between DCs and macrophages in humans.
Collapse
Affiliation(s)
- Masaya Aoki
- Department of General Thoracic Surgery, Kagoshima University School of Medicine, Kagoshima, Japan
| | - Zhe-Wu Jin
- Department of Anatomy, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Kazuhiro Ueda
- Department of General Thoracic Surgery, Kagoshima University School of Medicine, Kagoshima, Japan
| | - Go Kamimura
- Department of General Thoracic Surgery, Kagoshima University School of Medicine, Kagoshima, Japan
| | - Aya Takeda-Harada
- Department of General Thoracic Surgery, Kagoshima University School of Medicine, Kagoshima, Japan
| | - Gen Murakami
- Department of Anatomy, Tokyo Dental College, Tokyo, Japan
| | - Masami Sato
- Department of General Thoracic Surgery, Kagoshima University School of Medicine, Kagoshima, Japan
| |
Collapse
|
4
|
Zhang X, Sun D, Zhou X, Zhang C, Yin Q, Chen L, Tang Y, Liu Y, Morozova-Roche LA. Proinflammatory S100A9 stimulates TLR4/NF-κB signaling pathways causing enhanced phagocytic capacity of microglial cells. Immunol Lett 2023; 255:54-61. [PMID: 36870421 DOI: 10.1016/j.imlet.2023.02.008] [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: 10/17/2022] [Revised: 02/26/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023]
Abstract
Alzheimer's disease (AD) is the main cause of dementia, affecting the increasingly aging population. Growing evidence indicates that neuro-inflammation plays crucial roles, e.g., the association between AD risk genes with innate immune functions. In this study, we demonstrate that moderate concentrations of pro-inflammatory cytokine S100A9 regulate immune response of BV2 microglial cells, i.e., the phagocytic capacity, reflected by elevated number of 1 μm diameter Dsred-stained latex beads in the cytoplasm. In contrast, at high S100A9 concentrations, both the viability and phagocytic capacity of BV2 cells drop substantially. Furthermore, it is uncovered that S100A9 affects phagocytosis of microglia via NF-κB signaling pathways. Application of related target-specific drugs, i.e., IKK and TLR4 inhibitors, effectively suppresses BV2 cells' immune responses. These results suggest that pro-inflammatory S100A9 activates microglial phagocytosis, and possibly contributes to the clearance of amyloidogenic species at the early stage of AD.
Collapse
Affiliation(s)
- Xiaoyin Zhang
- Laboratory of stem cell and Tissue Engineering, Chongqing Medical University, 400016, Chongqing, China
| | - Dan Sun
- State Key Laboratory of Photon-Technology in Western China Energy, Institute of Photonics and Photon Technology, Northwest University, 710127, Xi'an, China
| | - Xin Zhou
- Laboratory of stem cell and Tissue Engineering, Chongqing Medical University, 400016, Chongqing, China
| | - Ce Zhang
- State Key Laboratory of Photon-Technology in Western China Energy, Institute of Photonics and Photon Technology, Northwest University, 710127, Xi'an, China
| | - Qing Yin
- Laboratory of stem cell and Tissue Engineering, Chongqing Medical University, 400016, Chongqing, China
| | - Li Chen
- Laboratory of stem cell and Tissue Engineering, Chongqing Medical University, 400016, Chongqing, China
| | - Yong Tang
- Laboratory of stem cell and Tissue Engineering, Chongqing Medical University, 400016, Chongqing, China
| | - Yonggang Liu
- Laboratory of stem cell and Tissue Engineering, Chongqing Medical University, 400016, Chongqing, China.
| | | |
Collapse
|
5
|
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.
Collapse
|
6
|
Sangoi AR, Maclean F, Mohanty S, Hes O, Daniel R, Lal P, Canete‐Portillo S, Magi‐Galluzzi C, Cornejo KM, Collins K, Hwang M, Falzarano SM, Feely MM, Dababneh M, Harik L, Tretiakova M, Akgul M, Manucha V, Chan E, Kao C, Siadat F, Arora K, Barkan G, Cheng L, Hirsch M, Lei L, Wasco M, Williamson SR, Acosta AM. Granulomas associated with renal neoplasms: A multi‐institutional clinicopathological study of 111 cases. Histopathology 2022; 80:922-927. [DOI: 10.1111/his.14633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Fiona Maclean
- Department of Anatomic Pathology Douglass Hanly Moir Pathology, Sonic Healthcare Macquarie Park Australia
| | - Sambit Mohanty
- Department of Pathology and Laboratory Medicine Advanced Medical Research Institute Bhubaneswar India
| | - Ondrej Hes
- Department of Pathology Charles University Hospital and Medical Facility Plzen Plzen Czech Republic
| | - Reba Daniel
- Department of Pathology University of Pennsylvania Philadelphia PA USA
| | - Priti Lal
- Department of Pathology University of Pennsylvania Philadelphia PA USA
| | | | | | - Kristine M Cornejo
- Department of Pathology Massachusetts General Hospital and Harvard Medical School Boston MA USA
| | | | | | - Sara M Falzarano
- Department of Pathology, Immunology and Laboratory Medicine University of Florida Gainesville FL USA
| | - Mike M Feely
- Department of Pathology, Immunology and Laboratory Medicine University of Florida Gainesville FL USA
| | - Melad Dababneh
- Department of Pathology and Laboratory Medicine Emory University Atlanta GA USA
| | - Lara Harik
- Department of Pathology and Laboratory Medicine Emory University Atlanta GA USA
| | - Maria Tretiakova
- University of Washington Department of Laboratory Medicine and Pathology Seattle WA USA
| | - Mahmut Akgul
- Department of Pathology and Laboratory Medicine Albany Medical Center Albany NY USA
| | - Varsha Manucha
- Department of Pathology University of Mississippi Medical Center Jackson MS USA
| | - Emily Chan
- Department of Pathology University of California San Francisco San Francisco CA USA
| | | | - Farshid Siadat
- Department of Pathology and Laboratory Medicine Cumming School of Medicine University of Calgary Calgary AL Canada
| | - Kanika Arora
- Department of Pathology Henry Ford Hospital Detroit MI USA
| | - Guliz Barkan
- Loyola University Healthcare Center Department of Pathology Maywood IL USA
| | - Liang Cheng
- Indiana University, Pathology Indianapolis IN USA
| | - Michelle Hirsch
- Department of Pathology Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - Li Lei
- Department of Pathology and Laboratory Medicine University of California Davis Health System Sacramento CA USA
| | | | | | - Andres M Acosta
- Department of Pathology Brigham and Women's Hospital Harvard Medical School Boston MA USA
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Sarcoid-Like Reaction in Non-Hodgkin's Lymphoma-A Diagnostic Challenge for Deauville Scoring on 18F-FDG PET/CT Imaging. Diagnostics (Basel) 2021; 11:diagnostics11061009. [PMID: 34073137 PMCID: PMC8229233 DOI: 10.3390/diagnostics11061009] [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: 05/07/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/16/2022] Open
Abstract
The sarcoid-like reaction represents an autoinflammatory cause of mediastinal and hilar lymphadenopathy but may also involve other lymph node regions and organs. This rare phenomenon has mainly been reported in patients with Hodgkin’s lymphoma (HL) or solid tumors (particularly melanoma) undergoing immunotherapy and chemotherapy. Cases in non-Hodgkin’s lymphoma (NHL) are very uncommon. We present an uncommon case of a patient with primarily mediastinal diffuse large B-cell lymphoma (DLBCL) who showed a CT-based partial response in interim staging, whereas at end-of-treatment multiple newly enlarged and hypermetabolic mediastinal and bilateral hilar lymph nodes were detected by 18F-FDG PET/CT imaging. A subsequent histological workup determined a sarcoid-like reaction without any lymphomatous tissue. Therefore, sarcoid-like reactions should be considered as a potential pitfall in Deauville staging with 18F-FDG PET/CT imaging for patients with NHL.
