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Ramos MS, Mammo DA, Yuan A, Sharma S. VITREORETINAL LYMPHOMA WITH CENTRAL NERVOUS SYSTEM INVOLVEMENT IN A PATIENT WITH SARCOIDOSIS: A CASE REPORT. Retin Cases Brief Rep 2024; 18:464-467. [PMID: 36913665 DOI: 10.1097/icb.0000000000001411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND/PURPOSE To describe a case of primary vitreoretinal lymphoma with central nervous system involvement in a patient with sarcoidosis. METHODS Single, retrospective chart review. PATIENT A 59-year-old man with sarcoidosis. RESULTS The patient presented with a 3-year history of bilateral panuveitis thought secondary to his sarcoidosis diagnosed 11 years before. Shortly before presentation, the patient demonstrated recurrent uveitis with a lack of response to aggressive immunosuppression therapy. At presentation, ocular examination showed significant anterior and posterior inflammation. Fluorescein angiography demonstrated hyperfluorescence of the optic nerve with late and small vessel leakage in the right eye. The patient also described a two-month history of memory and word-finding deficits. An inflammatory and infectious disease work-up was unremarkable. A brain MRI showed multiple enhancing periventricular lesions with vasogenic edema, whereas a lumbar puncture was negative for malignant cells. A diagnostic pars plana vitrectomy confirmed a diagnosis of large B-cell lymphoma. CONCLUSION Sarcoidosis and vitreoretinal lymphoma are known masqueraders. Recurrent inflammation typical of sarcoid uveitis may mask a more sinister diagnosis such as vitreoretinal lymphoma. Furthermore, sarcoid uveitis treatment with corticosteroids may transiently improve symptoms, but further delay a timely diagnosis of primary vitreoretinal lymphoma.
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Affiliation(s)
- Michael S Ramos
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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2
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Neumann M, Meyer F, Oksentyuk Polyakova T, Barth U, Jechorek D, Croner RS, Petersen M. Uncommon diagnosis of multinodular goiter - isolated extrapulmonary manifestation of sarcoidosis in thyroid gland (scientific case reports). Pathol Res Pract 2024; 256:155235. [PMID: 38490098 DOI: 10.1016/j.prp.2024.155235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/31/2024] [Accepted: 03/02/2024] [Indexed: 03/17/2024]
Abstract
AIM By means of the scientific description of two uncommon cases who underwent. surgical resection of multinodous goiter and following histopathological investigation revealing isolated extrapulmonary manifestation of sarcoidosis, this uncommon diagnosis including symptomatology, clinical findings, diagnostic and therapeutic management is to be illustrated. CASE DESCRIPTIONS Diagnostics: Scintigraphy of the thyroid gland with a left-thyroid cold node; ultrasound-guided puncture (cytological investigation, non-suspicious). THERAPY Elective thyroidectomy with no macroscopic anomalies und no abnormal aspects with regard to surgical tactic and technique. Histopathological investigation: Complete resection specimen of the thyroid gland with granulomatous inflammation consistent with sarcoidosis. CLINICAL COURSE Uneventful with no further manifestations of sarcoidosis in the following diagnostics. DIAGNOSTICS Ultrasound, inhomogeneous node (37×30×35 mm) of the right thyroideal gland with echo-poor parts and peripheral vascularization; scintigraphy showing marginally compensated unifocal autonomy of the thyroid gland (laboratory parameters, increased serum level of thyroglobulin [632 ng/mL]). THERAPY Planned right hemithyroidectomy with confirmed nodous structure of thyroid parenchyma, without suspicious lymph nodes. Histopathological investigation: 33-mm follicular, nodular, encapsulated structure of thyroid parenchyma (diagnosed as follicular adenoma); 2nd opinion: low-grade differentiated carcinoma of thyroid gland with angioinfiltrating growth and granulomatous inflammation of sarcoidosis type. Procedural intent: After tumor-board consultation, completing thyroidectomy was performed within a 5-weeks interval (pT2 pN0[0/1] V1 L0 G3 R0) with subsequent ablating radio'active iodine therapy; 18 F-FDG-PET-CT (several atypical infiltrates within the right upper lobe of the lung) and bronchoscopy with no detection of further manifestation of sarcoidosis. CONCLUSION Sarcoidosis is considered a rare granulomatous multi-locular, systemic disease of not completely known etiopathogenesis with substantial heterogeneity. In most cases, it is associated with the lung, but which can become manifest in various organs. Frequently, extrapulmonary manifestations are usually detected as histological findings by coincidence, which require further investigation to find out additional manifestations as well as to exclude florid infection or other granulomatous processes (clarifying competently differential diagnosis). Therapy is only indicated in symptomatic organ manifestations, taking into account the high rate of spontaneous healing and possible side effects.
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Affiliation(s)
- Marcel Neumann
- Dept. of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Magdeburg, Germany
| | - Frank Meyer
- Dept. of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Magdeburg, Germany.
| | | | - Udo Barth
- Division of Vascular Surgery, Dept. of General, Abdominal, Vascular and Transplant Surgery; Magdeburg, Germany
| | - Dörthe Jechorek
- Institute of Pathology. University Hospital, Magdeburg, Germany
| | - Roland S Croner
- Dept. of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Magdeburg, Germany
| | - Manuela Petersen
- Dept. of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Magdeburg, Germany
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3
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Lower EE, Baughman RP. Hematologic and Oncologic Aspects of Sarcoidosis: Some of the Least Studied but Most Common Dilemmas. Clin Chest Med 2024; 45:119-129. [PMID: 38245361 DOI: 10.1016/j.ccm.2023.08.008] [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: 01/22/2024]
Abstract
The hematologic system is frequently involved in sarcoidosis. Lymphopenia is the most common hematologic manifestation noted, although anemia and thrombocytopenia also occur. The etiology of these common manifestations can be direct granulomatous infiltration of bone marrow, lymph nodes, or spleen or related to immunologic dysfunction. Although not life threatening, these problems can lead to cytopenias requiring close monitoring in patients receiving a variety of disease treatments. The relationship between sarcoidosis and malignancy remains complex. However, some sarcoidosis patients are at increased risk for the development of malignancies, particularly lymphomas and gastrointestinal cancers. Conversely, cancer patients can experience an increase in the likelihood for the development of breast cancer and lymphomas.
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Affiliation(s)
- Elyse E Lower
- Department of Medicine, University of Cincinnati Medical Center, 200 Eden Avenue, Cincinnati, OH 45219, USA.
| | - Robert P Baughman
- Department of Medicine, University of Cincinnati Medical Center, 200 Eden Avenue, Cincinnati, OH 45219, USA
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4
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Kırkıl G. Predictors of Mortality in Sarcoidosis. Clin Chest Med 2024; 45:175-183. [PMID: 38245365 DOI: 10.1016/j.ccm.2023.06.006] [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: 01/22/2024]
Abstract
Sarcoidosis is a systemic granulomatous disorder that affects individuals of all racial/ethnic origins and occurs at any time of life. Spontaneous remission is frequent and may occur in 2 of 3 patients, while the remaining cases have chronic, progressive disease, with some patients presenting with organ- and life-threatening involvements. Many reports have investigated which features may be related to poor outcomes in patients with sarcoidosis. Pulmonary hypertension and respiratory failure from pulmonary fibrosis are the most common complications associated with the cause of death in sarcoidosis. Other major causes of death include cardiac, neurologic, hepatic involvement, and hemoptysis from aspergilloma.
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Affiliation(s)
- Gamze Kırkıl
- Medicine Faculty, Department of Chest Disease, Firat University, Elazig 23200, Turkey.
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5
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Kouranos V, Wells AU. Monitoring of Sarcoidosis. Clin Chest Med 2024; 45:45-57. [PMID: 38245370 DOI: 10.1016/j.ccm.2023.08.002] [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: 01/22/2024]
Abstract
This article focuses on the monitoring of pulmonary sarcoidosis. The monitoring of sarcoidosis is, in part, focused on serial change in major organ involvement but also includes diagnostic re-evaluation and review of change in quality of life. Recent criteria for progression of fibrotic interstitial lung disease are adapted to pulmonary sarcoidosis. The frequency and nature of monitoring are discussed, integrating baseline risk stratification and strategic treatment goals. Individual variables used to identify changes in pulmonary disease severity are discussed with a focus on their flaws and the need for a multidimensional approach. Other key monitoring issues are covered briefly.
