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Ostrowska M, Świniarski P, Ostrowski A, Kowalski FR, Adamowicz J, Grzanka D, Drewa TA, Juszczak K. Sarcoidosis of the spermatic cord - case report and literature review. Basic Clin Androl 2022; 32:7. [PMID: 35590251 PMCID: PMC9118738 DOI: 10.1186/s12610-022-00158-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/05/2022] [Indexed: 12/02/2022] Open
Abstract
Background Sarcoidosis is a multi-system disease characterized by the formation of non-caseating granulomas in various organs. The lungs remain the most frequently affected organ, whereas lesions in the genitourinary system affect around 0.2% of patients. The primary site found in the spermatic cord is extremely rare. Case presentation We present a patient’s case where the spermatic cord involvement was the first manifestation of sarcoidosis. For several months, a number of tests had been performed, which showed, among others, non-caseating granulomas in pathomorphological material, bilateral hilar lymphadenopathy, and leukopenia with lymphopenia. Tumor markers were normal. Infection with urogenital pathogens (including Chlamydia Trachomatis, Neisseria gonorrhea, Mycoplasma hominis) was excluded. The patient did not report any general symptoms such as fever, excessive fatigue, weight loss. He denied swelling, shortness of breath. At the same time, a complete differential diagnosis was carried out, and the extent of the disease was assessed. Due to interdisciplinary management, the patient’s quality of life and fertility is preserved. In the discussion, we present the diagnosis, treatment, and prognosis of such patients. Conclusion Sarcoidosis is a multi-system disease, which should not be omitted in the differential diagnosis. Selective excision of the lesion with intraoperative examination plays a significant role while establishing a diagnosis. However, in the primary site in the genitourinary system, the diagnosis is challenging.
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Affiliation(s)
- Magdalena Ostrowska
- Department of Urology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Piotr Świniarski
- Department of Urology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Adam Ostrowski
- Department of Urology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland.
| | - Filip Ryszard Kowalski
- Department of Urology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Jan Adamowicz
- Department of Urology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Dariusz Grzanka
- Department of Clinical Pathomorphology, Faculty of Medicine, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Tomasz Adam Drewa
- Department of Urology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Kajetan Juszczak
- Department of Urology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
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Hyakutake Y, Shibahara I, Inukai M, Koizumi H, Hide T, Morota N, Yoshida T, Sasaki J, Kumabe T. A Case of Synchronous Occurrence of Intracranial Germinoma and Systemic Sarcoidosis. NMC Case Rep J 2022; 8:645-650. [PMID: 35079529 PMCID: PMC8769452 DOI: 10.2176/nmccrj.cr.2021-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022] Open
Abstract
Although the synchronous occurrence of testicular seminoma and systemic sarcoidosis has been reported, that of intracranial germinoma and systemic sarcoidosis is unknown. A 26-year-old man presented with symptoms of panhypopituitarism and consciousness disturbance. Imaging demonstrated a large nodule in the upper right lung field and swelling of multiple bilateral pulmonary and mediastinal lymph nodes in addition to the bifocal pineal and suprasellar tumors with obstructive hydrocephalus. The pathological diagnosis of the intracranial bifocal tumors was pure germinoma, whereas that of the mediastinal lymph nodes was epithelioid granuloma. Three courses of chemotherapy using carboplatin and etoposide were administered, followed by whole ventricle irradiation. The intracranial tumors completely disappeared, but the lung nodule and mediastinal lymph nodes progressed. Whole-body fluorine-18-fluorodeoxyglucose positron emission tomography demonstrated accumulation in the mediastinal lymphadenopathy, lung masses, and multiple lymph nodes of the whole body. Transbronchial lung biopsy revealed epithelioid granuloma with multinucleated giant cells. In conjunction with the high blood concentration of angiotensin-converting enzyme and soluble interleukin-2 receptor, these findings established a diagnosis of sarcoidosis. This is the first report of synchronous occurrence of intracranial germinoma and sarcoidosis. Such coexistence is extremely rare, but we should mind that sarcoidosis can occur with intracranial germinoma.