Collapse
|
9
|
Itai Y, Ueda Y, Etoh T, Shirasaka Y, Shiroshita H, Shiraishi N, Daa T, Inomata M. Clinical significance of sarcoid-like reaction in lymph nodes of gastric cancer patients. J Surg Oncol 2021; 124:293-300. [PMID: 34003494 DOI: 10.1002/jso.26525] [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: 04/21/2021] [Accepted: 05/02/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although granulomatous formation (sarcoid-like reaction [SR]) similar to sarcoidosis occasionally occurs in regional lymph nodes of malignant tumors, the pathological significance of SR is unknown. We aimed to elucidate the clinicopathological significance and prognostic relevance of SR in gastric cancer. METHODS We evaluated 391 patients who underwent curative gastrectomy for gastric cancer between 2007 and 2016 at our hospital. The patients were divided into two groups according to presence of SR in lymph nodes, and clinicopathological factors and prognosis were compared between the two groups. RESULTS SR was found in 67 (17.1%) of the 391 patients, and 332 (3.3%) of 10,149 lymph nodes examined. Regarding clinicopathological factors, SR-positive group showed significantly higher average age (p < 0.01) and numbers of differentiated tumors than SR-negative group (p < 0.05). Three-year overall survival rate in elderly patients aged ≥75 years was significantly more favorable in SR-positive group (n = 27, 85.2%) versus SR-negative group (n = 97, 63.4%) (p < 0.05). Immunohistochemical studies showed the predominant presence of CD68-positive macrophages for SR, with CD4/CD8-positive T cells and interleukin-10 also positive. CONCLUSION The presence of SR in gastric cancer is frequent in elderly patients and might be a favorable indicator of prognosis. SR is suggested to reflect immune activation in the host.
Collapse
Affiliation(s)
- Yusuke Itai
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan.,Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Oita, Japan
| | - Yoshitake Ueda
- Department of Comprehensive Surgery for Community Medicine, Faculty of Medicine, Oita University, Oita, Japan
| | - Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Yoshinori Shirasaka
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Hidefumi Shiroshita
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Norio Shiraishi
- Department of Comprehensive Surgery for Community Medicine, Faculty of Medicine, Oita University, Oita, Japan
| | - Tsutomu Daa
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Oita, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan
| |
Collapse
|
10
|
Mizota T, Suzuoki M, Kaku S, Mizunuma K, Ohtaka K, Takahashi R, Komuro K, Iwashiro N, Ohara M, Kimura N, Hirano S. Hepatocellular carcinoma with regional lymphadenopathy caused by sarcoid-like reaction: a case report. Surg Case Rep 2021; 7:63. [PMID: 33665746 PMCID: PMC7933298 DOI: 10.1186/s40792-021-01146-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sarcoid-like reaction (SLR) is a histological pattern of granulomatous inflammation that is clinically differentiated from sarcoidosis. Since SLR is known to occur in several neoplasias and occasionally causes lymphadenopathy and mimics metastatic malignancy, it needs to be considered whether lymphadenopathy is due to metastasis or SLR for the choice of cancer treatment. Few cases of hepatocellular carcinoma (HCC) with SLR have been reported. Here, a case of HCC with lymphadenopathy diagnosed as SLR without metastasis is presented. CASE PRESENTATION A 69-year-old woman was admitted to our hospital because of upper abdominal pain. She tested positive for hepatitis C virus ribonucleic acid. Imaging modalities showed an 81 × 65-mm-sized tumor with multiple nodules in segment 3 and a 17 × 12-mm-sized tumor in segment 5 with a common HCC enhancement pattern. In addition, a lymph node in the hepatoduodenal ligament was enlarged at 13 mm in size, suggesting the metastasis of HCC. Hepatectomy of the lateral segment and segment 5 and lymph node dissection in the hepatoduodenal ligament were performed. Both tumors in segments 3 and 5 were pathologically diagnosed as HCC without vessel invasion. The tumors contained necrotic cells and epithelioid cell granulomas with multinucleated giant cells, which is typically observed in sarcoidosis. The dissected lymph nodes also contained epithelioid cell granulomas, as well as giant cells with asteroid bodies. There was no malignancy in the lymph nodes. The pathological findings suggested the coexistence of malignancy and sarcoidosis. However, since the patient did not show any typical findings of pulmonary or cardiac sarcoidosis, the case was diagnosed as HCC with SLR in the primary lesion and regional lymph nodes. CONCLUSIONS SLR needs to be considered in the differential diagnosis when a cancer patient develops lymphadenopathy. However, lymphadenopathy due to SLR is indistinguishable from that due to metastasis even when using multiple imaging modalities. Pathological examinations may be helpful for the diagnosis.
Collapse
Affiliation(s)
- Tomoko Mizota
- Department of Surgery, National Hospital Organization Hakodate National Hospital, 18-16, Kawahara-cho, Hakodate, Hokkaido, 041-8512, Japan.
| | - Masato Suzuoki
- Department of Surgery, National Hospital Organization Hakodate National Hospital, 18-16, Kawahara-cho, Hakodate, Hokkaido, 041-8512, Japan
| | - Saya Kaku
- Department of Surgery, National Hospital Organization Hakodate National Hospital, 18-16, Kawahara-cho, Hakodate, Hokkaido, 041-8512, Japan
| | - Kenichi Mizunuma
- Department of Surgery, National Hospital Organization Hakodate National Hospital, 18-16, Kawahara-cho, Hakodate, Hokkaido, 041-8512, Japan
| | - Kazuto Ohtaka
- Department of Surgery, National Hospital Organization Hakodate National Hospital, 18-16, Kawahara-cho, Hakodate, Hokkaido, 041-8512, Japan
| | - Ryo Takahashi
- Department of Surgery, National Hospital Organization Hakodate National Hospital, 18-16, Kawahara-cho, Hakodate, Hokkaido, 041-8512, Japan
| | - Kazuteru Komuro
- Department of Surgery, National Hospital Organization Hakodate National Hospital, 18-16, Kawahara-cho, Hakodate, Hokkaido, 041-8512, Japan
| | - Nozomu Iwashiro
- Department of Surgery, National Hospital Organization Hakodate National Hospital, 18-16, Kawahara-cho, Hakodate, Hokkaido, 041-8512, Japan
| | - Masanori Ohara
- Department of Surgery, National Hospital Organization Hakodate National Hospital, 18-16, Kawahara-cho, Hakodate, Hokkaido, 041-8512, Japan
| | - Noriko Kimura
- Department of Pathology, National Hospital Organization Hakodate National Hospital, 18-16, Kawahara-cho, Hakodate, Hokkaido, 041-8512, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| |
Collapse
|
11
|
Russell DH. Granulomata in Clear Cell Renal Cell Carcinoma: An Uncommon Presentation of a Common Cancer, Not Two Separate Entities. CLINICAL PATHOLOGY 2020; 13:2632010X20954215. [PMID: 33063009 PMCID: PMC7534079 DOI: 10.1177/2632010x20954215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/05/2020] [Indexed: 11/17/2022]
Abstract
Sarcoidal-like granulomata (SLG) are known to occur as a response to a variety of tumor types, including lymphomas, prominently seminoma, other miscellaneous carcinomas, and rarely in renal cell carcinoma. There have been a handful of previously reported cases in the literature of SLG occurring in association with RCC. Of those previously reported, none were associated with infection and only 3 patients had a history of sarcoidosis. The prognostic significance of SLG in RCC is unsettled and somewhat complicated by the relative rarity of its occurrence and the paucity of data therein. A case is presented of an otherwise histologically typical clear cell renal cell carcinoma with peri-tumoral and intra-tumoral SLG. Special stains were negative for organisms and past medical history was negative for sarcoidosis and connective tissue disease.
