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Matsuo T, Tanaka T, Omote R, Okada T, Notohara K, Okada K. Diffuse large B-cell lymphoma in the course of systemic sarcoidosis: A case report and review of 30 Japanese patients with sarcoidosis-lymphoma syndrome. J Clin Exp Hematop 2022; 62:226-237. [PMID: 36171112 PMCID: PMC9898715 DOI: 10.3960/jslrt.22015] [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] [Indexed: 12/30/2022] Open
Abstract
We report a patient with sarcoidosis who developed diffuse large B-cell lymphoma. A 71-year-old woman with persistent cough was diagnosed pathologically with sarcoidosis by resection of the right upper lung lobe with a nodule after an unsuccessful attempt of transbronchial needle aspiration for mediastinal lymphadenopathy. She was referred for an eye examination and found to have spotty retinal degeneration on the lower fundi of both eyes, together with residual macular edema and vitreous opacity in the left eye. At 76 years, she underwent cataract surgery and vitrectomy to gain a visual acuity of 0.6 in the left eye. At 77 years, she developed a cough and fever, and showed leukopenia and thrombocytopenia. Computed tomography showed multiple small nodular lesions in both lungs, and bilateral hilar, mediastinal, and hepatic lymphadenopathy. Fluorodeoxyglucose positron emission tomography demonstrated high uptake in the liver, spleen, pancreatic head, and lymph nodes. Bone marrow biopsy was intact, but liver biopsy revealed anomalous large lymphoid cells in the sinusoids which were positive for CD20 and showed a high Ki-67 index, leading to the diagnosis of diffuse large B-cell lymphoma. Chemotherapy with 8 courses of THP-COP (cyclophosphamide, pirarubicin, vincristine, and prednisolone) with rituximab, followed by intrathecal injection of methotrexate, cytarabine, and dexamethasone, resulted in complete remission. She maintained complete remission for 10 years until 88 years old at present. The literature review found 30 patients, including this case, who developed lymphoma in the course of sarcoidosis. A novel pathological diagnosis is required in the setting of acute symptomatic changes and novel lesions on imaging in patients with sarcoidosis.
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Affiliation(s)
- Toshihiko Matsuo
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama City, Japan
| | - Takehiro Tanaka
- Department of Pathology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama City, Japan
| | - Rika Omote
- Department of Pathology, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Toshiaki Okada
- Department of Respiratory Medicine, National Hospital Organization Fukuyama Medical Center, Fukuyama City, Japan
| | - Kenji Notohara
- Department of Pathology, Kurashiki Central Hospital, Kurashiki City, Japan
| | - Kazuya Okada
- Department of Hematology/Oncology, Kurashiki Central Hospital, Kurashiki City, Japan
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Chikamori F, Yorita K, Yoshino T, Ito S, Mizobuchi M, Ueta K, Mizobuchi K, Shimizu S, Nanjo K, Yukishige S, Iwabu J, Matsuoka H, Hokimoto N, Yamai H, Onishi K, Tanida N, Sharma N. Sarcoidosis-lymphoma syndrome with portal hypertension: diagnostic clues and approach. Radiol Case Rep 2021; 16:2192-2201. [PMID: 34178191 PMCID: PMC8213984 DOI: 10.1016/j.radcr.2021.05.045] [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: 04/20/2021] [Revised: 05/14/2021] [Accepted: 05/15/2021] [Indexed: 11/16/2022] Open
Abstract
Sarcoidosis-lymphoma syndrome associated with portal hypertension is very rare. A 68-year-old female presented with a 5 kg weight loss in 6 months. Soluble interleukin-2 receptor activity was increased and total platelet count was decreased. Contrast-enhanced computed tomography showed the presence of hepatosplenomegaly and a 3 cm-sized tumor in segment 3 of the liver. The hepatic venous catheterization showed mild portal hypertension. On fluorodeoxyglucose-positron emission tomography/computed tomography, progressive malignant lymphoma was suspected. However, bone marrow biopsy showed multiple noncaseating granulomas. A laparoscopic liver biopsy revealed that the liver tumor had features of Hodgkin lymphoma. There were multiple noncaseating epithelioid granulomas in the portal tracts of the liver. Splenectomy for splenomegaly and partial hepatectomy for the liver tumor were performed. Pathological examination of the resected specimens revealed multiple noncaseating epithelioid granulomas in the liver and spleen. Histopathology of the liver tumor confirmed classic Hodgkin lymphoma with mixed cellularity. We conclude that hepatic venous catheterization, positron emission tomography/computed tomography, and pathological examinations of bone marrow, liver, and spleen are crucial for the diagnosis of sarcoidosis-lymphoma syndrome associated with portal hypertension.