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Affiliation(s)
- Yuri Hyakutake
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Ichiyo Shibahara
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Madoka Inukai
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hiroyuki Koizumi
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Takuichiro Hide
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Nobuhito Morota
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Tsutomu Yoshida
- Department of Pathology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Jiichiro Sasaki
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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3
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Jeong YJ, Lim ST, Jeong HJ, Park HS, Lee SY, Han YH. Atypical sarcoid reaction mimicking recurrence on F-18 FDG PET/CT in a patient with breast malignancy. Radiol Case Rep 2021; 16:3834-3837. [PMID: 34745400 PMCID: PMC8551536 DOI: 10.1016/j.radcr.2021.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/11/2021] [Accepted: 09/16/2021] [Indexed: 11/26/2022] Open
Abstract
Malignancy may lead to sarcoidosis, which is referred to as sarcoid reaction. This reaction is believed to be a host immune response to the release of soluble antigens from cancer cells. Studies have shown strong 2'-deoxy-2'-[F-18]fluoro-D-glucose (F-18 FDG) uptake in sarcoid reaction and in true sarcoidosis. Therefore, in patients with malignancy, sarcoid reactions can mimic metastasis or recurrence on F-18 FDG positron emission tomography/computed tomography (PET/CT). Herein, we report the case of a 58-year-old woman with a history of left breast cancer whose FDG PET/CT evaluated at 3 months after adjuvant chemotherapy presented hypermetabolic lymphadenopathy in the right supraclavicular and right mediastinal areas. We interpreted these as metastases because the involved lymph nodes were intensely hypermetabolic and appeared newly. Pathologic evaluation of the excised lymph node revealed noncaseating chronic granulomas without malignant cells, indicating a sarcoid reaction. After appropriate steroid therapy, both the size and metabolic activity of the lymphadenopathy substantially decreased. Most sarcoid reactions present as bilateral hilar and peribronchial lymphadenopathies. Our patient presents an atypical example that a sarcoid reaction can also present in a unilateral pattern, making its diagnosis challenging. When interpreting FDG PET/CT images, considering that the sarcoid reaction pattern can vary is crucial.
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Affiliation(s)
- Young Jin Jeong
- Department of Nuclear Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Seok Tae Lim
- Department of Nuclear Medicine, Molecular Imaging & Therapeutic Medicine Research Center, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, 20, Geonjiro, Jeonju, Jeonbuk 54907, Republic of Korea
| | - Hwan-Jeong Jeong
- Department of Nuclear Medicine, Molecular Imaging & Therapeutic Medicine Research Center, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, 20, Geonjiro, Jeonju, Jeonbuk 54907, Republic of Korea
| | - Ho Sung Park
- Department of Pathology, Jeonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, Republic of Korea
| | - Sun Young Lee
- Department of Radiation Oncology, Jeonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, Republic of Korea
| | - Yeon-Hee Han
- Department of Nuclear Medicine, Molecular Imaging & Therapeutic Medicine Research Center, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, 20, Geonjiro, Jeonju, Jeonbuk 54907, Republic of Korea
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4
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Nappi L, Nichols C, Kollmannsberger C. Narrative review of developing new biomarkers for decision making in advanced testis cancer. Transl Androl Urol 2021; 10:4075-4084. [PMID: 34804849 PMCID: PMC8575592 DOI: 10.21037/tau-20-1246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/30/2020] [Indexed: 12/03/2022] Open
Abstract
Management of testicular germ cell tumor (GCT) patients is based on clinical determinants, mainly CT scan and serum tumor markers (alpha-fetoprotein, beta subunit of HCG and LDH). Treatment decisions are usually straightforward for patients with clear evidence of metastatic disease, confirmed either by imaging tests or by unequivocal elevated tumor markers. However, there are several clinical scenarios where the assessment of metastatic disease is complicated by the limited specificity of the current imaging tests and serum tumor markers. These include patients with clinical stage IIA GCT with negative tumor markers and patients with post-chemotherapy residual disease where, in absence of clear indicators of GCT, decision making and patient treatment allocation become challenging. Therefore, more accurate biomarkers are critical to reduce the risk of under-or over-treatment and to always deliver the most optimal therapy. The objectives of this narrative review are to review the available publications about micro-RNAs in GCT s and their potential clinical applications. Two clusters of micro-RNAs, miR-371a-3p and miR-302/367, specifically expressed by both seminoma and non-seminoma GCT and easily detectable in the peripheral blood, have demonstrated to be promising in this endeavor. Large prospective trials are ongoing to define the operating characteristics of these biomarkers and their clinical utility to improve GCT patient management and reduce the error rate deriving from clinical uncertainty, therefore reducing the risk of sub-optimal treatments.
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Affiliation(s)
- Lucia Nappi
- Division of Medical Oncology, British Columbia Cancer - Vancouver Cancer Centre, Vancouver, BC, Canada.,Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | | | - Christian Kollmannsberger
- Division of Medical Oncology, British Columbia Cancer - Vancouver Cancer Centre, Vancouver, BC, Canada
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5
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Tissue Pathogens and Cancers: A Review of Commonly Seen Manifestations in Histo- and Cytopathology. Pathogens 2021; 10:pathogens10111410. [PMID: 34832566 PMCID: PMC8624235 DOI: 10.3390/pathogens10111410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 02/07/2023] Open
Abstract
Tissue pathogens are commonly encountered in histopathology and cytology practice, where they can present as either benign mimickers of malignancy or true malignancies. The aim of this review is to provide a timely synthesis of our understanding of these tissue pathogens, with an emphasis on pertinent diagnostic conundrums associated with the benign mimickers of malignancy that can be seen with viral infections and those which manifest as granulomas. The oncogenic pathogens, including viruses, bacteria, and parasites, are then discussed with relationship to their associated malignancies. Although not exhaustive, the epidemiology, clinical manifestations, pathogenesis, and histological findings are included, along with a short review of emerging therapies.