Collapse
Affiliation(s)
- Daniel Hugh Russell
- Anatomic Pathology, Department of Pathology, Tripler Army Medical Center, Honolulu, HI, USA
| |
Collapse
|
12
|
Kinoshita Y, Ishii H, Eishi Y, Uchida K, Yoshimura M, Iwasaki A, Fujita M, Nabeshima K, Watanabe K. Histological differences between sarcoidosis and lung cancer-related sarcoid reaction. Respir Investig 2020; 58:421-424. [PMID: 32482594 DOI: 10.1016/j.resinv.2020.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/17/2020] [Accepted: 04/13/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Yoshiaki Kinoshita
- Department of Respiratory Medicine, Fukuoka University School of Medicine, Fukuoka, Japan; Department of Pathology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yoshinobu Eishi
- Department of Human Pathology, Tokyo Medical and Dental University, Graduate School and Faculty of Medicine, Tokyo, Japan
| | - Keisuke Uchida
- Department of Human Pathology, Tokyo Medical and Dental University, Graduate School and Faculty of Medicine, Tokyo, Japan
| | - Masayo Yoshimura
- Department of Pathology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Akinori Iwasaki
- Thoracic Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Masaki Fujita
- Department of Respiratory Medicine, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kentaro Watanabe
- Department of Respiratory Medicine, Nishi Fukuoka Hospital, Fukuoka, Japan.
| |
Collapse
|
13
|
Herron M, Chong SG, Gleeson L, Nicholson S, Fahy RJ. Paraneoplastic sarcoidosis: a review. QJM 2020; 113:17-19. [PMID: 31407005 DOI: 10.1093/qjmed/hcz207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/28/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sarcoidosis is occasionally seen in association with malignancy, both at the time of cancer diagnosis or during follow up. AIM The purpose of this study is to identify patients with paraneoplastic sarcoid, their associated malignancies and disease characteristics. METHODS We identified 289 patients diagnosed histologically with sarcoidosis over a 6-year period in one centre, from 2010 to 2016. Fifty of these patients had a prior or concomitant diagnosis of cancer. RESULTS 17.3% of sarcoid cases had an associated malignancy. The most common malignancies were Gastrointestinal (20%), Haematological (18%), Lung (12%), Gynaecological (12%) and Head and Neck cancer (12%). 74% of sarcoid cases had pulmonary disease with sarcoid diagnostic tissue obtained most frequently via endobronchial ultrasound fine needle aspiration (68%). Most sarcoid cases (66%) were diagnosed within the first year of their malignancy diagnosis. DISCUSSION Careful consideration needs to be given to the possibility that potential cancer recurrences suspected on imaging studies may indeed be sarcoid reactions.
Collapse
Affiliation(s)
- M Herron
- Department of Respiratory Medicine, St James's Hospital, James's Street North, Ushers, Dublin 8, Ireland
| | - S G Chong
- Department of Respiratory Medicine, St James's Hospital, James's Street North, Ushers, Dublin 8, Ireland
| | - L Gleeson
- Department of Respiratory Medicine, St James's Hospital, James's Street North, Ushers, Dublin 8, Ireland
| | - S Nicholson
- Department of Pathology, St James's Hospital, James's Street North, Ushers, Dublin 8, Ireland
- Department of Medicine, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
| | - R J Fahy
- Department of Respiratory Medicine, St James's Hospital, James's Street North, Ushers, Dublin 8, Ireland
- Department of Medicine, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
| |
Collapse
|
14
|
Bhatti P, Waight M, Bromage D, Sado D. Cardiac sarcoidosis in a patient with testicular seminoma. BMJ Case Rep 2019; 12:12/9/e229912. [PMID: 31527203 DOI: 10.1136/bcr-2019-229912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Sarcoidosis is a multisystem disorder characterised by non-caseating granulomas that typically affect the lungs, skin and lymph nodes. Sarcoidosis has been associated with various cancers, and we describe the case of a patient with systemic sarcoidosis associated with testicular seminoma. This was originally diagnosed as stable sarcoid-like reaction. He subsequently presented with ventricular tachycardia. Cardiovascular MRI suggested cardiac sarcoidosis, which was confirmed by myocardial biopsy. This case highlights the association between some types of cancer and sarcoidosis. In addition, it highlights the importance of close follow-up for patients with a history of malignancy to monitor for sarcoid-like reactions and sarcoidosis, which are often difficult to differentiate clinically.
Collapse
Affiliation(s)
- Prashan Bhatti
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Michael Waight
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Daniel Bromage
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Daniel Sado
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
15
|
Cayci Z, Ozturk K, Ustun C, Omer AK, Dincer E, Sachs Z, Peterson BA, Linden MA. Sarcoid-like Histiocytic Proliferations in Patients With Lymphoma Can Be FDG-avid Concerning for Refractory or Recurrent Disease. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e597-e601. [PMID: 31548163 DOI: 10.1016/j.clml.2019.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/15/2019] [Accepted: 08/23/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Zuzan Cayci
- Department of Radiology, University of Minnesota, Minneapolis, MN.
| | - Kerem Ozturk
- Department of Radiology, University of Minnesota, Minneapolis, MN
| | - Celalettin Ustun
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Aazim K Omer
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Erhan Dincer
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Zohar Sachs
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Bruce A Peterson
- Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Michael A Linden
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of Minnesota, Minneapolis, MN
| |
Collapse
|
16
|
Iftikhar A, Cheema MAI, Ramachandran P, Sahni S. Sarcoid-like reaction associated with renal cell carcinoma - A case report. Respir Med Case Rep 2019; 27:100847. [PMID: 31024794 PMCID: PMC6476811 DOI: 10.1016/j.rmcr.2019.100847] [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: 02/24/2019] [Revised: 04/14/2019] [Accepted: 04/14/2019] [Indexed: 11/30/2022] Open
Abstract
Renal cell carcinoma (RCC) is a highly vascular tumor, which may spread to the lungs and other organs. It often presents with localized or systemic manifestation, including paraneoplastic syndromes. Sarcoidosis is a systemic granulomatous inflammatory disease characterized by non-caseating granulomas that typically afflicts the respiratory system. In the absence of any evidence of systemic sarcoidosis they are referred to as sarcoid-like reactions. Non-caseating epithelioid granulomas, also regarded to sarcoid-like granulomas have been described in association with certain malignancies such as carcinomas of the breast, colon, seminoma, and Hodgkin's lymphoma. However, sarcoid like reaction associated with renal cell carcinoma is uncommon. Herein we present a rare case of a patient with renal cell carcinoma with mediastinal lymphadenopathy initially thought to metastatic disease, though revealed a sarcoid-like reaction with review of literature.
Collapse
Affiliation(s)
- Asma Iftikhar
- New York - Presbyterian Queens, Division of Pulmonary, Critical Care and Sleep Medicine, Flushing, NY, 11355, USA
| | - Muhammad A I Cheema
- New York - Presbyterian Queens, Division of Pulmonary, Critical Care and Sleep Medicine, Flushing, NY, 11355, USA
| | - Preethi Ramachandran
- Brookdale University Hospital Medical Center, Division of Hematology and Oncology, Brooklyn, NY, 11212, USA
| | - Sonu Sahni
- Brookdale University Hospital Medical Center, Department of Internal Medicine, Brooklyn, NY, 11212, USA.,Touro College of Osteopathic Medicine, Department of Primary Care, New York, NY, 10027, USA
| |
Collapse
|
17
|
McGrath LA, Mudhar HS, Sheard R, Spiteri-Cornish K, Winder S, Rundle P, Rennie IG. Paraneoplastic Granulomatous Vitritis: Elaboration of 8 Cases. Ophthalmol Retina 2019; 3:589-596. [PMID: 31036533 DOI: 10.1016/j.oret.2019.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/25/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To describe the clinical features in a series of 8 patients with cytologically proven granulomatous vitritis in the context of systemic malignancy. DESIGN Retrospective case review series from 2004 through 2018 to identify all cases of cytologically proven granulomatous vitritis and to analyze its disease associations and causes. PARTICIPANTS Twenty-three patients with a cytologic diagnosis of granulomatous vitritis were identified, 8 of whom demonstrated systemic malignancy. MAIN OUTCOME MEASURES To identify a clinical profile of the 8 cases of granulomatous vitritis occurring in the setting of systemic malignancy, focusing on the timing of the eye presentation compared with the timing of the systemic malignancy. METHODS Patients with a cytologic diagnosis of granulomatous vitritis seeking treatment from 2004 through 2018 were included in this retrospective case series. Case notes were recalled and reviewed for demographic features, medical history, presenting symptoms, investigations, surgical procedures, and follow-up. RESULTS Twenty-three patients were diagnosed cytologically with granulomatous vitritis. Ten of 23 patients (43%) showed autoimmune and infectious causes, 5 of 23 patients (22%) showed were idiopathic causes, and 8 of 23 patients' (35%) disease was associated with systemic malignancy. In the latter group, the median age at presentation was 70 years (range, 55-89 years). Six patients showed bilateral disease, and the remaining 3 showed unilateral disease. Three of 8 patients showed primary systemic malignancy diagnosed after eye symptoms and 5 of 8 showed malignancy before the eye symptoms. These latter 5 patients all demonstrated a major relapse, metastasis, or both at the time of eye symptoms. CONCLUSIONS Paraneoplastic vitritis is primarily a disease of older age, with 67% of those affected older than 65 years. Ophthalmologists should maintain a high index of suspicion of paraneoplastic cause in bilateral posterior segment inflammation of uncertain origin, presenting for the first time, or heralding malignancy recurrence or metastasis in known cases of malignancy.
