Sarcoid-like reaction in a HER2-positive breast cancer patient: A case report

Sarcoid-Like Reactions in Breast Cancer Patients: A Report of Two Cases

Sarcoid-like reactions (SLR) in patients with malignancies are a relatively common finding. Defined by the presence of non-caseating granulomas, SLR does not meet the clinical criteria for classic sarcoidosis. In cancer patients, SLR often presents a challenging differential diagnosis, as it must be distinguished from disease progression due to malignancy. We present two cases of SLRs associated with breast cancer, underscoring the need for heightened vigilance among physicians. SLR should always be considered a potential diagnosis in these patients, with histological confirmation being essential for accurate identification.

Sarcoidosis associated with Trastuzumab in a young female with carcinoma of breast

Trastuzumab is a humanized monoclonal antibody against human epidermal growth factor, useful in breast cancer. It is well tolerated but sometimes may associate with significant adverse effects. Sarcoidosis is a granulomatous disease involving multiple organs with poorly understood aetiology. Mediastinal lymphadenopathy is the most common presenting feature of Sarcoidosis. Reported cases of Sarcoidosis associated with Trastuzumab are quite less in number. High degree of suspicion of the above is thought of in a scenario of malignancy patients receiving chemotherapy. Newly appearing FDG avid lymph node in PET scan may give first impression of metastasis and treatment failure or infection. However correct diagnosis is a must (differentiating metastasis, treatment failure or infection) to provide correct treatment and avoid side effects of inappropriate therapies. Correct diagnosis also helps in appropriate prognostication and unnecessary stoppage of Trastuzumab. Here we are describing Sarcoidosis associated with Trastuzumab in a patient with breast cancer.

A Unique Case of Sarcoid-associated Myelopathy Accompanied by Lung Cancer

The differential diagnosis of myelopathy in patients with malignancies may be challenging, as a spinal biopsy is not always applicable. A 66-year-old woman who had shown transient double vision and nausea developed spasticity and impaired deep sensation in both feet. Magnetic resonance imaging showed abnormal gadolinium enhancement of the brainstem, spinal meninges, and nerve root. Cerebrospinal fluid (CSF) revealed mild pleocytosis and elevated protein and decreased glucose levels, although CSF cytology was normal. Lung carcinoma was simultaneously detected, and noncaseating granuloma was detected from the hilar and axillary lymph nodes, so she was diagnosed with sarcoid-associated myelopathy. Her symptoms were kept stable by intravenous methylprednisolone, oral prednisolone, and methotrexate. This is the first case of sarcoid-associated myelopathy accompanied by lung cancer, suggesting the importance of clinical course, repetitive CSF cytology, and a biopsy of the lymph nodes to distinguish sarcoid-associated myelopathy from meningeal metastasis in patients with malignancies.

Granulomatous peritoneal disease associated with oxaliplatin-based chemotherapy for ampullary adenocarcinoma: a case report

Adenocarcinomas of the ampulla of Vater represent only 0.2% of all gastrointestinal cancers. Due to the low incidence no large clinical trials evaluating efficacy of treatments are available. Adjuvant therapy is often administered in patients with stage IB or higher. Oxaliplatin is considered as an effective and well tolerated therapeutic option. Adverse events associated with this therapy include cardio-, neuro-, nephrotoxicity and myelosuppression. Previously granulomatous pulmonary and liver manifestations have been described in oxaliplatin-based chemotherapy. In this report peritoneal manifestation of granulomatous disease associated with oxaliplatin is described for the first time. Sarcoidlike reactions may be misinterpreted as tumour progression or metastatic disease, and may consequently result in over-treatment.