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6
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Ballet B, Roelandt M, Lockefeer F, Thüer D. Testicular Sarcoidosis: Diagnostic Approach and Management Strategies. Cureus 2021; 13:e12715. [PMID: 33614320 PMCID: PMC7883556 DOI: 10.7759/cureus.12715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Sarcoidosis is a multisystem disorder which, in rare cases, can affect the urogenital tract. The clinical presentation of this benign inflammatory disorder can easily mimic that of testicular malignancy. Therefore, it is crucial to differentiate between these two entities, as misdiagnosis may lead to unnecessary surgical interventions, which have important implications for future fertility. While testicular cancer must always be ruled out, sarcoidosis should be considered in all patients presenting with a testicular mass. Here, we present a case of sarcoidosis with bilateral epididymal and testicular involvement. The diagnosis was made by frozen section and the patient was treated with corticosteroids.
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Affiliation(s)
- Brice Ballet
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, BEL
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7
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Sano Y, Fujiwara M, Yuasa T, Komai Y, Yamamoto T, Kohno A, Nakao M, Inamura K, Yonese J. Testicular seminoma with a progressing pulmonary nodule and mediastinal lymphadenopathy without retroperitoneal metastasis. IJU Case Rep 2020; 3:211-214. [PMID: 32914079 PMCID: PMC7469829 DOI: 10.1002/iju5.12191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/11/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Testicular germ cell cancer has a relatively good prognosis even if visceral and/or lymph node metastases are present thanks to chemotherapy. Yet chemotherapy can lead to various adverse events. Therefore, it is crucial to distinguish whether a suspected metastatic disease is metastasis or not. CASE PRESENTATION A 33-year-old male visited our hospital to receive subsequent therapy for suspected recurrent seminoma with a progressing pulmonary nodule and mediastinal lymphadenopathy after orchiectomy. The pathological diagnosis of needle aspiration and resected specimen of the several lesions was consistent with epithelioid cell granuloma without caseous necrosis. Based on these findings, the lung and mediastinal lymph node lesions were diagnosed as sarcoidosis. CONCLUSION In cases where the simultaneous occurrence of other benign or malignant diseases is suspected, pathological confirmation is necessary for appropriate decision-making.
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Affiliation(s)
- Yuta Sano
- Department ofUrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Motohiro Fujiwara
- Department ofUrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Takeshi Yuasa
- Department ofUrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Yoshinobu Komai
- Department ofUrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Tatsuya Yamamoto
- Department ofRadiologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Atsushi Kohno
- Department ofRadiologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Masayuki Nakao
- Department ofThoracic Surgical OncologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Kentaro Inamura
- Department ofPathologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Junji Yonese
- Department ofUrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
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8
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Lee H, Lim JK, Lee SY, Shin KM. Granulomatous reaction of primary mediastinal seminoma leading to diagnostic delay: a case report. J Thorac Dis 2018; 10:E98-E102. [PMID: 29607195 DOI: 10.21037/jtd.2018.01.94] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary mediastinal seminoma (PMS) is a rare tumor. PMS can be morphologically related to secondary changes in the form of thymic remnants, cystic degeneration, epithelioid granulomas, fibrotic change, and syncytiotrophoblast-like cells. Ours was an interesting case where a 26-year-old male presented with an incidentally-found anterior mediastinal mass. Even though he had no pulmonary symptoms, the transthoracic co-axial needle biopsy of the mass suggested tuberculosis (TB). However, on follow-up computed tomography (CT) and magnetic resonance image (MRI) in 2 months, the mass slightly increased in size, and a small part of low density or signal intensity appeared, despite the regular anti-TB treatment regimen. Surgical resection was performed, and the resected specimens revealed scattered and irregular-shaped seminoma cells with an intervening chronic granulomatous reaction. The aim of this article is to report a case of PMS in a young male patient who had a granulomatous reaction that mimicked a neoplastic population of cells leading to an erroneous diagnosis of the small biopsy. Therefore, awareness of the secondary changes that can mimic a primary lesion can help with an early correction of this misdiagnosis.
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Affiliation(s)
- Hoseok Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jae-Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sang Yub Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Kyung Min Shin
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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9
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Spiekermann C, Kuhlencord M, Huss S, Rudack C, Weiss D. Coexistence of sarcoidosis and metastatic lesions: A diagnostic and therapeutic dilemma. Oncol Lett 2017; 14:7643-7652. [PMID: 29344212 PMCID: PMC5755156 DOI: 10.3892/ol.2017.7247] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/27/2017] [Indexed: 12/14/2022] Open
Abstract
Sarcoidosis, a chronic, inflammatory disease that affects various different organs, is characterized by noncaseating epitheloid granulomas. This systemic inflammatory process is associated with an increased risk of cancer. Several cases of sarcoidosis that mimic metastatic tumor progression in radiological findings have been reported so far. However, there are also cases that have presented a coexistence of sarcoidosis and metastasis, which have caused a diagnostic and therapeutic dilemma. Due to inadequate current therapies, a reliable differentiation between benign and malignant lesions is crucial. This review focuses on the residual risk of the coexistence of metastases within radiological suspicious lesions in patients with a history of solid tumors and sarcoidosis, as well as immunological findings, in order to explain the potential associations. Sarcoidosis has the potential to promote metastasis as it includes tumor-promoting and immune-regulating cell subsets. Notably, myeloid derived suppressor cells may serve a pivotal role in metastatic progression in patients with sarcoidosis. In addition, the present review also evaluates the potential novel diagnostic approaches, which may be able to differentiate between metastatic lesions and sarcoidosis. The risk of coexistent metastasis in sarcoidosis lesions must be considered by clinical practitioners, and a multidisciplinary approach may be required to avoid misdiagnosis and the subsequent unnecessary surgery or insufficient treatments.