Collapse
Affiliation(s)
- Lindsay A McGrath
- Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Hardeep S Mudhar
- National Specialist Ophthalmic Pathology Service, Department of Histopathology, Royal Hallamshire Hospital, Sheffield, United Kingdom.
| | - Richard Sheard
- Sheffield Vitreoretinal Service, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom; Tasmanian Eye Clinics, Hobart, Australia
| | - Kurt Spiteri-Cornish
- Sheffield Vitreoretinal Service, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Stephen Winder
- Sheffield Vitreoretinal Service, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Paul Rundle
- Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Ian G Rennie
- Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, Sheffield, United Kingdom
| |
Collapse
|
18
|
Kurata A, Saito A, Hashimoto H, Fujita K, Ohno SI, Kamma H, Nagao T, Kobayashi S, Yamashina A, Kuroda M. Difference in immunohistochemical characteristics between Takayasu arteritis and giant cell arteritis: It may be better to distinguish them in the same age. Mod Rheumatol 2019; 29:992-1001. [DOI: 10.1080/14397595.2019.1570999] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Atsushi Kurata
- Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan
| | - Akira Saito
- Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan
| | | | - Koji Fujita
- Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan
| | - Shin-ichiro Ohno
- Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan
| | - Hiroshi Kamma
- Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Shigeto Kobayashi
- Department of Rheumatology, Juntendo Koshigaya Hospital, Saitama, Japan
| | - Akira Yamashina
- Department of Medical Education Promotion Center, Tokyo Medical University, Tokyo, Japan
| | - Masahiko Kuroda
- Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan
| |
Collapse
|
19
|
Tone M, Awano N, Inomata M, Kuse N, Jo T, Yoshimura H, Furuhata Y, Takemura T, Kumasaka T, Izumo T. The combination of EBUS-TBNA and the PAB antibody led to a successful treatment for lung cancer in a patient with asymptomatic sarcoidosis mimicking nodal metastasis. Respir Med Case Rep 2018; 25:296-299. [PMID: 30364678 PMCID: PMC6198119 DOI: 10.1016/j.rmcr.2018.10.014] [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: 10/03/2018] [Accepted: 10/16/2018] [Indexed: 11/21/2022] Open
Abstract
Correct staging of lung cancer is important for the selection of the best therapy, but discriminating between lymphadenopathy from lung cancer and from sarcoidosis by imaging examinations is difficult. Additionally, distinguishing lymphadenopathy of sarcoidosis from sarcoid reactions which are sometimes caused by lung cancer is difficult on imaging and pathological findings. A 73-year-old woman was diagnosed as lung cancer clinical T1bN3M0 stage ШB based on false-positive 18F-fluoro-2-deoxyglucose positron emission tomography uptake. Because the effects of chemotherapy were different between the lymphadenopathy and the primary lesion, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed and revealed sarcoidosis as the cause of the lymphadenopathy with using a specific monoclonal antibody against Propionibacterium acnes (PAB antibody). Accordingly, the stage was changed to clinical T1bN0M0 stage ІA, for which radical operation was performed. EBUS-TBNA should be performed aggressively when the effect of chemotherapy is different between lymphadenopathies and other lesions, and the PAB antibody can help to discriminate between sarcoidosis and sarcoid reactions caused by lung cancer. The combination of EBUS-TBNA and the PAB antibody is expected to be valuable in the definitive diagnosis of a lymphadenopathy for the staging of lung cancer.
Collapse
Affiliation(s)
- Mari Tone
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Nobuyasu Awano
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Minoru Inomata
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Naoyuki Kuse
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Tatsunori Jo
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Hanako Yoshimura
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Yoshiaki Furuhata
- Department of Thoracic Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Tamiko Takemura
- Department of Pathology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Toshio Kumasaka
- Department of Pathology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| | - Takehiro Izumo
- Department of Pathology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan
| |
Collapse
|
20
|
De Gregorio M, Brett AJ. Metastatic sigmoid colon adenocarcinoma and tumour-related sarcoid reaction. Intern Med J 2018; 48:876-878. [PMID: 29984515 DOI: 10.1111/imj.13812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/12/2017] [Accepted: 11/14/2017] [Indexed: 11/29/2022]
Abstract
The association between malignancy and tumour-related sarcoid reaction is well documented, characterised by non-caseating granulomatous disease in haematological and solid malignancies. Its occurrence in colon cancer is rare and of unclear clinical significance. Herein, we present a case report of a 32-year-old woman diagnosed with concurrent metastatic sigmoid colon adenocarcinoma and pulmonary granulomatous disease suggestive of a tumour-related sarcoid reaction.
Collapse
Affiliation(s)
- Michael De Gregorio
- Department of General Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Andrew J Brett
- Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
21
|
Crouser ED, White P, Caceres EG, Julian MW, Papp AC, Locke LW, Sadee W, Schlesinger LS. A Novel In Vitro Human Granuloma Model of Sarcoidosis and Latent Tuberculosis Infection. Am J Respir Cell Mol Biol 2017; 57:487-498. [PMID: 28598206 DOI: 10.1165/rcmb.2016-0321oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Many aspects of pathogenic granuloma formation are poorly understood, requiring new relevant laboratory models that represent the complexity (genetics and diversity) of human disease. To address this need, we developed an in vitro model of granuloma formation using human peripheral blood mononuclear cells (PBMCs) derived from patients with active sarcoidosis, latent tuberculosis (TB) infection (LTBI), or normal healthy control subjects. PBMCs were incubated for 7 days with uncoated polystyrene beads or beads coated with purified protein derivative (PPD) or human serum albumin. In response to PPD-coated beads, PBMCs from donors with sarcoidosis and LTBI formed robust multicellular aggregates resembling granulomas, displaying a typical T-helper cell type 1 immune response, as assessed by cytokine analyses. In contrast, minimal PBMC aggregation occurred when control PBMCs were incubated with PPD-coated beads, whereas the response to uncoated beads was negligible in all groups. Sarcoidosis PBMCs responded to human serum albumin-coated beads with modest cellular aggregation and inflammatory cytokine release. Whereas the granuloma-like aggregates formed in response to PPD-coated beads were similar for sarcoidosis and LTBI, molecular profiles differed significantly. mRNA expression patterns revealed distinct pathways engaged in early granuloma formation in sarcoidosis and LTBI, and they resemble molecular patterns reported in diseased human tissues. This novel in vitro human granuloma model is proposed as a tool to investigate mechanisms of early granuloma formation and for preclinical drug discovery research of human granulomatous disorders. Clinical trial registered with www.clinicaltrials.gov (NCT01857401).
Collapse
Affiliation(s)
- Elliott D Crouser
- 1 Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, the Dorothy M. Davis Heart and Lung Research Institute, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Peter White
- 2 Center for Microbial Pathogenesis, the Research Institute at Nationwide Children's Hospital, Columbus, Ohio; and
| | - Evelyn Guirado Caceres
- 3 Department of Microbial Infection and Immunity, Center for Microbial Interface Biology, and
| | - Mark W Julian
- 1 Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, the Dorothy M. Davis Heart and Lung Research Institute, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Audrey C Papp
- 4 Department of Cancer Biology and Genetics, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Landon W Locke
- 3 Department of Microbial Infection and Immunity, Center for Microbial Interface Biology, and
| | - Wolfgang Sadee
- 4 Department of Cancer Biology and Genetics, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Larry S Schlesinger
- 3 Department of Microbial Infection and Immunity, Center for Microbial Interface Biology, and
| |
Collapse
|
22
|
Arora K, Divatia MK, Truong L, Shen SS, Ayala AG, Ro JY. Sarcoid-like granulomas in renal cell carcinoma: The Houston Methodist Hospital experience. Ann Diagn Pathol 2017; 31:62-65. [PMID: 29146061 DOI: 10.1016/j.anndiagpath.2017.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 10/19/2022]
Abstract
Sarcoid-like (SL) granulomas have been previously described in association with malignant tumors. These granulomas appear to be tumor-related but are not indicative of systemic sarcoidosis, and hence are referred to as SL reactions. These SL reactions can be seen within the primary tumor, its vicinity, or in uninvolved sites such as the spleen, bone marrow, skin, and/or regional lymph nodes draining the tumor. It is a widely held view that SL granulomas are caused by soluble antigenic factors, shed by tumor cells or released due to tumor necrosis. SL reactions reported in Hodgkin lymphoma have been associated with a better prognosis. SL granulomas are thought to play an important role in the host's defenses against metastatic extension. SL granulomas have been reported in approximately 4.4% of carcinomas. Isolated cases of renal cell carcinoma (RCC) with SL granulomas have been reported with questionable prognostic significance. We identified 11 cases of RCCs with SL granulomas. Interestingly, all cases had abundant clear cell cytoplasm (10 clear cell RCC cases and 1 clear cell papillary RCC). We propose that this clear, abundant cytoplasm of the tumor cells with high content of glycogen and lipids may trigger granuloma formation akin to that seen in seminomas with SL granulomas. To date, this is the largest case series of RCCs with SL granulomas.