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Affiliation(s)
- Fumio Chikamori
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Kenji Yorita
- Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Satoshi Ito
- Department of Radiology, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Miki Mizobuchi
- Department of Internal Medicine, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Koji Ueta
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Kai Mizobuchi
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Shigeto Shimizu
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Kazumasa Nanjo
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Sawaka Yukishige
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Jun Iwabu
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Hisashi Matsuoka
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Norihiro Hokimoto
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Hiromichi Yamai
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Kazuhisa Onishi
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Nobuyuki Tanida
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Niranjan Sharma
- Department of Surgery, Adv Train Gastroint & Organ Transp Surgery, Dunedin, New Zealand
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Di L, Wang CP, Tang J, Macaulay R, Tran N. Sarcoidosis-Lymphoma Syndrome Presenting As Bony Vertebral Metastasis: A Case Report and Literature Review. Cureus 2021; 13:e13227. [PMID: 33728177 PMCID: PMC7946476 DOI: 10.7759/cureus.13227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Sarcoidosis preceding a diagnosis of lymphoma has been a reported phenomenon termed sarcoidosis-lymphoma syndrome. Skeletal metastasis is extremely rare. Here, we detail a case of sarcoidosis-lymphoma syndrome presenting as a lumbar vertebral metastasis with suspected associated intracranial lesions. A 72-year-old man with a history of follicular lymphoma presented with symptomatic central nervous system (CNS) lesions with concurrent lumbar vertebral metastases visualized with CT and MRI. Rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone (R-CHOP) with dexamethasone treatment resulted in significant radiographic regression of his intracranial lesions with dramatic symptomatic improvement. Out of concern for compression fracture of his lytic lumbar lesions, kyphoplasty with biopsy was performed showing lymphocytes that were positive for cluster-of-differentiation 10 (CD10), CD20, and B-cell lymphoma 2 (Bcl2). The patient was diagnosed with CNS and vertebral sarcoidosis-lymphoma syndrome and began treatment with high-dose methotrexate. Including the present case, only four occurrences of sarcoidosis-lymphoma syndrome with bony involvement have been described. We detail our own experience and summarize all previous literature. While rare, sarcoidosis-lymphoma may present with CNS and lytic bone involvement; in these cases, symptomatic severity, as well as an effective response to steroid treatment, underscore the importance of an accurate and prompt diagnosis.
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Affiliation(s)
- Long Di
- Neurological Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Christopher P Wang
- Neurological Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Joseph Tang
- Neurological Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | | | - Nam Tran
- Neurological Surgery, Moffitt Cancer Center, Tampa, USA
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Taha-Mehlitz SS, Zschokke II, Metzger JJ, Fourie LL. Challenges in the management of life-threatening complications caused by a rare case of sarcoid-lymphoma syndrome. Int J Colorectal Dis 2020; 35:343-346. [PMID: 31832766 DOI: 10.1007/s00384-019-03484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE The sarcoid-lymphoma syndrome is a rare condition where both entities co-exist in the same patient. Overlapping clinical manifestations, imaging findings, and pathological characteristics pose both a diagnostic as well as therapeutic challenge, especially in the setting of life-threatening complications. The objective of this case report is to highlight rare complications caused by abdominal sarcoidosis as well as a subsequently diagnosed non-Hodgkin lymphoma. METHODS A 35-year-old man presented with massive upper gastrointestinal bleeding caused by a large retroperitoneal mass. Following several endoscopic and radiologic interventions, successful hemostasis could only be achieved by an emergency Whipple procedure. Biopsies of the mass showed an abdominal manifestation of sarcoidosis and corticosteroid therapy was started. The patient required several additional emergency surgeries due to a complicated bronchoperitoneal fistula, splenic abscess, perforation of the sigmoid colon, small bowel leakage, and repetitive intra-abdominal bleeding. RESULTS Histopathological findings finally revealed a concurrent lymphoma, as clinically suspected earlier. Ultimately, polychemotherapy was administered. CONCLUSION A concurrent lymphoma can lead to emergency surgery and should be considered when sarcoidosis treatment does not improve symptoms, lymphadenopathy occurs, or hematologic changes persist under therapy.
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Affiliation(s)
- Stephanie S Taha-Mehlitz
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland.
| | - Irin I Zschokke
- Department of General Surgery, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000, Lucerne 16, Switzerland
| | - Jürg J Metzger
- Department of General Surgery, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000, Lucerne 16, Switzerland
| | - Lana L Fourie
- Department of General Surgery, Cantonal Hospital Lucerne, Spitalstrasse, CH-6000, Lucerne 16, Switzerland
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Pereiro T, Golpe A, Lourido T, Valdés L. Extrapulmonary Tumors and Sarcoidosis. An Incidental or Real association? Arch Bronconeumol 2018. [PMID: 29523377 DOI: 10.1016/j.arbres.2018.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tara Pereiro
- Servicio de Neumología, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, España.
| | - Antonio Golpe
- Servicio de Neumología, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España
| | - Tamara Lourido
- Servicio de Neumología, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, España
| | - Luis Valdés
- Servicio de Neumología, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, España; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España
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Yoshida S, Fujimura T, Kambayashi Y, Furudate S, Mizuashi M, Aiba S. Sarcoidosis-Lymphoma Syndrome Associated with Folliculotropic Peripheral T Cell Lymphoma Not Otherwise Specified. Case Rep Oncol 2017; 10:372-376. [PMID: 28559822 PMCID: PMC5436009 DOI: 10.1159/000472249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 11/19/2022] Open
Abstract
Sarcoidosis is occasionally accompanied by hematologic malignancies, including cutaneous T-cell lymphoma, called sarcoidosis-lymphoma syndrome. Although the mechanism underlying the induction of lymphomas is still unknown, understanding the immunological background of sarcoidosis could help explain the possible mechanisms of the induction of lymphomas. In this report, we describe a case of sarcoidosis-lymphoma syndrome associated with folliculotropic peripheral T cell lymphoma not otherwise specified, which caused dense infiltration of CD30+ CD163+ tumor-associated macrophages (TAMs) only in the lesional skin. Our present case might suggest the significance of TAMs in developing sarcoid-lymphoma syndrome.