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Affiliation(s)
- Christoph Spiekermann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Münster, D-48149 Münster, Germany.,Institute of Immunology, University Hospital Münster, D-48149 Münster, Germany
| | - Meike Kuhlencord
- Institute of Immunology, University Hospital Münster, D-48149 Münster, Germany
| | - Sebastian Huss
- Institute of Pathology, University Hospital Münster, D-48149 Münster, Germany
| | - Claudia Rudack
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Münster, D-48149 Münster, Germany
| | - Daniel Weiss
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Münster, D-48149 Münster, Germany
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10
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Nureki SI, Miyazaki E, Yamasue M, Takenaka R, Ando M, Kadota JI. Intrascrotal and osseous sarcoidosis mimicking intrascrotal organ cancer and bony metastasis. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2017; 34:373-379. [PMID: 32476871 DOI: 10.36141/svdld.v34i4.5523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/29/2017] [Indexed: 11/02/2022]
Abstract
We report a case of sarcoidosis with concomitant epididymis, testes, and phalanxes involvement mimicking intrascrotal organ cancer and metastatic bony disease. A 23-year-old man developed blurred vision and hyperemia of the left eye, and was diagnosed as having left iritis. A chest computed tomography scan detected bilateral hilar lymphadenopathy and lung nodular shadows. A transbronchial lung biopsy revealed a non-caseating granuloma and he was diagnosed with sarcoidosis. One year after the onset of his eye symptoms, he noticed enlargement of his right scrotum. Magnetic resonance imaging detected lesions of the right epididymis, bilateral testes, and bilateral phalanxes. A technetium-99m scintigram revealed a high accumulation in the bilateral bones of extremities. These radiological findings mimicked intrascrotal organ cancer and metastatic bony disease. Pathologic evaluation following the right epididymectomy revealed non-caseating granulomas compatible with sarcoidosis. Three and half years after the appearance of intrascrotal and bony lesions, they improved spontaneously. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 373-376).
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Affiliation(s)
| | - Eishi Miyazaki
- Center for Community Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita 879-5593, Japan
| | - Mari Yamasue
- Department of Respiratory Medicine and Infectious Diseases and
| | | | - Masaru Ando
- Department of Respiratory Medicine and Infectious Diseases and
| | - Jun-Ichi Kadota
- Department of Respiratory Medicine and Infectious Diseases and
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11
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Ureña-Vacas A, Pinilla-Pagnon I, Gorospe Sarasúa L. Sarcoid-Like Reaction with Mediastinal and Pulmonary Involvement in a Patient with Testicular Cancer. Arch Bronconeumol 2016; 53:77-78. [PMID: 27381973 DOI: 10.1016/j.arbres.2016.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 05/10/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Almudena Ureña-Vacas
- Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, España.
| | | | - Luis Gorospe Sarasúa
- Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, España
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12
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Bonifazi M, Bravi F, Gasparini S, La Vecchia C, Gabrielli A, Wells AU, Renzoni EA. Sarcoidosis and cancer risk: systematic review and meta-analysis of observational studies. Chest 2015; 147:778-791. [PMID: 25340385 DOI: 10.1378/chest.14-1475] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND An increased cancer risk in patients with sarcoidosis has been suggested, although results are conflicting in a number of case-control and cohort studies. We conducted a systematic review of all available data and performed a meta-analysis to better define and quantify the association between sarcoidosis and cancer. METHODS We searched Medline and Embase for all original articles on cancer and sarcoidosis published up to January 2013. Two independent authors reviewed all titles/abstracts to identify studies according to predefined selection criteria. We derived summary estimates using a random-effects model and reported them as relative risk (RR). Publication bias was evaluated using a funnel plot and was quantified by the Egger test. RESULTS Sixteen original studies, involving > 25,000 patients, were included in the present review. The summary RR to develop all invasive cancers was 1.19 (95% CI, 1.07-1.32). The results for selected cancer sites indicated a significantly increased risk of skin (RR, 2.00; 95% CI, 1.69-2.36), hematopoietic (RR, 1.92; 95% CI, 1.41-2.62), upper digestive tract (RR, 1.73; 95% CI, 1.07-2.79), kidney (RR, 1.55; 95% CI, 1.21-1.99), liver (RR, 1.79; 95% CI, 1.03-3.11), and colorectal cancers (RR, 1.33; 95% CI, 1.07-1.67). There was no evidence of publication bias for all cancers (P = .9), nor for any specific cancer site. CONCLUSIONS The present meta-analysis suggests a significant, though moderate, association between sarcoidosis and malignancy.