Collapse
Affiliation(s)
- Komal Arora
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, United States
| | - Mukul K Divatia
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, United States
| | - Luan Truong
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, United States
| | - Steven S Shen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, United States
| | - Alberto G Ayala
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, United States
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, United States.
| |
Collapse
|
23
|
Kim H, Kim JW, Kim A, Chang H. Clear Cell Renal Cell Carcinoma with Intratumoral Granulomatous Reaction: A Case Report and Review of the Literature. J Pathol Transl Med 2017; 51:325-328. [PMID: 28288504 PMCID: PMC5445199 DOI: 10.4132/jptm.2016.09.08] [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: 07/04/2016] [Revised: 08/26/2016] [Accepted: 09/07/2016] [Indexed: 11/23/2022] Open
Abstract
Granulomatous reaction associated with clear cell renal cell carcinoma (CCRCC) is a rare finding, and only a few cases have been described in the literature. It is postulated to occur due to cancer-related antigenic factors such as cancer cells themselves or soluble tumor antigens shed into the blood. Herein, we describe a case of a 56-year-old male patient diagnosed with CCRCC with intratumoral granulomatous inflammation.
Collapse
Affiliation(s)
- Hayeon Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Jong Wook Kim
- Department of Urology, Korea University Guro Hospital, Seoul, Korea
| | - Aeree Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Hyeyoon Chang
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| |
Collapse
|
24
|
Enhanced formation of giant cells in common variable immunodeficiency: Relation to granulomatous disease. Clin Immunol 2017; 175:1-9. [DOI: 10.1016/j.clim.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 10/17/2016] [Accepted: 11/11/2016] [Indexed: 01/08/2023]
|
25
|
Moreira C, Rios E, Baudrier T, Azevedo F. Cutaneous granulomatous reaction as the first manifestation of Hodgkin's lymphoma. Rev Bras Hematol Hemoter 2017; 39:70-72. [PMID: 28270352 PMCID: PMC5339366 DOI: 10.1016/j.bjhh.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/01/2016] [Accepted: 11/07/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- Catarina Moreira
- Centro Hospitalar São João, Porto, Portugal; Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal.
| | | | | | | |
Collapse
|
26
|
Modifying effects of carboxyl group on the interaction of recombinant S100A8/A9 complex with tyrosinase. BIOCHIMICA ET BIOPHYSICA ACTA-PROTEINS AND PROTEOMICS 2016; 1865:370-379. [PMID: 28017864 DOI: 10.1016/j.bbapap.2016.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 12/16/2022]
Abstract
Tyrosinase is a determinant enzyme for modulating melanin production as its abnormal activity can result in an increased amount of melanin. Reduction of tyrosinase activity has been targeted for preventing and healing hyperpigmentation of skin, such as melanoma and age related spots. The aim of this systematic study is to investigate whether recombinant S100A8/A9 and its modified form reduce the activity of mushroom tyrosinase (MT) through changing its structure. Recombinant His-Tagged S100A8 and S100A9 are expressed in Escherichia coli BL21 (DE3) and modified using Woodward's reagent K which is a carboxyl group modifier. The structures of S100A8/A9 and its modified form are studied using fluorescence and circular dichroism spectroscopy, and the activity of MT is measured using UV-visible spectrophotometry in the presence of its substrate, L-3,4-dihydroxyphenylalanine (L-DOPA). The results show a lower stability of the modified protein when compared with its unmodified form. The interaction of S100A8/A9 with MT changes the structure and successfully reduces the activity of mushroom tyrosinase. Recombinant S100A8/A9 complex decreases MT activity which can control malignant melanoma, the most dangerous type of skin cancer.
Collapse
|
27
|
Díaz Del Arco C, Aceñero MJF. Sarcoid reaction: a rare occurrence associated to colon adenocarcinoma (case report and literature review). J Gastrointest Oncol 2016; 7:E72-6. [PMID: 27512605 DOI: 10.21037/jgo.2016.03.07] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Granulomatous reactions are related to infectious and non infectious diseases, but more rarely, granulomas may occur in association to malignancies. The presence of sarcoid-like granulomas in lymph nodes draining malignant tumors is an uncommon but well known occurrence. However, their presence in the stroma of malignant tumors is much rarer. We have only found two previous cases reported in the Japanese and English literature. In this study we report a well differentiated adenocarcinoma of the right colon associated to a stromal granulomatous sarcoid-like reaction. Lymph nodes were not involved. The patient had a clinical history of tuberculosis treated 15 years ago, but there was no clinical, histomorphological, immunohistochemical or molecular evidence of disease at the moment of these findings. We have reviewed the literature to find the keys and the diagnostic challenges posed by granulomatous sarcoid-like reaction occurring in lymph nodes draining malignant neoplasms, peritumoral stroma and in other organs far from the primary tumor. The diagnosis of granulomatous sarcoid-like reactions associated to malignancies can be challenging and it can only be made after ruling out specific infectious and non infectious causes of granulomatous inflammation. The mechanisms involved in granuloma formation, their relationship with demographic and histopathological features, their possible association with autoimmune disorders, their cytokine profile and, more importantly, their prognostic significance in each type of tumor are still unclear and require studies with larger number of patients.
Collapse
|
28
|
BRAF Inhibitor-Induced Antitumoral Granulomatous Dermatitis Eruption in Advanced Melanoma. Am J Dermatopathol 2016; 37:795-8. [PMID: 26381028 DOI: 10.1097/dad.0000000000000281] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Recent advances in targeting BRAF mutations, which occur in roughly 50% of the melanomas, have improved response rates and overall survival in patients with advanced disease. With the increasingly extensive use of the drug, new, nonpreventable, cutaneous and noncutaneous toxicities keep arising as infrequent adverse effects. We report a 55-year-old man with a history of metastatic melanoma treated with the dabrafenib who presented, 10 months after the initiation of the treatment, with erythematous, slightly squamous, round plaques on his upper trunk and on his left upper arm. Two skin biopsies from the lesions revealed a granulomatous dermatitis in the superficial reticular dermis. One of them showed admixed abundant melanophages from tumoral melanosis. No melanoma cells were seen in any of the specimens. No interruption of the treatment was necessary. Our observation indicates that such a response may represent a positive immune activation triggered by BRAF inhibitors. The erythematous rash was initially concerning for progression of metastatic disease, which suggests that a close monitoring of the patients with advanced melanomas treated with vemurafenib is advisable to prevent unnecessary discontinuation of the therapy.
Collapse
|
29
|
Saab J, Qin L, Jessurun J. Granulomatous Insulitis as a Cause of Acute-Onset Insulin-Dependent Diabetes Mellitus in a Patient With a Pancreatic Endocrine Carcinoma. Int J Surg Pathol 2016; 24:648-52. [PMID: 27160433 DOI: 10.1177/1066896916648770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Autoimmune destruction of β cells is the cause of most cases of type 1 diabetes mellitus. Lymphocytic insulitis has been documented in the early phases of this disease as well as in recurrent diabetes after pancreas transplantation and in certain viral infections. We report a unique case of granulomatous insulitis in a patient with an endocrine tumor of the pancreas that clinically manifested as acute-onset insulin-dependent diabetes mellitus. Granulomata were present in islets with complete disappearance of β cells, as well as in the primary tumor, metastases, and lymph nodes. We postulate that these granulomata represent a sarcoid-like reaction to the tumor with secondary injury to nonneoplastic endocrine cells through a mechanism of molecular mimicry.