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Affiliation(s)
- Vasileios Kouranos
- Interstitial Lung Disease/Sarcoidosis Unit, Royal Brompton Hospital, Sydney street, London, SW3 6NP; National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Cale Street, London, SW3 6LY.
| | - Athol Umfrey Wells
- Interstitial Lung Disease/Sarcoidosis Unit, Royal Brompton Hospital, Sydney street, London, SW3 6NP; National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Cale Street, London, SW3 6LY
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6
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Brito-Zerón P, Lower EE, Ramos-Casals M, Baughman RP. Hematological involvement in sarcoidosis: from cytopenias to lymphoma. Expert Rev Clin Immunol 2024; 20:59-70. [PMID: 37878359 DOI: 10.1080/1744666x.2023.2274363] [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: 06/23/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION We present an updated overview of the hematological involvementassociated with sarcoidosis, including a management approach forcytopenias and revisiting the association with hematologicalmalignancies. AREAS COVERED Theetiology of cytopenias in sarcoidosis can be attributed to two majoretiopathogenic mechanisms: infiltration of hematopoietic organs suchas the spleen and bone marrow, and autoimmune-mediated cytopenias.With respect to the association with hematological malignancies, itrequires careful evaluation of patients from a chronologicalperspective. Patients must be classified into one of three pathogenicscenarios, including preexisting hematological malignancies,synchronous development of malignancy and sarcoidosis due to commonpredisposing factors, or sarcoidosis as a predisposing factor formalignancies. EXPERT OPINION The association between sarcoidosis and hematologic involvement isbest understood as a pathogenic continuum, with cytopenias andhematologic neoplasms intertwined due to various etiopathogenicmechanisms. These mechanisms include sarcoid infiltration ofhematopoietic organs, common predisposing immunogenetics for thedevelopment of autoimmune cytopenias and malignancies, and anincreased risk of neoplasm development in patients with autoimmunecytopenias. Collaboration among the main specialties involved in theclinical management of these patients is crucial for an earlymonitoring and management.
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Affiliation(s)
- Pilar Brito-Zerón
- Autoimmune Diseases Unit, Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Milenium Balmes Sanitas, Barcelona, Spain
- SarcoGEAS Study Group ("Grupo de Estudio de Enfermedades Autoinmunes -GEAS-, Sociedad Española de Medicina Interna -SEMI-), Spain
| | - Elyse E Lower
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Manuel Ramos-Casals
- SarcoGEAS Study Group ("Grupo de Estudio de Enfermedades Autoinmunes -GEAS-, Sociedad Española de Medicina Interna -SEMI-), Spain
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Robert P Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
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Tadokoro K, Nakada Y, Sasaki R, Nakano Y, Yunoki T, Shin K, Taoka M, Ninomiya K, Nomura E, Takemoto M, Morihara R, Yamashita T. A Unique Case of Sarcoid-associated Myelopathy Accompanied by Lung Cancer. Intern Med 2023; 62:3531-3535. [PMID: 37062734 PMCID: PMC10749799 DOI: 10.2169/internalmedicine.0943-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 02/26/2023] [Indexed: 04/18/2023] Open
Abstract
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.
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Affiliation(s)
- Koh Tadokoro
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Yumi Nakada
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Ryo Sasaki
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Yumiko Nakano
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Taijun Yunoki
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Kotaro Shin
- Center for Graduate Medical Education, Okayama University, Japan
| | - Masataka Taoka
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Japan
| | - Kiichiro Ninomiya
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Japan
| | - Emi Nomura
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Mami Takemoto
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Ryuta Morihara
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Toru Yamashita
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
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Umeano L, Pujari HP, Nasiri SMZJ, Parisapogu A, Shah A, Montaser J, Mohammed L. The Association Between Lung Cancer and Sarcoidosis: A Literature Review. Cureus 2023; 15:e45508. [PMID: 37868478 PMCID: PMC10585050 DOI: 10.7759/cureus.45508] [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: 08/03/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Lung cancer is responsible for a significant number of cancer-related deaths worldwide. While various factors can lead to lung cancer, such as tobacco smoking, this article focuses on the relationship between sarcoidosis, a multisystem granulomatous disorder, and lung neoplasm. To investigate this association, the authors conducted a literature search using relevant keywords. The analysis of these reports concluded that while Sarcoidosis and lung cancer together is rare, it is possible. The presenting symptoms, age, gender, and diagnostic procedures of each case should be evaluated, and appropriate diagnostic procedures should be carried out to determine the appropriate treatment for each patient. Clinicians need to be aware of the possibility of these two diseases co-occurring, as they can impact the management of the patient's condition, whether it is curative or palliative. It is essential to rule out metastatic cancer in individuals with sarcoidosis-like clinical and radiographic features.
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Affiliation(s)
- Lotanna Umeano
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Hari Priya Pujari
- Diagnostic Radiology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | | | - Anusha Parisapogu
- Infectious Disease, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
- Infectious Disease, Mayo Clinic, Rochester, USA
| | - Anuj Shah
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Jamal Montaser
- Psychiatry, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Lubna Mohammed
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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9
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Brunner M, Ammer-Herrmenau C, Biggemann L, Ströbel P, König A, Ellenrieder V, Petzold G. [Metastasis or sarcoidosis - a diagnostic pitfall in metastatic rectal carcinoma]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:515-521. [PMID: 36126930 DOI: 10.1055/a-1880-1639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Granulomatous diseases as sarcoidosis can impair the staging of metastatic diseases since metastasis are hard to distinguish from granulomas in standard imaging. This case report describes the diagnostic workup and therapy in a patient with simultaneous sarcoidosis and rectal cancer with hepatic metastasis and how a curative stadium was achieved. CASE DESCRIPTION A 71-year old male patient was diagnosed with an adenocarcinoma of the rectum after presenting with involuntary weight loss and anemia. Further diagnostics raised strong suspicion of hepatic, pulmonary and splenic metastasis. Histology after bronchoscopy surprisingly discovered non-caseating granulomas, leading to the diagnosis of sarcoidosis. Due to an obstructive tumor, a rectum resection was performed. Due to a high suspicion of splenic metastasis during surgery, the spleen was removed. Histology revealed no metastasis in the spleen but multiple granulomas due to sarcoidosis. After surgery, biopsy of a suspicious lesion in the liver revealed both metastasis and sarcoidosis in the same sample. The patient was treated with a pseudo(neo)adjuvant chemotherapy with 5-Fluorouracil, Leukovorin, Oxaliplatin (FOLFOX) and Panitumumab (Anti-EGF-antibody). After treatment, CT scan revealed two hepatic lesions decreasing in size, while all other lesions were metrically stable. A right hemihepatectomy followed and histology revealed both sarcoidosis and metastasis. The curated patient was sent to aftercare and there is no suspicion for a relapse (13 month after last surgery). DISCUSSION The simultaneous appearance of metastatic tumors and sarcoidosis creates a diagnostic dilemma since both manifestations can barely be distinguished in regular imaging technologies. This case report demonstrates that the histological work-up of affected organs with consecutive resections can cure a patient of a metastatic tumor disease, even in the context of simultaneous sarcoidosis.
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Affiliation(s)
- Marius Brunner
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Christoph Ammer-Herrmenau
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Lorenz Biggemann
- Institut für diagnostische und interventionelle Radiologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Philipp Ströbel
- Institut für Pathologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Alexander König
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Volker Ellenrieder
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Golo Petzold
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Göttingen, Germany
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Abstract
Sarcoidosis is characterized by noncaseating granulomas which form in almost any part of the body, primarily in the lungs and/or thoracic lymph nodes. Environmental exposures in genetically susceptible individuals are believed to cause sarcoidosis. There is variation in incidence and prevalence by region and race. Males and females are almost equally affected, although disease peaks at a later age in females than in males. The heterogeneity of presentation and disease course can make diagnosis and treatment challenging. Diagnosis is suggestive in a patient if one or more of the following is present: radiologic signs of sarcoidosis, evidence of systemic involvement, histologically confirmed noncaseating granulomas, sarcoidosis signs in bronchoalveolar lavage fluid (BALF), and low probability or exclusion of other causes of granulomatous inflammation. No sensitive or specific biomarkers for diagnosis and prognosis exist, but there are several that can be used to support clinical decisions, such as serum angiotensin-converting enzyme levels, human leukocyte antigen types, and CD4 Vα2.3+ T cells in BALF. Corticosteroids remain the mainstay of treatment for symptomatic patients with severely affected or declining organ function. Sarcoidosis is associated with a range of adverse long-term outcomes and complications, and with great variation in prognosis between populations. New data and technologies have moved sarcoidosis research forward, increasing our understanding of the disease. However, there is still much left to be discovered. The pervading challenge is how to account for patient variability. Future studies should focus on how to optimize current tools and develop new approaches so that treatment and follow-up can be targeted to individuals with more precision.