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Affiliation(s)
- Martina Bonifazi
- Department of Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri-Istituto di Ricovero e Cura a carattere Scientifico, Milan, Italy.
| | - Francesca Bravi
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
| | - Stefano Gasparini
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
| | - Armando Gabrielli
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, England
| | - Elisabetta A Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, England
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13
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Ishii H, Igata F, Nabeshima K, Kushima H, Watanabe K. Mediastinal Seminoma with an Elevated Level of Serum Angiotensin-converting Enzyme. Intern Med 2015; 54:1909-12. [PMID: 26234235 DOI: 10.2169/internalmedicine.54.3953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 22-year-old man was admitted following the detection of right hilar enlargement during a medical checkup. The patient's serum angiotensin-converting enzyme (ACE) level was abnormally high, and a needle aspiration biopsy showed non-caseating epithelioid cell granulomas. Surgical resection was performed, and the resected specimens showed irregularly shaped seminoma nests with intervening stroma consisting of epithelioid cell granulomas. Furthermore, immunohistochemistry demonstrated ACE expression in the epithelioid cells and some tumor cells. The patient's serum ACE level declined after the surgery and subsequent systemic chemotherapy, indicating the presence of tumor-induced sarcoid-like reactions rather than the coexistence of seminoma and sarcoidosis.
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Affiliation(s)
- Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Hospital, Japan
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14
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Sarcoidosis vs. Sarcoid-like reactions: The Two Sides of the same Coin? Wien Med Wochenschr 2014; 164:247-59. [DOI: 10.1007/s10354-014-0269-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/17/2014] [Indexed: 12/18/2022]
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15
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Minami D, Takigawa N, Hayakawa H, Mizuta M, Kudo K, Uchida K, Ichihara E, Sato A, Hotta K, Tabata M, Tanimoto M, Kiura K. Usefulness of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in Distinguishing Sarcoidosis from Recurrent Cancer in Patients with Lymphadenopathy after Surgery. Jpn J Clin Oncol 2013; 43:1110-1114. [DOI: 10.1093/jjco/hyt123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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16
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Sarcoïdose médiastinale dans un contexte oncologique : apport de la ponction aspiration guidée par échoendoscopie. Rev Med Interne 2013; 34:600-4. [DOI: 10.1016/j.revmed.2013.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 04/25/2013] [Indexed: 11/18/2022]
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17
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Teo M, McCarthy JE, Brady AP, Curran DR, Power DG. A case of sarcoidosis in a patient with testicular cancer post stem cell transplant. Acta Oncol 2013; 52:869-71. [PMID: 22708529 DOI: 10.3109/0284186x.2012.689854] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Inoue K, Goto R, Shimomura H, Fukuda H. FDG-PET/CT of sarcoidosis and sarcoid reactions following antineoplastic treatment. SPRINGERPLUS 2013; 2:113. [PMID: 23543853 PMCID: PMC3610027 DOI: 10.1186/2193-1801-2-113] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 02/25/2013] [Indexed: 11/10/2022]
Abstract
Sarcoidosis or sarcoid reactions, which appear as FDG-avid lesions in oncologic patients, need to be differentiated from disseminated malignancies. We aimed to promote awareness of development of sarcoidosis or sarcoid reactions after antineoplastic therapy to avoid diagnostic errors with FDG-PET/CT findings and assess the utility of FDG-PET/CT for follow-up. We retrospectively reviewed radiological reports of FDG-PET/CT scans performed between January 2009 and December 2011. Among oncologic patients with more than 2 FDG-PET/CT scans, those with nearly symmetrical increases in FDG uptake in the hilar or mediastinal lymph nodes were identified, and those with known sarcoidosis, concurrent diagnoses of sarcoidosis with malignancy, or histopathologically proven malignancies were excluded. Then, only those cases were selected for which sarcoidosis or sarcoid reactions were diagnosed. Four of 376 oncologic cases met the criteria. At 9 months to 6 years after antineoplastic therapy, abnormal FDG uptakes were observed in the hilar, mediastinal, abdominal, pelvic, and inguinal nodes, and/or spleen and lung parenchyma with SUVmax up to 17.7. On the basis of these findings, 1 patient received anticancer chemotherapy because of tumor recurrence suspicion. A gradual decrease in FDG uptake was observed on subsequent PET/CT scans. Sarcoidosis or sarcoid reactions should be considered in differential diagnosis of oncologic patients who have developed FDG-avid lesions any time after antineoplastic therapy. FDG-PET/CT can be used for follow-up in nondiagnostic situations to detect decreases in FDG uptake due to presence of sarcoidal granulomas.