Collapse
Affiliation(s)
- Jad Saab
- New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Lihui Qin
- Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Jose Jessurun
- New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
30
|
Bernstein KE, Gonzalez-Villalobos RA, Giani JF, Shah K, Bernstein E, Janjulia T, Koronyo Y, Shi PD, Koronyo-Hamaoui M, Fuchs S, Shen XZ. Angiotensin-converting enzyme overexpression in myelocytes enhances the immune response. Biol Chem 2015; 395:1173-8. [PMID: 24633750 DOI: 10.1515/hsz-2013-0295] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/10/2014] [Indexed: 11/15/2022]
Abstract
Angiotensin-converting enzyme (ACE) plays an important role in blood pressure control. ACE also has effects on renal function, reproduction, hematopoiesis, and several aspects of the immune response. ACE 10/10 mice overexpress ACE in monocytic cells; macrophages from ACE 10/10 mice demonstrate increased polarization toward a proinflammatory phenotype. As a result, ACE 10/10 mice have a highly effective immune response following challenge with melanoma, bacterial infection, or Alzheimer disease. As shown in ACE 10/10 mice, enhanced monocytic function greatly contributes to the ability of the immune response to defend against a wide variety of antigenic and non-antigenic challenges.
Collapse
|
31
|
Tarjan G, Kim GJ, Haroon Al Rasheed MR. Renal Angiomyolipoma With Sarcoid Granulomas: Report of a Unique Case. Int J Surg Pathol 2015; 24:253-6. [PMID: 26582772 DOI: 10.1177/1066896915617028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Angiomyolipoma is a mesenchymal neoplasm characterized by the coexpression of melanocytic and smooth muscle markers. Sarcoidosis is a multisystem disorder of unknown etiology, which presents with characteristic nonnecrotizing granulomas and rarely involves the kidney. The coexistence of renal sarcoidosis with renal neoplasms is exceedingly rare and was reported only with renal cell carcinoma. Renal sarcoidosis associated with a nonepithelial renal neoplasm, such as an angiomyolipoma has never been reported. We present the first reported case of sarcoid granulomas in a renal angiomyolipoma, including morphologic and immunohistochemical features.
Collapse
Affiliation(s)
- Gabor Tarjan
- John H. Stroger Jr Hospital of Cook County, Chicago, IL, USA
| | - George J Kim
- John H. Stroger Jr Hospital of Cook County, Chicago, IL, USA University of Illinois at Chicago, Chicago, IL, USA
| | | |
Collapse
|
32
|
Grados A, Ebbo M, Bernit E, Veit V, Mazodier K, Jean R, Coso D, Aurran-Schleinitz T, Broussais F, Bouabdallah R, Gravis G, Goncalves A, Giovaninni M, Sève P, Chetaille B, Gavet-Bongo F, Weitten T, Pavic M, Harlé JR, Schleinitz N. Sarcoidosis Occurring After Solid Cancer: A Nonfortuitous Association: Report of 12 Cases and Review of the Literature. Medicine (Baltimore) 2015; 94:e928. [PMID: 26181571 PMCID: PMC4617083 DOI: 10.1097/md.0000000000000928] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The association between cancer and sarcoidosis is controversial. Some epidemiological studies show an increase of the incidence of cancer in patients with sarcoidosis but only few cases of sarcoidosis following cancer treatment have been reported. We conducted a retrospective case study from internal medicine and oncology departments for patients presenting sarcoidosis after solid cancer treatment. We also performed a literature review to search for patients who developed sarcoidosis after solid cancer. We describe the clinical, biological, and radiological characteristics and outcome of these patients. Twelve patients were included in our study. Various cancers were observed with a predominance of breast cancer. Development of sarcoidosis appeared in the 3 years following cancer and was asymptomatic in half of the patients. The disease was frequently identified after a follow-up positron emission tomography computerized tomography evaluation. Various manifestations were observed but all patients presented lymph node involvement. Half of the patients required systemic therapy. With a median follow-up of 73 months, no patient developed cancer relapse. Review of the literature identified 61 other patients for which the characteristics of both solid cancer and sarcoidosis were similar to those observed in our series. This report demonstrates that sarcoidosis must be considered in the differential diagnosis of patients with a history of malignancy who have developed lymphadenopathy or other lesions on positron emission tomography computerized tomography. Histological confirmation of cancer relapse is mandatory in order to avoid unjustified treatments. This association should be consider as a protective factor against cancer relapse.
Collapse
Affiliation(s)
- Aurélie Grados
- From the Department of Internal Medicine, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille (AG, ME, EB, VV, J-RH, NS); Department of Internal Medicine, CHU Conception, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille (KM, RJ); Department of Hematology, Paoli Calmette Institute, Marseille (DC, TA-S, FB, RB); Department of Oncology, Paoli Calmette Institute, Marseille (GG, AG, MG); Department of Internal Medicine, Croix-Rousse Hospital, Lyon (PS); Department of Pathology, Paoli Calmette Institute, Marseille (BC); Department of Internal Medicine, Alpes du Sud Hospital, Gap (FG-B, TW); and Department of Oncology, Desgenettes Hospital, Lyon (MP), France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
|
34
|
Kawasaki Y, Maemura K, Kurahara H, Mataki Y, Iino S, Sakoda M, Ueno S, Shinchi H, Takao S, Natsugoe S. Gallbladder adenocarcinoma with sarcoid-like reaction in regional lymph nodes: report of a case. BMC Cancer 2014; 14:946. [PMID: 25495692 PMCID: PMC4301567 DOI: 10.1186/1471-2407-14-946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 12/06/2014] [Indexed: 12/29/2022] Open
Abstract
Background Sarcoid-like reaction is often seen in various types of carcinoma, not only in the primary tumor, but also in regional lymph nodes, and can occur at any time, not only at the time of diagnosis, but also after treatment. However, few cases of hepatopancreatobiliary carcinoma, and no cases of gallbladder cancer with sarcoid-like reaction involving the lymph nodes have been described. This report is the first report of a sarcoid-like reaction involving the lymph nodes in a case of gallbladder cancer. Case presentation We encountered a rare case of gall bladder cancer with sarcoid-like reaction in the lymph nodes. Since regional lymph node swelling that was difficult to differentiate from metastasis was found preoperatively, swollen nodes were examined histologically using frozen sections. Based on this histology, the swollen nodes were diagnosed as showing sarcoid reaction and therefore extended lymphadenectomy was avoided. The patient did not receive any adjuvant chemotherapy and has shown no recurrence of disease as of 4 years after surgery. Conclusion Distinguishing between metastasis and sarcoid-like reaction in lymph nodes by preoperative imaging is still difficult. The present case shows that it is important to histologically examine swollen nodes by biopsy or by sampling before deciding on the treatment strategy for gall bladder cancer with swollen lymph nodes.
