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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.
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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
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Sekine C, Kawase K, Yoshida K. Sarcoid-like reaction in a HER2-positive breast cancer patient: A case report. Int J Surg Case Rep 2021; 85:106280. [PMID: 34393095 PMCID: PMC8361042 DOI: 10.1016/j.ijscr.2021.106280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Sarcoid-like reaction is a systemic granulomatous reaction that may develop in the lymph nodes and organs of cancer patients. Distinguishing a sarcoid-like reaction from metastasis is difficult. Accurate diagnosis of this reaction is key to preventing overtreatment. CASE PRESENTATION A 51-year-old woman presented with a lump in her left breast and swollen lymph nodes in her left axilla and infraclavicular fossa. A core biopsy was performed, leading to the diagnosis of grade 2 infiltrating ductal carcinoma, clinical stage T2N3M0 with estrogen and progesterone receptor negativity and human epidermal growth factor receptor-2 positivity. After neoadjuvant therapy, the tumor in her left breast reduced in size, but the lymph nodes remained swollen. Mastectomy and axillary lymph node dissections were performed. In the pathological findings, epithelioid cell granuloma was observed in the lymph nodes. Based on these findings, lymph node swelling was attributed to a sarcoid-like reaction. CLINICAL DISCUSSION SLRs have been reported in 4-14% of cancer patients. Although there are various imaging modalities for detecting swollen lymph nodes, the differential diagnosis of cancer metastasis is often difficult. CONCLUSION Histological evaluation of swollen lymph nodes is required to prevent overtreatment; especially in cases where the tumor size is reduced by chemotherapy, but the lymph nodes remain swollen.
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Affiliation(s)
- Chikako Sekine
- Department of Surgery, The Jikei University School of Medicine Katsushika Medical Center, 6-41-2 Aoto, Katsushika ward, Tokyo 125-8506, Japan; Department of Breast Surgery, International University of Health and Welfare, Narita Hospital, 852 Hatakeda Narita, Chiba 286-8520, Japan.
| | - Kazumi Kawase
- Department of Surgery, The Jikei University School of Medicine Katsushika Medical Center, 6-41-2 Aoto, Katsushika ward, Tokyo 125-8506, Japan
| | - Kazuhiko Yoshida
- Department of Surgery, The Jikei University School of Medicine Katsushika Medical Center, 6-41-2 Aoto, Katsushika ward, Tokyo 125-8506, Japan
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Hepatic Sarcoidosis Complicated with Pancreatic Adenocarcinoma. Case Reports Hepatol 2019; 2019:9383019. [PMID: 31827951 PMCID: PMC6885758 DOI: 10.1155/2019/9383019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/12/2019] [Accepted: 08/27/2019] [Indexed: 12/17/2022] Open
Abstract
Sarcoidosis is a systemic noncaseous granulomatous disease. The liver is a common location but usually asymptomatic. Current literature suggests an association between sarcoidosis and cancers. However, there is a lack of definite evidence. We present a case of a 59-year-old man with jaundice and acutely elevated alkaline phosphatase. The diagnosis was confirmed by obtaining a liver biopsy and was treated with 6 months of steroids. A year later, he had a recurrence of jaundice. MRCP showed biliary dilatation and a mass in the pancreatic head, confirmed by biopsy to be adenocarcinoma. This is the first case to be reported of hepatic sarcoidosis associated with pancreatic cancer.
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