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Affiliation(s)
- Kentaro Inoue
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aoba-ward, Sendai, 980-8575 Japan
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19
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Mohamed N, Nilsson E, Johansson P, Klingström J, Evander M, Ahlm C, Bucht G. Development and evaluation of a broad reacting SYBR-green based quantitative real-time PCR for the detection of different hantaviruses. J Clin Virol 2013; 56:280-5. [PMID: 23290388 DOI: 10.1016/j.jcv.2012.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 10/27/2012] [Accepted: 12/03/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hantaviruses are endemic in most parts of the world and cause hundreds of thousand human cases of hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS) annually throughout Eurasia and the Americas. They are zoonotic viruses, most commonly transmitted to humans by aerosolized rodent excreta. New hantaviruses are frequently discovered in previously unknown reservoir species and geographic areas. Consequently, there is a need to improve hantavirus diagnostics. OBJECTIVES This paper describes the design and evaluation of a rapid and robust quantitative real-time PCR (QRT-PCR) assay able to detect a wide range of hantaviruses. STUDY DESIGN Primers with the potential to detect different hantaviruses were designed from conserved regions of different hantavirus L segments, as identified from multiple sequence alignments. RESULTS By using SYBR-green-based QRT-PCR 100-1000 target molecules of in vitro produced RNA and less than 100 copies of hantavirus RNA from different hantavirus clades and regions of the world were detected. When using the assay on clinical samples from patients with acute HFRS, Puumala hantavirus (PUUV) RNA was confirmed in all previously positive samples. Notably, the broad reacting L-segment QRT-PCR also detected viral RNA in HFRS patient samples, previously negative by a QRT-PCR targeting the S segment of PUUV. CONCLUSIONS This novel assay provides a powerful tool for diagnosis of hantaviruses from different clades and regions and may also be useful in surveys with the purpose of finding new hantaviruses in rodent or insectivore species.
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Affiliation(s)
- Nahla Mohamed
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, SE-901 85 Umeå, Sweden
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20
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Claus F, De Wever L, Moerman P. Coincidence of seminoma and sarcoidosis in two patients presenting with peritoneal surface disease. Int J Urol 2012; 19:1126. [PMID: 22906149 DOI: 10.1111/j.1442-2042.2012.03129.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Hashimoto Y, Kudoh S, Yamamoto H, Hatakeyama S, Yoneyama T, Koie T, Kamimura N, Ohyama C. Sarcoidosis of the ureter. Urology 2012; 79:e81-2. [PMID: 22542358 DOI: 10.1016/j.urology.2012.02.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 02/20/2012] [Accepted: 02/27/2012] [Indexed: 11/16/2022]
Abstract
We report a rare case of sarcoidosis of the ureter in a 65-year-old Japanese man. Left nephroureterectomy and regional lymph node dissection were performed under the clinical diagnosis of transitional cell carcinoma of the left ureter with lymph node metastasis. Microscopically, noncaseous epithelioid granuloma with large Langerhans cells was noted in the ureter and dissected lymph nodes. Pulmonary lesions were not found on computed tomography. The final diagnosis was sarcoidosis of the ureter. Although sarcoidosis is rare in the genitourinary tract, it should be considered in the differential diagnosis of urologic conditions.
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Affiliation(s)
- Yasuhiro Hashimoto
- Department of Urology, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan.
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22
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Severe bronchoconstriction due to sarcoid-like reaction to lung cancer. Asian Cardiovasc Thorac Ann 2012; 20:199-201. [DOI: 10.1177/0218492311431493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chest radiography in a 59-year-old woman with recurrent pneumonia showed infiltrates in her left upper lung field. Fiberoptic bronchoscopy and chest computed tomography revealed severe constriction in the upper bronchus and a nodule in the left upper lobe. After lobectomy, adenocarcinoma was confirmed, with multiple non-caseating granulomas in the lung parenchyma and lymph nodes. Bronchial constriction was thought to be due to a sarcoid-like reaction secondary to lung cancer, leading to granuloma formation.
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23
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Abstract
Sarcoidosis is a systemic inflammatory condition that primarily affects the lungs, lymphatic system and skin. Extra thoracic manifestations occur in about 50% of cases; however, it rarely affects the male reproductive tract. The first documented case of epididymal and testicular sarcoid in the Irish literature is of a 25-year-old male who presented with a painful 1-cm extra-testicular scrotal mass. While the involvement of the male reproductive tract is rare, it should be included in the differential of testicular pathology. It can be diagnosed on frozen section and may be managed conservatively.
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Affiliation(s)
- Lisa G Smyth
- Department of Urology, St.Vincent's University Hospital, Dublin, Ireland
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24
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Abstract
Testicular sarcoidosis is a rare but benign entity. It is often mistaken for testicular neoplasm, leading to orchiectomy. It is, therefore, extremely important to identify and correctly diagnose testicular sarcoidosis on sonography to avoid unnecessary orchiectomy. This case study reports a young patient who had a prior history of unilateral orchiectomy for cryporchidism and presented with testicular lesions on the contralateral testis. He was later found to have skin lesions and chest symptoms that led to a diagnosis of sarcoidosis.