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Affiliation(s)
- Marios Rossides
- Department of Respiratory Medicine and Allergy, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden.,Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Darlington
- Department of Clinical Science and Education, Södersjukhuset and Karolinska Institutet, Stockholm, Sweden.,Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
| | - Susanna Kullberg
- Department of Respiratory Medicine and Allergy, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Respiratory Medicine Division & Center for Molecular Medicine (CMM), Karolinska Institutet, Stockholm, Sweden
| | - Elizabeth V Arkema
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
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Charakida A, Teixeira F, Kubba F, Anton A, Schulman D, Cintra ML. A rare manifestation of scalp sarcoidosis. Int J Dermatol 2023; 62:e9-e10. [PMID: 35781880 DOI: 10.1111/ijd.16329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/05/2022] [Accepted: 06/14/2022] [Indexed: 11/27/2022]
Affiliation(s)
| | - Fernanda Teixeira
- Department of Dermatology, London Northwest Healthcare Trust, London, UK.,School of Medical Sciences, UNICAMP, Campinas, Brazil
| | - Faris Kubba
- Department of Pathology, London Northwest Healthcare Trust, London, UK
| | - Andreea Anton
- Department of Dermatology, London Northwest Healthcare Trust, London, UK
| | - Daniel Schulman
- Department of Dermatology, London Northwest Healthcare Trust, London, UK
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12
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Zhang Z, Zhang X, Gao Y, Chen Y, Qin L, Wu IX. Risk factors for the development of lung cancer among never smokers: A systematic review. Cancer Epidemiol 2022; 81:102274. [PMID: 36209662 DOI: 10.1016/j.canep.2022.102274] [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: 06/21/2022] [Revised: 09/26/2022] [Accepted: 10/01/2022] [Indexed: 11/29/2022]
Abstract
This review aimed to summarize the up-to-date evidence on non-genetic factors for the development of never smoking lung cancer (NSLC) and to explore reasons behind the conflicting results. Relevant literature was searched in three electronic databases (PubMed, Embase and Web of Science) from 1 January 2000-31 July 2022. Cohort studies that investigated non-genetic risk factors for primary lung cancer in never smokers were included. The effect of non-genetic factors about NSLC were summarized with pooled relative risk (RR) and 95 % confidence intervals (CIs) through meta-analysis or narrative description when unexplained statistical heterogeneity was observed. The Newcastle-Ottawa Scale was used to appraise the methodological quality of included studies. Sixty cohort studies were included, covering population from Asia, Europe and America. Most included studies (42, 70.0 %) were of high methodological quality. Over 50 years old (RR = 5.26), environmental tobacco smoke (Pooled RR = 1.30), Chronic obstructive pulmonary disease (COPD) (RR = 2.67), family history of lung cancer (Pooled RR = 1.83) and higher level of neutrophil-lymphocyte ratio (RR = 1.73) increased the risk of NSLC. Dairy foods consumption (RR = 0.79), isoflavone intake (Pooled RR = 0.65), and riboflavin intake (RR = 0.62) decreased the risk among female population. Inconsistency or unclear definition for never smokers and risk factors could be observed in included studies. Most life behavior factors associated with NSLC can be modified through lifestyle changes. Future cohort studies are suggested to adopt a clearer definition on never smokers and exposure, conducting subgroup analysis when evidence indicating there is heterogeneity between genders, and explore dose-response relationship between the identified factors and NSLC.
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Affiliation(s)
- Zixuan Zhang
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Xuewei Zhang
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China; Centre for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Yinyan Gao
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Yancong Chen
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Lang Qin
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Irene Xy Wu
- Xiangya School of Public Health, Central South University, Changsha, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, China.
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López-Muñiz Ballesteros B, Noriega C, Lopez-de-Andres A, Jimenez-Garcia R, Zamorano-Leon JJ, Carabantes-Alarcon D, de Miguel-Díez J. Sex Differences in Temporal Trends in Hospitalizations and In-Hospital Mortality in Patients with Sarcoidosis in Spain from 2001 to 2020. J Clin Med 2022; 11:jcm11185367. [PMID: 36143020 PMCID: PMC9506482 DOI: 10.3390/jcm11185367] [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: 08/18/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: We aimed to analyze temporal trends in hospitalization and in-hospital mortality (IHM) in patients with sarcoidosis in Spain from 2001−2020. (2) Methods: Using the Spanish National Hospital Discharge Database, we included patients (aged ≥ 20 years) hospitalized with a sarcoidosis code in any diagnostic field. (3) Results: We included 44,195 hospitalizations with sarcoidosis (56.34% women). The proportion of women decreased over time, from 58.76% in 2001 and 2002 to 52.85% in 2019 and 2020 (p < 0.001). The crude rates per 100,000 inhabitants increased by 4.02% per year among women and 5.88% among men. These increments were confirmed using Poisson regression analysis, which yielded an IRR of 1.03; 95% CI 1.01−1.04 for women and 1.04; 95% CI 1.02−1.06 for men. During the study period, no significant sex differences in IHM were recorded. Older age, COVID-19, respiratory failure, and the need for mechanical ventilation were independent predictors of IHM in men and women hospitalized with sarcoidosis, with IHM remaining stable over time. (4) Conclusions: The number of hospital admissions among patients with sarcoidosis in Spain increased threefold from 2001 to 2020. Although the incidence rates were higher in women, the trend followed that the incidence rates between sexes became closer. IHM was similar among men and women, with no significant change over time in either sex after multivariable analysis.
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Affiliation(s)
| | - Concepción Noriega
- Department of Nursery and Physiotherapy, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain
- Correspondence:
| | - Ana Lopez-de-Andres
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Jose J. Zamorano-Leon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - David Carabantes-Alarcon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Javier de Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Faculty of Medicine, Universidad Complutense de Madrid, 28007 Madrid, Spain
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14
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Melin A, Routier É, Roy S, Pradere P, Le Pavec J, Pierre T, Chanson N, Scoazec JY, Lambotte O, Robert C. Sarcoid-like Granulomatosis Associated with Immune Checkpoint Inhibitors in Melanoma. Cancers (Basel) 2022; 14:cancers14122937. [PMID: 35740604 PMCID: PMC9221061 DOI: 10.3390/cancers14122937] [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: 05/09/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 02/05/2023] Open
Abstract
We aimed to review the clinical and biological presentation of granulomatosis associated with immune-checkpoint inhibitors (ICI) in patients with melanoma and to explore its association with classical sarcoidosis as well as with cancer response to ICI. To this end, a retrospective study on 18 melanoma patients with histologically proven ICI-induced granulomatosis over a 12-year period in a single center, as well as on 67 similar cases reported in the literature, was conducted. Results indicate ICI-induced granulomatosis is an early side effect (median time to onset: 2 months). Its clinical presentation, with predominant (90%) thoracic involvement, histopathological appearance and supposed underlying biology (involving the mTOR pathway in immune cells, Th17 polarization and TReg dysfunction) are indistinguishable from those of sarcoidosis. Moreover, it appears to be associated with ICI benefit (>65% objective response rate). Evolution is generally favorable, and symptomatic steroid treatment and/or ICI discontinuation are rarely necessary. ICI-associated granulomatosis is critical to explore for several reasons. Practically, it is essential to differentiate it from cancer progression. Secondly, this “experimental” sarcoidosis brings new elements that may help to address sarcoidosis origin and pathophysiology. Its association with ICI efficacy must be confirmed on a larger scale but could have significant impacts on patient management and biomarker definition.
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Affiliation(s)
- Audrey Melin
- Department of Dermatology, Gustave Roussy, 114 rue Edouard-Vaillant, 94800 Villejuif, France; (É.R.); (S.R.)
- Correspondence: (A.M.); (C.R.)
| | - Émilie Routier
- Department of Dermatology, Gustave Roussy, 114 rue Edouard-Vaillant, 94800 Villejuif, France; (É.R.); (S.R.)
| | - Séverine Roy
- Department of Dermatology, Gustave Roussy, 114 rue Edouard-Vaillant, 94800 Villejuif, France; (É.R.); (S.R.)
| | - Pauline Pradere
- Service de Pneumologie et Transplantation Pulmonaire, Hôpital Marie-Lannelongue, Groupe Hospitalier Paris-Saint Joseph, 133 Av. de la Résistance, 92350 Le Plessis-Robinson, France; (P.P.); (J.L.P.)
| | - Jerome Le Pavec
- Service de Pneumologie et Transplantation Pulmonaire, Hôpital Marie-Lannelongue, Groupe Hospitalier Paris-Saint Joseph, 133 Av. de la Résistance, 92350 Le Plessis-Robinson, France; (P.P.); (J.L.P.)
| | - Thibaut Pierre
- Department of Medical Imaging, Gustave Roussy, 114 rue Edouard-Vaillant, 94800 Villejuif, France;
| | - Noémie Chanson
- Department of Internal Medicine, Kremlin Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; (N.C.); (O.L.)
| | - Jean-Yves Scoazec
- Université Paris Saclay, AP-HP, 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France;
- Department of Pathology, Gustave Roussy, 114 rue Edouard-Vaillant, 94800 Villejuif, France
| | - Olivier Lambotte
- Department of Internal Medicine, Kremlin Bicêtre Hospital, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; (N.C.); (O.L.)
- Université Paris Saclay, AP-HP, 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France;
| | - Caroline Robert
- Department of Dermatology, Gustave Roussy, 114 rue Edouard-Vaillant, 94800 Villejuif, France; (É.R.); (S.R.)
- Université Paris Saclay, AP-HP, 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France;
- Correspondence: (A.M.); (C.R.)
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15
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The Relationship between Tumor Development and Sarcoidosis in Aspects of Carcinogenesis before and after the Onset of Sarcoidosis. Medicina (B Aires) 2022; 58:medicina58060768. [PMID: 35744031 PMCID: PMC9230813 DOI: 10.3390/medicina58060768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives: It is still unclear whether sarcoidosis is likely to be associated with tumors. In addition, the use of an immune checkpoint inhibitor has been reported to initiate the onset of sarcoidosis. We retrospectively analyzed tumor development before and after the diagnosis of sarcoidosis and examined the impact of having a history of tumors on the activity or the severity of sarcoidosis. Materials and Methods: We recruited 312 consecutive cases of sarcoidosis and analyzed the tumor development before and after the onset of sarcoidosis. Results: Among them, 25 cases were diagnosed with malignant tumor after diagnosis of sarcoidosis. In the analysis of the tumor-development group after diagnosis of sarcoidosis, both serum angiotensin I-converting enzyme and mediastinal lymph node size were significantly reduced at the time of malignant tumor diagnosis compared to at the onset of sarcoidosis, indicating that the decreasing activity of sarcoidosis may be partly associated with tumor development. Furthermore, we examined 34 cases having tumor history before the onset of sarcoidosis and analyzed the effect of tumor history on the severity of sarcoidosis. Cases with a malignant tumor in the past were older and had less complicated organs of sarcoidosis than cases without malignant tumors in the past. Oral corticosteroid therapy was administrated more frequently in cases without malignant tumors in the past, indicating that the history of a malignant tumor may influence the severity of sarcoidosis. Conclusion: These results indicate that tumor development may be partly associated with the activity or severity of sarcoidosis.