Collapse
Affiliation(s)
- Yota Kawasaki
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima 890-8520, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Nemati Nikoo F, Goodarzvand Chegini K, Najafi Pour R, Gheibi N. The Role of Calcium in Calprotectin Dimerization as a Cancer Biomarker. ACTA ACUST UNITED AC 2014. [DOI: 10.17795/bhs-26379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
36
|
Mahony J, Helms SE, Brodell RT. The sarcoidal granuloma: A unifying hypothesis for an enigmatic response. Clin Dermatol 2014; 32:654-9. [DOI: 10.1016/j.clindermatol.2014.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
37
|
Ritterhouse LL, Cykowski MD, Hassell LA, Slobodov G, Bane BL. Melanotic Xp11 translocation renal cancer: report of a case with a unique intratumoral sarcoid-like reaction. Diagn Pathol 2014; 9:81. [PMID: 24735727 PMCID: PMC4003493 DOI: 10.1186/1746-1596-9-81] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/22/2014] [Indexed: 12/24/2022] Open
Abstract
Background Melanotic Xp11 translocation renal cancer is a rare tumor belonging to the family of microphthalmia-associated transcription factor (MiTF)/transcription factor E (TFE) neoplasms. This tumor family also includes alveolar soft part sarcoma, perivascular epithelioid cell neoplasms, Xp11 translocation renal cell carcinoma, and melanoma. To date, six confirmed melanotic Xp11 translocation cancers (five renal, one ovarian) have been reported in the literature. Case Report Here, we report the clinical, histologic, immunohistochemical, and molecular features of a unique melanotic Xp11 translocation renal cancer arising in a 34-year-old African-American female. Histologically, the tumor was composed of epithelioid tumor cells arranged in a nested pattern. The cells had clear to eosinophilic granular cytoplasm, vesicular nuclear chromatin, and prominent nucleoli. Multifocal intracytoplasmic deposits of granular brown melanin pigment were identified and confirmed by Fontana-Masson stain. An unusual histologic feature, not previously reported in melanotic Xp11 translocation renal cancer, was a sarcoid-like granulomatous reaction consisting of tight epithelioid granulomas with lymphocytic cuffing, numerous giant cells, and calcifications. Nuclear transcription factor E3 expression was identified by immunohistochemistry and TFE3 rearrangement was confirmed by fluorescence in situ hybridization. Additional immunohistochemical findings included immunoreactivity for HMB45, cathepsin K, and progesterone receptor; negative staining was seen with actin, desmin, cytokeratins, epithelial membrane antigen, CD10, vimentin, and PAX-8. The patient is currently free of disease, two years following initial clinicoradiologic presentation and twenty-two months following partial nephrectomy without additional therapy. Conclusion This report further expands the spectrum of morphologic and clinical findings previously described in melanotic Xp11 translocation renal cancer, a distinctive tumor showing overlapping features between Xp11 translocation renal cell carcinoma, melanoma, and perivascular epithelioid cell neoplasms. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/7225796341180634
Collapse
Affiliation(s)
| | | | - Lewis A Hassell
- Department of Pathology, University of Oklahoma Health Sciences Center, BMSB 451 940 SL Young Blvd,, Oklahoma City, OK 73104, USA.
| | | | | |
Collapse
|
38
|
Matsushima H, Mori T, Hiroshi T, Ooshima K, Kitawaki J. Clear cell adenocarcinoma of the ovary with a sarcoid reaction in the spleen and regional lymph nodes: A case report. GYNECOLOGIC ONCOLOGY CASE REPORTS 2013; 5:43-5. [PMID: 24371694 PMCID: PMC3862226 DOI: 10.1016/j.gynor.2013.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 04/02/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Hiroshi Matsushima
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
- Department of Obstetrics and Gynecology, Nantan General Hospital, 25 Yagiueno, Yagi-cho, Nanntann-shi, Kyoto 629-0197, Japan
| | - Taisuke Mori
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
- Corresponding author. Fax: + 81 75 212 1265.
| | - Tsuchiya Hiroshi
- Department of Obstetrics and Gynecology, Nantan General Hospital, 25 Yagiueno, Yagi-cho, Nanntann-shi, Kyoto 629-0197, Japan
| | - Kazuya Ooshima
- Department of Obstetrics and Gynecology, Nantan General Hospital, 25 Yagiueno, Yagi-cho, Nanntann-shi, Kyoto 629-0197, Japan
| | - Jo Kitawaki
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| |
Collapse
|
39
|
Burhan W, Al Rowaie Z, Rajih E, Akhtar M. Sarcoid-like granulomatous reaction in renal cell carcinoma: report of a case with review of the published reports. Ann Saudi Med 2013; 33:614-8. [PMID: 24413868 PMCID: PMC6074919 DOI: 10.5144/0256-4947.2013.614] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A case of renal cell carcinoma with sarcoid-like granulomatous reaction within the tumor was reported. The granulomas were confined to the carcinoma while renal parenchyma and regional lymph nodes were completely free of involvement. Clinical workup of the patient did not reveal any evidence of sarcoidosis, tuberculosis, or any other systemic disease except for diabetes mellitus. Sarcoid-like granulomatous reaction confined to renal carcinoma is a rare finding with only a few cases reported in the published reports.
Collapse
Affiliation(s)
| | | | | | - Mohammed Akhtar
- Dr. Mohammed Akhtar, Pathology & Lab Medicine,, King Faisal Hospital and Research Center,, DPLM - MBC 10 PO Box 3354,, Riyadh 11211, Saudi Arabia, T: +966-1-4424235, F:00966-1-442-42-80,
| |
Collapse
|
40
|
Benjilali L, Essaadouni L. [About two particular aspects of sarcoid-like reaction]. REVUE DE PNEUMOLOGIE CLINIQUE 2013; 69:117-119. [PMID: 23498718 DOI: 10.1016/j.pneumo.2013.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 01/20/2013] [Accepted: 01/21/2013] [Indexed: 06/01/2023]
|
41
|
Markowitz J, Carson WE. Review of S100A9 biology and its role in cancer. Biochim Biophys Acta Rev Cancer 2012; 1835:100-9. [PMID: 23123827 DOI: 10.1016/j.bbcan.2012.10.003] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 10/24/2012] [Accepted: 10/25/2012] [Indexed: 12/28/2022]
Abstract
S100A9 is a calcium binding protein with multiple ligands and post-translation modifications that is involved in inflammatory events and the initial development of the cancer cell through to the development of metastatic disease. This review has a threefold purpose: 1) describe the S100A9 structural elements important for its biological activity, 2) describe the S100A9 biology in the context of the immune system, and 3) illustrate the role of S100A9 in the development of malignancy via interactions with the immune system and other cellular processes.
Collapse
Affiliation(s)
- Joseph Markowitz
- OSU Comprehensive Cancer Center, The Ohio State University, 320 West 10th Avenue, Columbus, OH 43210, USA.
| | | |
Collapse
|
42
|
Abstract
In this review, representative types of granulomatous lymphadenitis (GLA) are described. GLA can be classified as noninfectious GLA and infectious GLA. Noninfectious GLA includes sarcoidosis and sarcoid-like reaction. The cause of sarcoidosis remains unknown, but it has good prognosis. Sarcoid-like reaction, which is considered to be a biological defense mechanism, is observed in regional lymph nodes with many underlying diseases. Infectious GLA can be classified as suppurative lymphadenitis (LA) and nonsuppurative LA. Suppurative LA generally shows follicular hyperplasia and sinus histiocytosis in the early phase. In tularemia and cat scratch disease, monocytoid B lymphocytes (MBLs) with T cells and macrophages contribute to the formation of granuloma. However, none of the epithelioid cell granulomas of Yersinia LA contains MBLs like in cat scratch disease. In addition, almost all have a central abscess in granulomas induced by Gram-negative bacteria. In terms of the lymph nodes, tularemia and cat scratch disease are apt to affect the axillary and cervical regions while Yersinia LA affects the mesenteric lymph node. Nonsuppurative LA includes tuberculosis and BCG-histiocytosis. These are induced by delayed allergic reaction of M. tuberculosis. Tuberculosis LA mainly appears in the cervical lymph node. Organisms are histologically detected by Ziehl-Neelsen staining in the necrotic area. Toxoplasmosis is also a nonsuppurative protozoan infection (Toxoplasma gondii). In toxoplasma LA, MBLs can also be seen, but round and organized, well-formed granulomas are not found in this disease. Furthermore, necrosis is not induced and there are no accompanying neutrophils, eosinophils and fibrosis. GLA described above is associated with characteristic histological findings. An accurate pathological diagnosis using the above findings can lead to precise treatment.
Collapse
Affiliation(s)
- Shigeyuki Asano
- Department of Pathology, Iwaki Kyoritsu General Hospital, Iwaki, Japan.
| |
Collapse
|
43
|
Gessi M, Guerriero M, Denaro L, Lauriola L. Tibial nerve tumor in a 72-year-old man. Neuropathology 2012; 33:487-90. [PMID: 23025630 DOI: 10.1111/j.1440-1789.2012.01356.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marco Gessi
- Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany.
| | | | | | | |
Collapse
|
44
|
[Mature mediastinal teratoma and sarcoid-like granulomatosis]. Rev Mal Respir 2012; 29:898-902. [PMID: 22980550 DOI: 10.1016/j.rmr.2012.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 01/16/2012] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Sarcoidosis is a systemic granulomatous disorder. However, when epithelioid cell granulomata are found in association with malignancy, they could correspond to a sarcoid reaction. CASE REPORT We report the case of a young woman with mediastinal lymphadenopathy containing non-caseating granulomata. She also had a mass in the anterior mediastinum which proved, on surgical resection, to be an intrathymic mature teratoma. CONCLUSION An association between a sarcoid-like reaction and testicular germ cell tumours has been described in literature. Our observation of a sarcoid reaction associated with a teratoma could be due to a hypersensitivity reaction to antigen released by the tumour.