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Affiliation(s)
- Hamad H. Ghazle
- Rochester Institute of Technology, Diagnostic Medical Sonography Program, Rochester, NY, USA,
| | - Shweta Bhatt
- Rochester Institute of Technology, Diagnostic Medical Sonography Program, Rochester, NY, USA
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25
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Sarcoidosis and testicular cancer: A case series and literature review. Urol Oncol 2010; 28:350-4. [DOI: 10.1016/j.urolonc.2008.09.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 09/24/2008] [Accepted: 09/25/2008] [Indexed: 11/18/2022]
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26
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Tanizawa K, Tanaka E, Hashimoto S, Noma S, Kobashi Y, Okumura K, Shindo T, Taguchi Y. Paradoxical development of a sarcoid-like reaction during successful chemotherapy for seminoma. Intern Med 2010; 49:1423-6. [PMID: 20647660 DOI: 10.2169/internalmedicine.49.3444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Although the association between seminoma and sarcoidosis or a sarcoid-like reaction has been well recognized, a paradoxical case during chemotherapy for seminoma has not been reported. We report the first case of a sarcoid-like reaction that developed paradoxically during successful chemotherapy for recurrent seminoma. A 36-year-old Japanese man had recurrent seminoma in abdominal lymph nodes four years after left orchiectomy. Chemotherapy consisting of bleomycin, etoposide and cisplatin had reduced the abdominal mass, but mediastinal and bilateral hilar lymphadenopathy newly appeared. Surgical biopsy of the mediastinal lymph nodes and left nephrectomy and retroperitoneal lymphadenectomy revealed noncaseating granulomas only in mediastinal lymph nodes and confirmed complete remission of seminoma. Nine months later the thoracic lymphadenopathy had resolved spontaneously.
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27
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Sarcoidosis as a benign cause of lymphadenopathy in cancer patients. Am J Surg 2009; 197:629-32; discussion 632. [DOI: 10.1016/j.amjsurg.2009.01.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2008] [Revised: 12/22/2008] [Accepted: 01/05/2009] [Indexed: 11/20/2022]
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28
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[Intrathoracic lesions in association with germ cell tumor of the testis]. Chirurg 2008; 79:874-6. [PMID: 18209992 DOI: 10.1007/s00104-007-1450-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Intrathoracic enlarged lymph nodes in patients with malignant diseases always arouse suspicion of lymphatic metastases. Despite modern diagnostic investigation, surprising findings sometimes emerge. The present case of a young man with intrathoracic lesions in association with a germ-cell tumor of the testis turned out to have sarcoidosis mimicking testicular cancer relapse.
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29
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Gilligan T, Kantoff PW. Testis Cancer. Oncology 2007. [DOI: 10.1007/0-387-31056-8_49] [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]
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30
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Abstract
Malignancy in patients with sarcoidosis occurs in 3 settings. The first setting relates to patients with hematologic malignancies. It includes the sarcoidosis-lymphoma syndrome, which refers to the development of lymphoma at least 1 to 2 years after the diagnosis of sarcoidosis. It also includes patients with sarcoidosis who develop other hematologic malignancies. In addition, this subset of individuals includes patients with cancer and hematologic malignancies who subsequently develop sarcoidosis. The second setting consists of patients with sarcoidosis who develop solid tumors and oncologic patients in whom sarcoidosis subsequently appears; in addition to melanoma and nonmelanoma skin cancer, the neoplasms most commonly associated involve the cervix, liver, lung, testicles, and uterus. The third setting of malignancy-related sarcoidosis occurs when sarcoidosis presents as a paraneoplastic syndrome for the associated cancer, specifically when the discovery of cancer is concurrent with or within 1 year of the diagnosis of sarcoidosis or vis-a-vis. Antineoplastic treatment of either the hematologic malignancy or the solid tumor has also been observed to either induce the initial onset or flare the activity of sarcoidosis. Malignancy can also be associated with the occurrence of sarcoid reactions that typically are restricted to the regional lymph nodes or the visceral organ of tumor origin; rarely, the sarcoid reaction can also be observed in the skin or is only limited to the skin.
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31
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Sleijfer S. Pulmonary alterations during BEP? Always be aware of BIP. Oncol Res Treat 2007; 30:291-2. [PMID: 17551251 DOI: 10.1159/000102516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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32
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May M, Gunia S, Siegsmund M, Kaufmann O, Helke C, Hoschke B, Wille AH. Testikulärer Keimzelltumor und Sarkoidose. Urologe A 2006; 45:1176-80. [PMID: 16673125 DOI: 10.1007/s00120-006-1052-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Several case reports and small case series have described a total of 66 patients with sarcoidosis and testicular cancer so far. This report describes three additional cases. We highlight the association of sarcoidosis and testicular cancer and comment on the potential impact of this connection on the interpretation of the radiological and pathological findings in suspected cancer relapse. Sarcoidosis, a condition that can be combined with testicular cancer, should always be considered in the differential diagnosis.
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Affiliation(s)
- M May
- Urologische Klinik, Carl-Thiem-Klinikum, Akademisches Lehrkrankenhaus der Universitätsklinik Charité zu Berlin, Thiemstrasse 111, 03048, Cottbus.