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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
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17
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Huang YT, Lin CJ, Liao PL, Hsu MY, Chang CH, Tien PT, Lai CT, Hsia NY, Bair H, Chen HS, Chiang CC, Tsai YY. The incidence of uveitis after systemic lymphoma in Taiwan: An 18-year nationwide population-based cohort study. Medicine (Baltimore) 2022; 101:e28881. [PMID: 35212287 PMCID: PMC8878792 DOI: 10.1097/md.0000000000028881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/03/2022] [Indexed: 01/04/2023] Open
Abstract
Although uveitis can be an intraocular presentation of systemic lymphoma, it may be associated with direct lymphomatous infiltration and immune-mediated alterations. There have been no published studies describing the incidence of uveitis after systemic lymphoma. We conducted a nationwide cohort study to investigate the incidence of uveitis after systemic lymphoma diagnosis in Taiwan. Data were collected from the Taiwan National Health Insurance system and included patients newly diagnosed with systemic lymphoma between 2000 and 2017. We observed the risk of uveitis among study population since the index date until December 2017. The 1:8 of systemic lymphoma patient and paired comparison was identified by time distribution matching and individual paired with sex and age. Subsequent propensity score matching (PSM) was used to select the 1:1 of systemic lymphoma patient and paired comparison by greedy algorism with caliper of 0.05. The multiple Cox proportional hazard regression model was used to compare the developmental risk of uveitis (time-to-uveitis) between the systemic lymphoma and non-systemic lymphoma, while controlling for selected covariates. After time distribution matching, we selected 6846 patients with systemic lymphoma, and 54,768 comparisons. Among patients with systemic lymphoma groups, there were more men than women (52.94% vs 47.06%) and the mean age was 53.32 ± 21.22 years old. Systemic lymphoma incidence rates (per 10,000 person-months) of uveitis were 1.94 (95% confidence interval [CI], 1.60-2.35) in the systemic lymphoma cohort and 1.52 (95% CI, 1.42-1.63) in the non-systemic lymphoma cohort. Compared with the non-systemic lymphoma cohort, adjusted hazard ratio (aHR) of developing uveitis were 1.24 (95% CI, 1.00-1.52) in people with systemic lymphoma. But not significant in after PSM, aHR of developing uveitis were 1.17 (95% CI, 0.90-1.53). This 18-year nationwide population-based cohort study in Taiwan, showed that the risk of uveitis in patients' systemic lymphoma was not significantly higher than non-systemic lymphoma after PSM. In elderly and rheumatic patients with intraocular inflammation, it is important to first exclude uveitis masquerade syndrome, which could be a harbinger of intraocular involvement from systemic lymphoma. Further large-scale prospective clinical studies to investigate whether systemic lymphoma influences the incidence of uveitis are warranted.
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Affiliation(s)
- Yu-Te Huang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
| | - Pei-Lun Liao
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Min-Yen Hsu
- Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cheng-Hsien Chang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of Ophthalmology, Changhua Hospital, Changhua, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Henry Bair
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Byers Eye Institute, Stanford University School of Medicine, Stanford, CA
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Chun-Chi Chiang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
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18
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Mehta AA, Pavithran K, Jose WM, Vallonthaiel AG, George DR, Sudhakar N. Case series of concurrent occurrence of sarcoidosis and breast cancer - A diagnostic dilemma. Respir Med Case Rep 2022; 35:101565. [PMID: 35004168 PMCID: PMC8717247 DOI: 10.1016/j.rmcr.2021.101565] [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: 06/21/2021] [Revised: 09/08/2021] [Accepted: 12/12/2021] [Indexed: 11/24/2022] Open
Abstract
Sarcoidosis is a multi-system granulomatous disorder characterized by involvement of multiple systems with or without lymphadenitis. Pulmonary complications are common and may lead to morbidity. Breast cancer is one of the commonest malignancy among women across the world. There is an increased risk of malignancies in sarcoidosis. This association with cancer creates a diagnostic dilemma due to the predominant involvement of nodes and organ systems in both conditions. Here we report three cases of sarcoidosis with breast cancer diagnosed over one year.
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Affiliation(s)
- Asmita A Mehta
- Department of Respiratory Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, P.O. AIMS Ponekkara, Kochi, 682041, Kerala, India
| | - Keechilat Pavithran
- Department of Medical Oncology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, P.O. AIMS Ponekkara, Kochi, 682041, Kerala, India
| | - Wesley M Jose
- Department of Medical Oncology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, P.O. AIMS Ponekkara, Kochi, 682041, Kerala, India
| | - Archana George Vallonthaiel
- Department of Pathology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, P.O. AIMS Ponekkara, Kochi, 82041, Kerala, India
| | - Dr Richie George
- Department of Respiratory Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, P.O. AIMS Ponekkara, Kochi, 682041, Kerala, India
| | - Nidhi Sudhakar
- Department of Respiratory Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, P.O. AIMS Ponekkara, Kochi, 682041, Kerala, India
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Faurschou M, Omland LH, Obel N, Lindhardsen J, Baslund B. Risk of Cancer Among Sarcoidosis Patients With Biopsy-verified Nonnecrotizing Granulomatous Inflammation: Population-based Cohort Study. J Rheumatol 2021; 49:186-191. [PMID: 34782449 DOI: 10.3899/jrheum.210588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the long-term risk of hematologic cancers, invasive solid tumors, and nonmelanoma skin cancer (NMSC) among sarcoidosis patients with biopsy-verified nonnecrotizing granulomatous inflammation. METHODS We used Danish administrative registers with nationwide coverage to construct a cohort of 3892 patients with sarcoidosis and an age- and sex-matched comparison cohort of 38,920 population controls. For all patients, a biopsy demonstrating nonnecrotizing granulomatous inflammation had been obtained from the lower respiratory tract at the time of diagnosis. Study outcome was time to diagnosis of cancer. Follow-up began at time of sarcoidosis diagnosis and continued for up to 10 years. We calculated hazard ratios (HRs) as estimates of the cancer risk among the patients with sarcoidosis relative to that among the population controls and used cumulative incidence functions to calculate absolute 10-year risk estimates. RESULTS We observed an increased long-term risk of hematologic cancers (HR during the first 2 years of follow-up: 2.71 [95% CI 1.18-6.25]; HR after > 2 years of follow-up: 2.12 [95% CI 1.29-3.47]) and NMSC (HR after > 2 years of follow-up: 1.82 [95% CI 1.43-2.32]) among the patients with sarcoidosis. An increased risk of invasive solid tumors was only observed during the first 2 years (HR 1.55, 95% CI 1.18-2.04). Compared with the population controls, the patients with sarcoidosis had an increased absolute 10-year risk of hematologic cancers (risk difference 0.56%, 95% CI 0.11-1.01%) and NMSC (risk difference 1.58%, 95% CI 0.70-2.47%). CONCLUSION Sarcoidosis patients with biopsy-verified nonnecrotizing granulomatous inflammation have an increased long-term risk of hematologic cancers and NMSC compared with the general population.