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Affiliation(s)
- Saaya Yoshida
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taku Fujimura
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yumi Kambayashi
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Sadanori Furudate
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masato Mizuashi
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Setsuya Aiba
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Tuqan W, Khirfan K, Hanson J, Alcorn J. Trouble Spotted in the Liver! Dig Dis Sci 2016; 61:2231-2235. [PMID: 27339638 DOI: 10.1007/s10620-016-4235-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Wa'el Tuqan
- Department of Internal Medicine, MSC10-5550, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Khaldoon Khirfan
- Department of Internal Medicine, MSC10-5550, University of New Mexico, Albuquerque, NM, 87131, USA.
- Division of Gastroenterology and Hepatology, University of New Mexico School of Medicine, Albuquerque, NM, USA.
| | - Joshua Hanson
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Joseph Alcorn
- Division of Gastroenterology and Hepatology, University of New Mexico School of Medicine, Albuquerque, NM, USA
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Differentiation of sarcoidosis-lymphoma syndrome lesions: a case report on the use of two different positron emission tomography tracers. BMC Med Imaging 2016; 16:1. [PMID: 26746426 PMCID: PMC4706726 DOI: 10.1186/s12880-015-0104-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background Sarcoidosis–lymphoma syndrome (SLS) is a rare disease in which both entities coexist. We aimed to study the role of 18F-fluorodeoxyglucose (FDG) and L–[3-18F] α-methyltyrosine (FAMT) positron emission tomography (PET)/computed tomography (CT) in differentiating between these two lesions. Case presentation A 54-year-old female with large liver tumors was referred to our Nuclear Medicine Department for staging using FDG PET/CT. She had a history of primary biliary cirrhosis (PBC) for 15 years and developed lung and mediastinal sarcoidosis 1 year before the liver tumors were noted. Abdominal dynamic CT revealed two well-circumscribed, peripherally-enhancing, low-density masses in the right lobe of the liver with intensive ring-form FDG uptakes at maximum standard uptake values (SUVmax) of 18.3 and 19.5, respectively. In the arterial phase, a hepatic artery was seen penetrating the tumor, a phenomenon known as “angiogram sign”. Chest PET/CT findings showed irregular thickening of the bronchovascular bundles, central peribronchial shaggy consolidations in the right middle and lower lobes (SUVmax, 4.6), and mediastinal and hilar lymphadenopathies (SUVmax, 2.7). After assessment, chemotherapy with rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone (R–CHOP) was administered for eight cycles. Follow-up imaging studies using FDG and FAMT PET/CT were performed 3 months after the last cycle of chemotherapy, which showed that the two highly FDG-avid tumors in the liver had disappeared. However, faint FDG uptake persisted in the lung consolidations (SUVmax, 6.3), and FDG uptake for the mediastinal lymphadenopathies increased (SUVmax of 5.8). In contrast, there was no significant uptake of FAMT in the liver, as well as in the lungs and the bilateral mediastinal lymphadenopathies. These discrepant uptakes between FDG and FAMT were compatible with sarcoidosis. Conclusion Combination of FDG and FAMT in PET/CT studies may play an important role in the management of SLS patients, especially in differentiating between sarcoidosis and lymphoma lesions.
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[Sarcoidosis-lymphoma syndrome]. Med Clin (Barc) 2015; 145:277-8. [PMID: 25771337 DOI: 10.1016/j.medcli.2015.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 01/16/2015] [Accepted: 01/22/2015] [Indexed: 11/21/2022]
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Carbone RG, Penna D, Baughman RP, Lower EE. Accuracy of Serial PET-CT Imaging in Systemic Sarcoidosis. J Clin Imaging Sci 2014; 4:21. [PMID: 24987568 PMCID: PMC4060399 DOI: 10.4103/2156-7514.131645] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/03/2014] [Indexed: 01/11/2023] Open
Abstract
Positron emission tomography (PET) in combination with computed tomography (PET-CT) is commonly used to identify malignant lesion in the lung. Despite there being only a few reports in literature, PET-CT imaging may have many advantages in the study of sarcoidosis, being useful in the diagnosis as well as in monitoring the response to treatment. The object of this case report is to highlight the clinical utility of integrated PET-CT imaging for evaluation of patients with systemic sarcoidosis and for comparing baseline findings to follow-up readings.
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Affiliation(s)
- Roberto G Carbone
- Respiratory Unit, Department of Internal Medicine Regional Hospital Aosta, and University of Genoa, Genoa, Italy
| | | | - Robert P Baughman
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Elyse E Lower
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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