Collapse
|
45
|
Sarcoid-reaction mimicking metastatic malignant hepatopancreatobiliary tumors: report of two cases and review of the literature. J Gastrointest Surg 2012; 16:1245-50. [PMID: 22258875 DOI: 10.1007/s11605-011-1820-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 12/28/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Sarcoidosis is a multisystem chronic granulomatous disease found predominantly in the lungs and lymph nodes. Its pathologic hallmark is the presence of systemic non-caseating granulomas; however, a variation of this disease known as "sarcoid-like reaction" has been described in patients with underlying cancer. REPORT Sarcoid-like reactions in patients with hepatopancreatobiliary (HPB) tumors are rare findings, with only 15 cases having been reported in the English language literature. These reactions can be found in local lymph nodes or in distant organs, and when present in patients with cancer, they can mimic metastatic disease on imaging, potentially resulting in incorrect cancer staging and management. DISCUSSION We describe two cases of patients with HPB tumors who had distant organ disease on cross-sectional imaging suspicious for metastases, which on further workup were found to be sarcoid-like reactions. We also discuss malignancy-induced sarcoid-like reactions and provide a review of the literature of sarcoid-like reactions in the setting of HPB tumors.
Collapse
|
46
|
Phagocyte-specific S100 proteins in the local response to the Echinococcus granulosus larva. Parasitology 2012; 139:271-83. [PMID: 22216900 DOI: 10.1017/s003118201100179x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Infection by larval Echinococcus granulosus is usually characterized by tight inflammatory control. However, various degrees of chronic granulomatous inflammation are also observed, reaching a high point in infection of cattle by the most prevalent parasite strain worldwide, which is not well adapted to this host species. In this context, epithelioid and multinucleated giant macrophages surround the parasite, and the secreted products of these cells often associate with the larval wall. The phagocyte-specific S100 proteins, S100A8, S100A9 and S100A12, are important non-conventionally secreted amplifiers of inflammatory responses. We have analysed by proteomics and immunohistochemistry the presence of these proteins at the E. granulosus larva-host interface. We found that, in the context of inflammatory control as observed in human infections, the S100 proteins are not abundant, but S100A9 and S100A8 can be expressed by eosinophils distal to the parasite. In the granulomatous inflammation context as observed in cattle infections, we found that S100A12 is one of the most abundant host-derived, parasite-associated proteins, while S100A9 and S100A8 are not present at similarly high levels. As expected, S100A12 derives mostly from the epithelioid and multinucleated giant cells. S100A12, as well as cathepsin K and matrix metalloproteinase-9, also expressed by E. granulosus-elicited epithelioid cells, are connected to the Th17 arm of immunity, which may therefore be involved in this granulomatous response.
Collapse
|
47
|
Inflammatory myofibroblastic tumor of the trachea with concomitant granulomatous lymph node lesions. Case Rep Med 2011; 2011:151729. [PMID: 21918650 PMCID: PMC3171926 DOI: 10.1155/2011/151729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 06/15/2011] [Indexed: 12/04/2022] Open
Abstract
We report herein the case of a 57-year-old lady who had two concomittant lesions, an inflammatory myofibroblastic tumor in the trachea, and severe granulomatous lesions in the adjacent hilar lymph nodes. While these two lesions shared histological and some immunohistochemical features lesions. They differed in terms of ALK-1 expression, which was positive in the tracheal tumor and negative in the lymph nodes. The discussion of the case circles around putative pathophysiological links between the lesions. The authors favor the idea that the lymph nodes present a sarcoid-like granulomatous reaction to the inflammatory myofibroblastic tumor in the trachea over a coexistence of two independent entities. However, no conclusive evidence for this interpretation can be presented based on the existing literature.
Collapse
|
48
|
Sato J, Fujiwara M, Kawakami T, Sumiishi A, Sakata S, Sakamoto A, Kurata A. Fascin expression in dendritic cells and tumor epithelium in thymoma and thymic carcinoma. Oncol Lett 2011; 2:1025-1032. [PMID: 22848263 DOI: 10.3892/ol.2011.383] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 08/05/2011] [Indexed: 11/06/2022] Open
Abstract
The majority of thymomas are histologically characterized by tumor-infiltrating lymphocytes. Mature dendritic cells (DCs) are known to assemble lymphocytes through antigen presentation to T lymphocytes. Fascin, a 55-kDa actin-binding protein and a known marker for mature DCs, regulates filaments necessary for the formation of filopodia in cell migration. Moreover, fascin expression in various epithelial neoplasms has recently been reported to be associated with invasion of tumor cells and clinically aggressive manifestations. In the present study, we investigated fascin expression immunohistochemically in tissues of thymomas and thymic carcinomas surgically resected at our institute. A total of 34 thymomas and 5 thymic carcinomas were included. The amount and immunohistochemical intensity of both fascin(+) DCs and tumor epithelium were counted and assessed, and the clinicopathological data were also scored. Statistical analyses revealed that the amount of fascin(+) DCs with the formation of clusters was associated with lymphocyte-rich variants (p=0.002) and cortical differentiation (p=0.037) of thymoma with complication from myasthenia gravis (p=0.002). The quantity of fascin(+) epithelium was associated with a strong intensity of fascin in infiltrating DCs (p=0.002) with the formation of clusters (p=0.002) and favorable prognosis, as assessed by the Masaoka staging system (p=0.001). The amount of infiltrating DCs (p=0.024) and fascin(+) epithelium were lower in thymic carcinoma. It was concluded that fascin(+) epithelium may induce tumor immunity through the surveillance activity of fascin(+) DCs in thymic neoplasms, thus improving prognosis.
Collapse
|
49
|
Sarcoidal reactions in regional lymph nodes of patients with early stage non-small cell lung cancer predict improved disease-free survival: a pilot case-control study. Hum Pathol 2011; 43:333-8. [PMID: 21835432 DOI: 10.1016/j.humpath.2011.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 04/29/2011] [Accepted: 05/04/2011] [Indexed: 11/22/2022]
Abstract
Sarcoidal reactions occurring in regional lymph nodes of patients with non-small cell lung carcinoma appear to be limited to patients with stage I disease. The prognostic significance of this remains unknown. Such reactions are thought to represent a cell-mediated antitumor response and have been associated with improved outcomes in other solid organ malignancies. We performed a retrospective chart review of all patients undergoing lobectomy with curative intent for non-small cell lung carcinoma. Eligible cases were selected based on pathologic reports, with matched controls then drawn from the same surgical cohort. One hundred fifty-seven patients underwent lobectomy and lymph node dissection. Eight patients with sarcoidal granulomas present in regional lymph nodes were identified as cases and matched to 16 control subjects. All subjects were staged pN0. Disease recurrence was noted in no case subjects but in 7 (44%) of control subjects (P = .044, χ(2) = 4.051). The presence of sarcoidal reactions within regional lymph nodes of patients with non-small cell lung carcinoma predicts a lower rate of disease recurrence after definitive surgical resection. The exact mechanism by which antitumor immunity is achieved remains to be elucidated.
Collapse
|
50
|
Goswami T, Siddique S, Cohen P, Cheson BD. The sarcoid-lymphoma syndrome. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 10:241-7. [PMID: 20709659 DOI: 10.3816/clml.2010.n.052] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Whether a relationship exists between sarcoidosis and lymphoma is controversial. We present 4 patients diagnosed with sarcoidosis either during or after the treatment of lymphoma, review the data surrounding the entity known as "sarcoid-lymphoma syndrome" and discuss the diagnostic pitfalls it can present. As both entities are fluorine-18 fluorodeoxyglucose avid, histologic verification and clinical acumen are needed to avoid misdiagnosis before initiating therapy.
Collapse
|