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Affiliation(s)
- Mikkel Faurschou
- This work was supported by the Board of Research at the Copenhagen University Hospital, Rigshospitalet, Denmark (MF). M. Faurschou, MD, DMSci, J. Lindhardsen, MD, PhD, B. Baslund, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; L.H. Omland, MD, DMSci, N. Obel, Professor, MD, DMSci, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. M. Faurschou, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, 9 Blegdamsvej, Copenhagen, Denmark. . Accepted for publication November 2, 2021
| | - Lars H Omland
- This work was supported by the Board of Research at the Copenhagen University Hospital, Rigshospitalet, Denmark (MF). M. Faurschou, MD, DMSci, J. Lindhardsen, MD, PhD, B. Baslund, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; L.H. Omland, MD, DMSci, N. Obel, Professor, MD, DMSci, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. M. Faurschou, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, 9 Blegdamsvej, Copenhagen, Denmark. . Accepted for publication November 2, 2021
| | - Niels Obel
- This work was supported by the Board of Research at the Copenhagen University Hospital, Rigshospitalet, Denmark (MF). M. Faurschou, MD, DMSci, J. Lindhardsen, MD, PhD, B. Baslund, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; L.H. Omland, MD, DMSci, N. Obel, Professor, MD, DMSci, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. M. Faurschou, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, 9 Blegdamsvej, Copenhagen, Denmark. . Accepted for publication November 2, 2021
| | - Jesper Lindhardsen
- This work was supported by the Board of Research at the Copenhagen University Hospital, Rigshospitalet, Denmark (MF). M. Faurschou, MD, DMSci, J. Lindhardsen, MD, PhD, B. Baslund, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; L.H. Omland, MD, DMSci, N. Obel, Professor, MD, DMSci, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. M. Faurschou, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, 9 Blegdamsvej, Copenhagen, Denmark. . Accepted for publication November 2, 2021
| | - Bo Baslund
- This work was supported by the Board of Research at the Copenhagen University Hospital, Rigshospitalet, Denmark (MF). M. Faurschou, MD, DMSci, J. Lindhardsen, MD, PhD, B. Baslund, MD, PhD, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases; L.H. Omland, MD, DMSci, N. Obel, Professor, MD, DMSci, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. M. Faurschou, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, 9 Blegdamsvej, Copenhagen, Denmark. . Accepted for publication November 2, 2021
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20
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Renzulli M, Casavola M, Foà A, Pizzi C, Golfieri R. Imaging of Biliary Involvement in Sarcoidosis: Computed Tomography, Magnetic Resonance Cholangiopancreatography, and Gadolinium Ethoxybenzyl Diethylenetriamine Pentaacetic Acid-Enhanced Magnetic Resonance Imaging Findings. Tomography 2021; 7:783-791. [PMID: 34842833 PMCID: PMC8628976 DOI: 10.3390/tomography7040065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022] Open
Abstract
Sarcoidosis is a multisystem disease usually affecting the chest, hilar lymph nodes, and lungs, but can potentially involve any organ; therefore, its clinical presentation may vary. Hepatobiliary involvement is rare, and typically asymptomatic; however, it can lead to cirrhosis, and may require liver transplantation. In this report, we present a rare case of a patient affected by sarcoidosis with hepatobiliary involvement. He presented to our hospital complaining of dyspnea triggered by moderate efforts and oppressive thoracic discomfort. Chest X-ray showed multiple bilateral nodular opacities and enlargement of both hilar regions, confirmed by a subsequent total-body computed tomography scan and positron emission tomography, which also revealed cardiac, splenic, and hepatic involvement. Liver function was studied via gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging, and magnetic resonance cholangiopancreatography (MRCP) was also performed. The diagnosis of sarcoidosis was finally achieved via liver biopsy, revealing non-necrotizing granulomas in the periportal space. The patient was treated with prednisone per os, with regression of all lesions at all levels. Although other cases of biliary sarcoidosis have been described, this report provides a complete image set of Gd-EOB-DTPA-enhanced magnetic resonance and MRCP images that is lacking in the English literature, and which may be useful for diagnosis.
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Affiliation(s)
- Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.C.); (R.G.)
- Correspondence: ; Tel.: + 39-0512142958
| | - Mario Casavola
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.C.); (R.G.)
| | - Alberto Foà
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, IRCCS Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (A.F.); (C.P.)
| | - Carmine Pizzi
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, IRCCS Sant’Orsola-Malpighi Hospital, 40138 Bologna, Italy; (A.F.); (C.P.)
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.C.); (R.G.)
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21
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Kang Q, Haibo L, Gang L, Yanyan H, Lin N, Janhua Z, Bing W, Jian L. Metastasis of lung cancer? Acta Chir Belg 2021; 123:313-316. [PMID: 34753409 DOI: 10.1080/00015458.2021.2001900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Sarcoidosis is a multi-system, idiopathic, inflammatory disorder that affects the lungs in over 90% of patients. The incidence of bone lesions in sarcoidosis is only 1-13%. CASE REPORT This study describes a 60-year-old woman with a previous history of thyroid cancer, and a more recent diagnosis of lung cancer with suspicious metastatic lesions, which were confirmed to be sarcoidosis. CONCLUSION This case suggests that pulmonary neoplasms and pulmonary sarcoidosis can coexist and be easily confused. When lung cancer is accompanied by symmetric hilar lymph node enlargement and multiple lung nodules, sarcoidosis should be considered in addition to metastasis, and a biopsy should be performed for confirmation.
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Affiliation(s)
- Qi Kang
- Department of Thoracic surgery, The First Affiliated Hospital, Peking University, Beijing, China
| | - Liu Haibo
- Department of Thoracic surgery, The First Affiliated Hospital, Peking University, Beijing, China
| | - Lin Gang
- Department of Thoracic surgery, The First Affiliated Hospital, Peking University, Beijing, China
| | - Hu Yanyan
- Department of Oncology Department, The Fouth Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Nong Lin
- Department of Department of Pathology, The First Affiliated Hospital, Peking University, Beijing, China
| | - Zhang Janhua
- Department of Department of Nuclear Medicine, The First Affiliated Hospital, Peking University, Beijing, China
| | - Wang Bing
- Department of Department of Orthopedics, The First Affiliated Hospital, Peking University, Beijing, China
| | - Li Jian
- Department of Thoracic surgery, The First Affiliated Hospital, Peking University, Beijing, China
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22
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Clinical Characteristics of Sarcoidosis Patients with Self-Reported Lymphoma: A US Nationwide Registry Study. Lung 2021; 199:611-618. [PMID: 34665319 DOI: 10.1007/s00408-021-00485-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Little is known about the association between sarcoidosis and lymphoma. We aim to determine the prevalence of lymphoma in US sarcoidosis patients and compare the clinical characteristics of patients with and without lymphoma. METHODS Using a national registry-based study investigating 3560 respondents to the Foundation for Sarcoidosis Research Sarcoidosis Advanced Registry for Cures Questionnaire (FSR-SARC) completed between June 2014 and August 2019, we identified patients who reported the diagnosis of lymphoma following sarcoidosis and randomly selected a computer-generated control sample of sarcoidosis patients with no reported lymphoma with a 2:1 ratio. RESULTS Among 3560 patients with sarcoidosis, 43 (1.2%) reported developing lymphoma following their sarcoidosis diagnosis. Patients with lymphoma were more likely to be diagnosed with sarcoidosis at a younger age (median, IQR) 40 (27-50) vs 45 (34.8-56, p = 0.017) years, were more likely to be African-Americans OR 95% CI 3.9 (1.6-9.6, p = 0.002), and have low annual income (OR 2.7, 1.1-6.4 p = 0.026). The sarcoidosis-lymphoma group were more likely to have salivary gland (16% vs 5%, p = 0.026) (OR 4; 1.1-14.5) and cutaneous (46% vs 23%, p = 0.023) (OR 2.9; 1.1-7.3) sarcoidosis. They also reported more chronic fatigue (42% vs 23%, p = 0.029), chronic pain (37% vs 13%, p = 0.001), and depression (42% vs 22%, p = 0.019). CONCLUSION The prevalence of lymphoma reported in sarcoidosis patients is higher than the general population which further supports the possible increased risk of lymphoma in sarcoidosis. Diagnosis of sarcoidosis at a younger age, African-American race, cutaneous, and salivary glands sarcoidosis were associated with lymphoma. Sarcoidosis patients who developed lymphoma reported higher disease burden and more non-organ-specific manifestations.
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Learned BN, Nasiri-Ahad W, Davis JE, Desai AG, Chang A. Rare Association between Sarcoidosis and Smoldering Multiple Myeloma: A Case Report. Cancer Invest 2021; 39:880-884. [PMID: 34606401 DOI: 10.1080/07357907.2021.1988633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
While several case reports suggest an association between sarcoidosis and multiple myeloma (MM), few cases involve smoldering MM. We report a case of sarcoidosis and smoldering MM discovered simultaneously in a patient admitted for hypercalcemia. Initial tests raised suspicion for sarcoidosis and MM, prompting invasive testing. Surgical lung biopsy revealed necrotizing granulomas, which could represent sarcoidosis in the appropriate setting. Thus, sarcoidosis was diagnosed following a negative infectious workup. Bone marrow biopsy revealed 13% plasma cells leading to subsequent diagnosis of smoldering MM. This case demonstrates the challenge of determining disease activity when other causes of CRAB symptoms are present.
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Affiliation(s)
- Brooke N Learned
- Department of Medicine, Stony Brook Medicine, Stony Brook, New York, USA
| | - Wazhma Nasiri-Ahad
- Division of Endocrinology and Metabolism, Stony Brook Medicine, Stony Brook, New York, USA
| | - James E Davis
- Department of Pathology, Stony Brook Medicine, Stony Brook, New York, USA
| | - Alpa G Desai
- Division of Pulmonary, Critical Care, and Sleep Medicine, Stony Brook Medicine, Stony Brook, New York, USA
| | - Alan Chang
- Division of Endocrinology and Metabolism, Stony Brook Medicine, Stony Brook, New York, USA
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Limninart N, Harvey JA, Schultz KJ, Mills AM, Noland MMB, Schroen AT, Rochman CM. "What Do You Mean It's Not Cancer?" A Review of Autoimmune and Systemic Inflammatory Diseases Involving the Breast. JOURNAL OF BREAST IMAGING 2021; 3:612-625. [PMID: 38424941 DOI: 10.1093/jbi/wbab029] [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: 12/14/2020] [Indexed: 03/02/2024]
Abstract
Autoimmune and systemic inflammatory diseases represent a heterogeneous group of immune-mediated conditions with a wide range of clinical presentations and various affected organs. Autoimmune diseases can present in the breast as localized disease or as part of systemic involvement. Although breast involvement is uncommon, the spectrum of imaging findings can include breast masses, axillary adenopathy, calcifications, and skin changes, the appearance of which can mimic breast cancer. Common etiologies include diabetic mastopathy, systemic lupus erythematosus, scleroderma, rheumatoid arthritis, idiopathic granulomatous mastitis, sarcoidosis, and Immunoglobulin-G4 related mastopathy. This educational review will present multimodality imaging findings of breast manifestations of systemic inflammatory and autoimmune diseases and coexisting complications. It will also review how these disorders may affect breast cancer risk and breast cancer treatment options, including radiation therapy.