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33
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Cohen PR. Granuloma annulare, relapsing polychondritis, sarcoidosis, and systemic lupus erythematosus: conditions whose dermatologic manifestations may occur as hematologic malignancy-associated mucocutaneous paraneoplastic syndromes. Int J Dermatol 2006; 45:70-80. [PMID: 16426383 DOI: 10.1111/j.1365-4632.2005.02667.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Philip R Cohen
- Dermatologic Surgery Center of Houston, and the Department of Dermatology, University of Texas-Houston Medical School, USA.
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34
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Kramer H, Koëter GH, Sleijfer DT, van Putten JWG, Groen HJM. Endoscopic ultrasound-guided fine-needle aspiration in patients with mediastinal abnormalities and previous extrathoracic malignancy. Eur J Cancer 2004; 40:559-62. [PMID: 14962723 DOI: 10.1016/j.ejca.2003.11.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2003] [Accepted: 11/07/2003] [Indexed: 11/23/2022]
Abstract
Enlarged mediastinal lymph nodes in patients with previous extrathoracic malignancy require pathological verification. However, surgical procedures lead to morbidity and (rarely) mortality. Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is a minimally invasive, outpatient procedure. We prospectively assessed its usefulness in patients with mediastinal abnormalities and previous extrathoracic malignancy. All patients underwent EUS-FNA prior to planned surgical procedures. Specimens were categorised as positive, negative, or inconclusive. Surgical procedures were cancelled after positive EUS-FNA. Twenty patients underwent EUS-FNA, being positive in eleven and providing an alternative diagnosis in one patient (a total of 60%). In 8 patients, EUS-FNA was negative or inconclusive, while surgery was positive in five and negative in three. Sensitivity and specificity of EUS-FNA were 69 and 100%, respectively. EUS-FNA is useful in the assessment of mediastinal abnormalities in patients with previous extrathoracic malignancy. Surgical diagnostic procedures were precluded in 60% of such patients.
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Affiliation(s)
- H Kramer
- Department of Pulmonary Diseases, Groningen University Hospital, Department of Pulmonary Diseases, PO Box 30 001, 9700 RB Groningen, The Netherlands.
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35
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Karapetis CS, Strickland AH, Yip D, van der Walt JD, Harper PG. PET and PLAP in suspected testicular cancer relapse: beware sarcoidosis. Ann Oncol 2001; 12:1485-8. [PMID: 11762823 DOI: 10.1023/a:1012548312538] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 31-year-old man previously treated with chemotherapy for metastatic testicular cancer presented with new mediastinal lymphadenopathy and peripheral lung opacities. Serum tumour markers were not elevated and a PET (positron emission tomography) scan revealed increased FDG (fluoro-deoxyglucose) uptake in the lungs and mediastinum consistent with testis cancer relapse. A biopsy of a mediastinal lymph node was performed and the pathology was that of sarcoidosis. Immunohistochemistry however was positive for PLAP (placental alkaline phosphatase) and negative for EMA (epithelial membrane antigen). This immunohistochemical profile raised concerns that the observed pathology represented a sarcoid reaction to micro-metastatic testicular cancer relapse. We performed immunohistochemical pathology analysis on four known cases of sarcoidosis and found the same immunohistochemical-staining pattern. This case highlights the problem of specificity when interpreting the significance of PET scans and immunohistochemical analysis in this situation. Sarcoidosis, a condition that has been associated with testicular cancer, should always be considered in the differential diagnosis.
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Affiliation(s)
- C S Karapetis
- Department of Medical Oncology, Guy's Hospital, London, UK
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36
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Yanagawa H, Goto H, Maniwa K, Ogushi F, Takahashi K, Monden Y, Hirose T, Sano N, Sone S. A case of resectable lung adenocarcinoma associated with sarcoidosis. Cancer Immunol Immunother 1999; 16:216-20. [PMID: 10523803 DOI: 10.1007/bf02906135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 71-year-old woman with uveitis was referred to our hospital for further examination of the possible underlying diseases. In roentgenological examination with plain X-ray and CT scan, hilar and mediastinal lymphadenopathy and a mass shadow in the right upper lung field was observed, whereas fibrotic changes were not obvious in both lung fields. Transbronchial lung biopsy with fiberoptic bronchoscope revealed granulomatous interstitial pneumonia. CD4-positive lymphocytes were increased in bronchoalveolar lavage. The patient was diagnosed as having sarcoidosis. Subsequently, right upper lobectomy was performed, and Stage I lung adenocarcinoma was diagnosed. The patient is under follow up without medication and the disease has been stable for two years. A relationship between epithelioid granulomatosis and malignant diseases is discussed and a review of the literature is given. Since it is still controversial as to the incidence of malignant diseases in sarcoidosis patients, it is important to accumulate data on these associations.
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Affiliation(s)
- H Yanagawa
- Third Department of Internal Medicine, The University of Tokushima School of Medicine, Japan.
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