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Affiliation(s)
- Narisara Limninart
- King Chulalongkorn Memorial Hospital, Department of Radiology, Bangkok, Thailand
| | - Jennifer A Harvey
- University of Rochester, Department of Medicine Imaging Sciences, Rochester, NY, USA
| | - Katherine J Schultz
- Cincinnati Children's Hospital, Department of Pediatric Rheumatology, Cincinnati, OH, USA
| | - Anne M Mills
- University of Virginia, Department of Pathology, Charlottesville, VA, USA
| | | | - Anneke T Schroen
- University of Virginia, Department of Surgery, Charlottesville, VA, USA
| | - Carrie M Rochman
- University of Virginia, Department of Radiology and Medical Imaging, Charlottesville, VA, USA
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25
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Sarcoidosis vs. Colon Cancer Metastasis: Diagnostic Dilemma and the Role of PET Scan in Monitoring Disease Activity. Case Rep Rheumatol 2021; 2021:5529523. [PMID: 34258100 PMCID: PMC8244180 DOI: 10.1155/2021/5529523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/31/2021] [Accepted: 04/12/2021] [Indexed: 11/18/2022] Open
Abstract
Sarcoidosis is a systemic inflammatory disorder characterized by “noncaseating granulomas.” It primarily affects the lungs, but multiple other organs can be involved. Sarcoidosis has been increasingly reported in association with cancer. It can precede, follow or occur at the same time as the diagnosis of cancer. We report a case of sarcoidosis that was diagnosed concomitantly with colon cancer, highlighting the diagnostic dilemma of sarcoidosis vs. cancer metastasis, the relationship between the two, and the value of PET scan in follow-up and monitoring of disease activity.
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Abstract
PURPOSE OF REVIEW There is a complex interaction between sarcoidosis and malignancy. Since tumors can elicit a granulomatous reaction, the presence of granulomas alone is insufficient to diagnose sarcoidosis in a patient with cancer. In addition, check point inhibitors can also lead to a granulomatous reaction which can be misdiagnosed as sarcoidosis. These issues need to be considered when exploring the relationship between sarcoidosis and malignancy. Despite these limitations, a growing amount of evidence supports the potential interaction of sarcoidosis and malignancy. RECENT FINDINGS Several large epidemiologic studies of patients from Europe, the USA, and Japan reveal an increased relative risk for cancer in sarcoidosis patients. The highest relative risks are seen in patients with lymphoma and breast cancer. New criteria have been developed to standardize the diagnosis of sarcoidosis, which should further clarify the association. SUMMARY The diagnosis of sarcoidosis may precede or occur after malignancy. In a sarcoidosis patient with an atypical lesion, such as a breast mass, a biopsy should be considered.
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Okwundu N, Grossman D, Hu-Lieskovan S, Grossmann KF, Swami U. The dark side of immunotherapy. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1041. [PMID: 34277841 PMCID: PMC8267325 DOI: 10.21037/atm-20-4750] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/28/2020] [Indexed: 12/13/2022]
Abstract
Immunotherapy has broadened the therapeutic scope and response for many cancer patients with drugs that are generally of higher efficacy and less toxicity than prior therapies. Multiple classes of immunotherapies such as targeted antibodies and immune checkpoint inhibitors (ICI), cell-based immunotherapies, immunomodulators, vaccines, and oncolytic viruses have been developed to help the immune system target and destroy malignant tumors. ICI targeting programmed cell death protein-1 (PD-1) or its ligand (PD-L1) are among the most effective immunotherapy agents and are a major focus of current investigations. They have received approval for at least 16 different tumor types as well as for unresectable or metastatic tumors with microsatellite instability-high (MSI-H) or mismatch repair deficiency or with high tumor mutational burden (defined as ≥10 mutations/megabase). However, it is important to recognize that immunotherapy may be associated with significant adverse events. To summarize these events, we conducted a PubMed and Google Scholar database search through April 2020 for manuscripts evaluating treatment-related adverse events and knowledge gaps associated with the use of immunotherapy. Reviewed topics include immune-related adverse events (irAEs), toxicities on combining immunotherapy with other agents, disease reactivation such as tuberculosis (TB) and sarcoid-like granulomatosis, tumor hyperprogression (HPD), financial toxicity, challenges in special patient populations such as solid organ transplant recipients and those with auto-immune diseases. We also reviewed reports of worse or even lethal outcomes compared to other oncologic therapies in certain scenarios and summarized biomarkers predicting adverse events.
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Affiliation(s)
- Nwanneka Okwundu
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Douglas Grossman
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Siwen Hu-Lieskovan
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Kenneth F Grossmann
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Umang Swami
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, UT, USA
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28
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Sarcoidosis or cancer? That is the question. Respir Med Case Rep 2021; 33:101426. [PMID: 34401272 PMCID: PMC8348150 DOI: 10.1016/j.rmcr.2021.101426] [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: 02/01/2021] [Revised: 04/08/2021] [Accepted: 05/07/2021] [Indexed: 12/03/2022] Open
Abstract
Sarcoidosis is a granulomatous inflammatory disease of unknown etiology. Sarcoid like granuloma may develop concurrently or following cancer. Detection of granuloma in mediastinal lymph nodes biopsy in patient with pulmonary nodules may be a concern for undiagnosed lung cancer. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a diagnostic modality of choice for the lung lesions. We discussed A 71-year-old man with history of chronic obstructive lung disease (COPD), who presented with a lung nodule and mediastinal lymphadenopathies. The nodule was 9.9 mm when detected and his endobronchial ultrasound-guided transbronchial fine needle aspiration (EBUS-TBNA) of lymph nodes in station 7 & 4R showed normal lymph node structure. Two years later, his surveillance chest CT scan indicated an increase in the size of the nodule to 15 mm, and PET/CT showed Fluorodeoxyglucose (FDG) avid nodule & mediastinal Lymph nodes. He complained of Shortness of breath after 2–3 climbs of stairs, without any history of cough or fever. He quit cigarette smoking recently and smoked 50 pack years before. He underwent another set of EBUS and was referred for sarcoidosis treatment due to finding non-necrotizing granuloma in 4L and 11L lymph nodes. The patient also underwent another biopsy of the nodule concerning the possibility of cancer sarcoid syndrome. A poorly differentiated lung adenocarcinoma positive for GATA3, positive for P63 and CK7, TTF-1 was reported. Concurrent lung cancer and granulomatous reaction in mediastinal lymph nodes are being reported more often. Recent studies have shown a better survival of patients with diagnosis of cancer and granulomatous findings of sarcoidosis. Performing lung biopsy from any nodular lesion in a patient with sarcoidosis is essential for the differential diagnosis and early therapeutic measures.
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McVeigh N, Murphy DJ, McKone E, Dodd JD. Obliterating Airway Bronchus Sign of Occult Malignancy in Sarcoid Conglomerate Fibrotic Masses. J Clin Imaging Sci 2021; 11:12. [PMID: 33767904 PMCID: PMC7981934 DOI: 10.25259/jcis_103_2020] [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: 06/24/2020] [Accepted: 01/29/2021] [Indexed: 11/04/2022] Open
Abstract
Sarcoidosis is a multiorgan disease which presents in up to 95% of cases with lung involvement, a proportion of which develops conglomerate fibrotic masses (CFMs). CFMs typically progressively increase in size overtime. The development of a lung malignancy within a CFM is rare and difficult to diagnose within the underlying lung fibrosis. Here, we describe the obstructing airway bronchus sign in CFMs as an important part of assessing CFMs overtime on computed tomography, which when it occurs should raise suspicion of an occult underlying carcinoma.
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Affiliation(s)
- Niall McVeigh
- Department of Cardiothoracic Surgery, St. Vincent's University College, Dublin, Ireland
| | - David J Murphy
- Department of Radiology, St. Vincent's University College, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Edward McKone
- Department of Respiratory Medicine, St. Vincent's University College, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Jonathan D Dodd
- Department of Radiology, St. Vincent's University College, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin 4, Ireland
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30
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Wenter V, Albert NL, Ahmaddy F, Unterrainer M, Hornung J, Ilhan H, Bartenstein P, Spitzweg C, Kneidinger N, Todica A. The diagnostic challenge of coexistent sarcoidosis and thyroid cancer - a retrospective study. BMC Cancer 2021; 21:139. [PMID: 33550991 PMCID: PMC7868024 DOI: 10.1186/s12885-020-07745-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 12/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Sarcoid lesions may mimic metastatic disease or recurrence in thyroid cancer (TC) patients as both diseases may affect the lungs and lymph nodes. We present the first study to systematically evaluate the clinical course of patients with (TC) after adjuvant radioactive iodine therapy (RIT) and concomitant sarcoidosis of the lung or the lymph nodes. METHODS We screened 3285 patients and retrospectively identified 16 patients with TC (11 papillary thyroid cancer (PTC), 3 follicular thyroid cancer (FTC), 1 oncocytic PTC, 1 oncocytic FTC) and coexisting sarcoidosis of the lung and/or the lymph nodes treated at our institute. All patients had undergone thyroidectomy and initial adjuvant RIT. Challenges in diagnosing and the management of these patients were evaluated during long term follow-up (median 4.9 years (0.8-15.0 years)). RESULTS Median age at first diagnosis of TC was 50.1 years (33.0-71.5 years) and of sarcoidosis 39.4 years (18.0-63.9 years). During follow-up, physicians were able to differentiate between SA and persistent or recurrent TC in 10 of 16 patients (63%). Diagnosis was complicated by initial negative thyroglobulin (Tg), positive Tg antibodies and non-specific imaging findings. Histopathology can reliably distinguish between SA and TC in patients with one suspicious lesion. CONCLUSION Physicians should be aware of the rare coexistence of sarcoidosis and TC. Lymphadenopathy and pulmonary lesions could be metastases, sarcoidosis or even a mix of both. Therefore, this rare patient group should receive a thorough work up including histopathological clarification and, if necessary, separately for each lesion.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/diagnostic imaging
- Adenocarcinoma, Follicular/metabolism
- Adenocarcinoma, Follicular/surgery
- Adolescent
- Adult
- Aged
- Biomarkers, Tumor/metabolism
- Diagnosis, Differential
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Prognosis
- Retrospective Studies
- Sarcoidosis/diagnosis
- Sarcoidosis/diagnostic imaging
- Sarcoidosis/metabolism
- Sarcoidosis/surgery
- Thyroid Cancer, Papillary/diagnosis
- Thyroid Cancer, Papillary/diagnostic imaging
- Thyroid Cancer, Papillary/metabolism
- Thyroid Cancer, Papillary/surgery
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/diagnostic imaging
- Thyroid Neoplasms/metabolism
- Thyroid Neoplasms/surgery
- Young Adult
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Affiliation(s)
- Vera Wenter
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Nathalie L Albert
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Freba Ahmaddy
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Marcus Unterrainer
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Julia Hornung
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Harun Ilhan
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Comprehensive Cancer Center (CCC LMU) and Interdisciplinary Center for Thyroid Carcinoma (ISKUM), University Hospital, LMU Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Comprehensive Cancer Center (CCC LMU) and Interdisciplinary Center for Thyroid Carcinoma (ISKUM), University Hospital, LMU Munich, Munich, Germany
| | - Christine Spitzweg
- Comprehensive Cancer Center (CCC LMU) and Interdisciplinary Center for Thyroid Carcinoma (ISKUM), University Hospital, LMU Munich, Munich, Germany
- Department of Internal Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center (CPC-M), Helmholtz Zentrum München, Member of the German Centre for Lung Research (DZL), Munich, Germany
| | - Andrei Todica
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Comprehensive Cancer Center (CCC LMU) and Interdisciplinary Center for Thyroid Carcinoma (ISKUM), University Hospital, LMU Munich, Munich, Germany
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Kawai H, Sarai M, Toyama H, Izawa H. Activation of cardiac sarcoidosis associated with development of gastric cancer: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytaa558. [PMID: 33738412 PMCID: PMC7954260 DOI: 10.1093/ehjcr/ytaa558] [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: 09/10/2020] [Revised: 10/08/2020] [Accepted: 12/14/2020] [Indexed: 11/17/2022]
Abstract
Background The high 18F-fluorodeoxyglucose (FDG) uptake in sarcoidosis lesions reflects infiltration of inflammatory cells such as macrophages. An increased incidence of cancer in patients with sarcoidosis has been suggested, and some combination of the following mechanisms has been proposed: chronic inflammation, immune dysfunction, shared aetiologic agents, and genetic susceptibility to both cancer and autoimmune diseases. Case summary A 73-year-old man was admitted to our hospital due to effort dyspnoea. Initial investigations showed complete atrioventricular block on electrocardiography, basal thinning of the interventricular septum, and preserved left ventricular (LV) systolic function on echocardiography, and late gadolinium enhancement (LGE) in all layers of the basal interventricular septum on cardiac magnetic resonance imaging. FDG positron emission tomography/computerized tomography (FDG-PET/CT) showed no abnormal uptake in the whole-body including myocardium. After discussion, corticosteroid was not initiated then. One year later, he developed stomach adenocarcinoma. Repeated investigations demonstrated enlargement of the LV (LV diastolic diameter 63 mm) and diffuse systolic impairment of LV function (LV ejection fraction 31%) on echocardiography, and abnormal focal uptake at the lateral walls of LV and hilar lymph nodes on FDG-PET/CT imaging. One more year after the surgery for gastric cancer and corticosteroid initiation, echocardiography showed recovery of systolic function and FDG-PET/CT showed no uptake in either the myocardium or hilar lymph nodes. Discussion In the present case, it is speculated that the first inflammation which left scarred areas showing LGE was already completed before the first FDG-PET/CT. The development of gastric cancer may be associated with the reactivation of cardiac sarcoidosis.
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Affiliation(s)
- Hideki Kawai
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, Japan
| | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, Japan
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Tamada T, Nara M, Murakami K, Gamo S, Aritake H, Shimizu M, Kazama I, Ichinose M, Sugiura H. The Clinical Features of Patients with Sarcoidosis and Malignant Diseases in Japan. Intern Med 2021; 60:209-216. [PMID: 33456025 PMCID: PMC7872817 DOI: 10.2169/internalmedicine.5441-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective Recent studies suggest a significant association between sarcoidosis and malignancy, although the results have remained controversial. The aim of this study is to evaluate the clinical features of patients with sarcoidosis associated with malignant diseases in Japan. Patients We conducted a medical record review of all sarcoidosis patients in Tohoku University Hospital between January 1, 1981, and May 31, 2017. Methods The clinical records and pathology reports for each patient were screened, and the clinical characteristics of malignancies as well as sarcoidosis were reviewed. Results A total of 52 (18.8%) patients with malignancy were identified among 277 patients with sarcoidosis. Among those 52 patients, we identified 62 with malignant diseases. These patients were older and more likely to be women than the remaining 225 (81.2%) sarcoidosis patients without malignancy. The most prevalent malignant disease was breast cancer (14 cases, 22.6%), followed by stomach cancer (8 cases, 12.9%) and lung cancer (7 cases, 11.3%). Among the 14 patients with both sarcoidosis and breast cancer, 8 (57.1%) were diagnosed with breast cancer before sarcoidosis. All of these eight cases had undergone surgical resection of the cancer. Conclusion This study showed a higher incidence of patients with both sarcoidosis and malignancy in Japan than in some western countries. Breast cancer is the most prevalent malignant disease. The high frequency of sarcoidosis after surgical resection of breast cancer may suggest a causative association between malignancy and the development of sarcoidosis.
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Affiliation(s)
- Tsutomu Tamada
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Masayuki Nara
- National Hospital Organization Akita National Hospital, Japan
| | - Koji Murakami
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Shunichi Gamo
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Hidemi Aritake
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Megumi Shimizu
- Department of Gerontological and Home Healthcare Nursing, Course of Nursing, Tohoku University Graduate School of Medicine, Japan
| | | | - Masakazu Ichinose
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Hisatoshi Sugiura
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Japan
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33
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Malignancy in patients with sarcoidosis. ACTA ACUST UNITED AC 2021; 17:49-51. [DOI: 10.1016/j.reuma.2019.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/04/2019] [Accepted: 04/30/2019] [Indexed: 11/19/2022]
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Case Report and Review of 7 Similar Cases in the Literature: Cutaneous Sarcoidosis as Side Effect of Pembrolizumab Plus Chemotherapy in Stage IV Squamous Cell Carcinoma of Lung. J Immunother 2020; 44:90-94. [PMID: 33298795 DOI: 10.1097/cji.0000000000000351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/31/2020] [Indexed: 11/26/2022]
Abstract
Advanced squamous cell lung cancer used to have universally dismal long-term outcomes before the use of immune checkpoint inhibitors (ICIs). Due to the expanding role of ICIs, there has been an increasing number of long-term survivors in this relatively large group of patients. ICIs such as anti-cytotoxic T-lymphocyte-associated protein 4 and anti-programmed cell death protein 1/programmed death-ligand 1 monoclonal antibodies increase the T-cell activation and limit the tumor capacity to escape the adaptive immune response. However, efficacy comes along with unique immune-related adverse events. We present an unusual case of cutaneous sarcoidosis in a 63-year-old white female who was diagnosed with stage IV squamous cell lung cancer developed skin manifestations 3 months after started chemo/pembrolizumab. Sarcoidosis was confirmed by skin punch biopsy and resolved after a short course of systemic glucocorticoid while maintained on pembrolizumab with lower frequency. These sarcoid-like lesions associated with the blockage of programmed death receptor-1 have been increasingly described in many different malignancies especially in melanoma. There is a need for further investigation to the characterization of the population prone to this immune-related adverse events.
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Tirelli C, Bortolotto C, Morbini P, Stella GM. Case Report: All That Glisters Is Not * Cancer. Front Med (Lausanne) 2020; 7:541629. [PMID: 33330521 PMCID: PMC7734188 DOI: 10.3389/fmed.2020.541629] [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: 03/09/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
Properly performed staging in non-small-cell lung cancer (NSCLC) is necessary to avoid wrong therapeutic decisions. Here we present a case which manifested as advanced NSCLC but ultimately was composed of two different and rare pathologies. The first is a TTF-1 positive axillary lymph node that could be defined either as an unusual isolated differentiated cancer of unknown primary or as an even rarer case of ectopic lung epithelium which underwent malignant transformation. The second is sarcoidosis, a sarcoid-like alteration, in remission after oral steroids. The main implication of a correct diagnosis regards patient outcome and the avoidance of toxic inappropriate systemic chemotherapy.
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Affiliation(s)
- Claudio Tirelli
- Unit of Respiratory System Diseases, Department of Medical Sciences and Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo Foundation, Pavia, Italy
| | - Chandra Bortolotto
- Unit of Radiology, Department of Intensive Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
| | - Patrizia Morbini
- Unit of Pathology, Department of Molecular Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
| | - Giulia Maria Stella
- Unit of Respiratory System Diseases, Department of Medical Sciences and Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo Foundation, Pavia, Italy
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El Jammal T, Pavic M, Gerfaud-Valentin M, Jamilloux Y, Sève P. Sarcoidosis and Cancer: A Complex Relationship. Front Med (Lausanne) 2020; 7:594118. [PMID: 33330555 PMCID: PMC7732692 DOI: 10.3389/fmed.2020.594118] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/30/2020] [Indexed: 12/19/2022] Open
Abstract
Sarcoidosis is a systemic disease of unknown etiology, characterized by the presence of non-caseating granulomas in various organs, mainly the lungs, and the lymphatic system. Since the individualization of sarcoidosis-lymphoma association by Brincker et al., the relationship between sarcoidosis or granulomatous syndromes and malignancies has been clarified through observational studies worldwide. Two recent meta-analyses showed an increased risk of neoplasia in sarcoidosis. The granulomatosis can also reveal malignancy, either solid or hematological, defining paraneoplastic sarcoidosis. Recent cancer immunotherapies, including immune checkpoint inhibitors (targeting PD-1, PD-L1, or CTLA-4) and BRAF or MEK inhibitors were also reported as possible inducers of sarcoidosis-like reactions. Sarcoidosis and neoplasia, especially lymphoma, can show overlapping presentations, thus making the diagnosis and treatment harder to deal with. There are currently no formal recommendations to guide the differential diagnosis workup between the evolution of lymphoma or a solid cancer and a granulomatous reaction associated with neoplasia. Thus, in atypical presentations (e.g., deeply impaired condition, compressive lymphadenopathy, atypical localization, unexplained worsening lymphadenopathy, or splenomegaly), and treatment-resistant disease, targeted biopsies on suspect localizations with histological examination could help the clinician to differentiate neoplasia from sarcoidosis. Pathological diagnosis could sometimes be challenging since very few tumor cells may be surrounded by massive granulomatous reaction. The sensitization of currently available diagnostic tools should improve the diagnostic accuracy, such as the use of more “cancer-specific” radioactive tracers coupled with Positron Emission Tomography scan.
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Affiliation(s)
- Thomas El Jammal
- Internal Medicine Department, La Croix-Rousse Hospital, Lyon, France
| | - Michel Pavic
- Medicine Department, Sherbrooke University, Sherbrooke, QC, Canada
| | | | - Yvan Jamilloux
- Internal Medicine Department, La Croix-Rousse Hospital, Lyon, France.,INSERM U1111, Center International de Recherche en Infectiologie/International Research Center in Infectiology (CIRI), University Claude-Bernard Lyon 1, Villeurbanne, France
| | - Pascal Sève
- Internal Medicine Department, La Croix-Rousse Hospital, Lyon, France.,Pôle IMER, Hospices Civils de Lyon, Lyon, France.,HESPER EA 7425, Lyon University, University Claude-Bernard Lyon 1, Lyon, France
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Murthi M, Yoshioka K, Cho JH, Arias S, Danna E, Zaw M, Holt G, Tatsumi K, Kawasaki T, Mirsaeidi M. Presence of concurrent sarcoid-like granulomas indicates better survival in cancer patients: a retrospective cohort study. ERJ Open Res 2020; 6:00061-2020. [PMID: 33263026 PMCID: PMC7682654 DOI: 10.1183/23120541.00061-2020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction An increased risk of sarcoidosis and sarcoid-like reactions in subjects with a history of malignancy has been suggested. We assessed the incidence and clinical characteristics of cancer patients with biopsies containing sarcoid-like granulomas on cancer metastasis and patient survival. Methods This is a retrospective, multicentre, observational study involving endobronchial ultrasound transbronchial needle aspiration and a melanoma patient dataset at the University of Miami, USA, and a sarcoidosis patient database at Chiba University, Japan. Subjects with a confirmed diagnosis of cancer and who subsequently developed granulomas in different organs were enrolled. The study was registered at Clinicaltrials.gov (NCT03844698). Results 133 patients met the study's criteria. The most common primary cancer sites were the skin (22.5%), breast (20.3%) and lymph node (12.8%). 24 (18%) patients developed sarcoid-like granulomas within 1 year of cancer diagnosis, 54 (40.6%) between 1 and 5 years and 49 (36.8%) after 5 years. Imaging showed possible sarcoid-like granulomas in lymph nodes in 51 cases (38.3%) and lung tissue and mediastinal lymph nodes in 73 cases (54.9%); some parenchymal reticular opacity and fibrosis was found in 5 (3.7%) and significant parenchymal fibrosis in 2 (1.5%) subjects. According to logistic regression analysis, the frequency of metastatic cancer was significantly lower in patients with sarcoid-like granulomas than in controls. Moreover, multivariate Cox proportional hazard analysis showed a significant survival advantage in those with sarcoid-like granuloma. Conclusion Sarcoid-like granulomas are uncommon pathology findings in cancer patients. There is a significant association between the presence of granulomas and reduced metastasis and increased survival. Further study is warranted to understand the protective mechanism involved.
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Affiliation(s)
- Mukunthan Murthi
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, USA
| | - Keiichiro Yoshioka
- Dept of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jeong Hee Cho
- Dept of Pathology, University of Miami, Miami, FL, USA
| | - Sixto Arias
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, USA
| | - Elio Danna
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, USA
| | - Moe Zaw
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, USA
| | - Greg Holt
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, USA.,Section of Pulmonary, Miami VA Healthcare System, Miami, FL, USA
| | - Koichiro Tatsumi
- Dept of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeshi Kawasaki
- Dept of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mehdi Mirsaeidi
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, USA.,Section of Pulmonary, Miami VA Healthcare System, Miami, FL, USA
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Recurrent Superior Vena Cava Syndrome in a Patient with Sarcoidosis and Pancreatic Adenocarcinoma: A Case Report and Literature Review. MEDICINES 2020; 7:medicines7090056. [PMID: 32899649 PMCID: PMC7555268 DOI: 10.3390/medicines7090056] [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: 07/31/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 11/17/2022]
Abstract
Background: Superior vena cava (SVC) syndrome may result from extravascular compression or intravascular obstruction such as thrombosis. Recurrent venous thrombosis is typically associated with a hypercoagulable state such as malignancy, and inheritable or acquired coagulopathy. Sarcoidosis is a derangement of the immune system, and it has been associated with malignant diseases and hypercoagulation. The association of pancreatic cancer and sarcoidosis with SVC syndrome has not been reported previously. Here, we present a case of recurrent venous thrombosis causing SVC syndrome in a patient with pancreatic ductal adenocarcinoma and underlying thoracic sarcoidosis. Methods: The patient's electronic health record was retrospectively analyzed. Results: A 66-year-old woman with pancreatic adenocarcinoma was treated with neoadjuvant chemotherapy followed by Whipple procedure, before developing tumor recurrence in the liver. Her treatment course was complicated with repeated incidents of venous thrombosis in the presence of a central venous catheter leading to recurrent SVC syndrome, which resolved with anti-coagulation. Conclusions: This case raises a plausible inter-relationship between sarcoidosis, pancreatic cancer, and hypercoagulable state. We suggest that patients with multiple risk factors for developing venous thrombosis should be carefully monitored for any thrombotic event, and they may benefit from prophylactic anti-coagulation.
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Lim PN, Kirby L, Wylie G. Presentation of squamous cell carcinoma in pre-existing cutaneous sarcoidosis. BMJ Case Rep 2020; 13:13/8/e236426. [PMID: 32843386 DOI: 10.1136/bcr-2020-236426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Puo Nen Lim
- Dermatology Department, Stobhill Hospital (New), Glasgow, UK
| | - Lisa Kirby
- Dermatology Department, Stobhill Hospital (New), Glasgow, UK
| | - Grant Wylie
- Dermatology Department, Stobhill Hospital (New), Glasgow, UK
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James WE. Overlap Syndromes in Sarcoidosis: Clinical Features and Outcomes. Semin Respir Crit Care Med 2020; 41:607-617. [PMID: 32777847 DOI: 10.1055/s-0040-1713008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Sarcoidosis is a multisystem inflammatory disease characterized by noncaseating granulomatous inflammation. While pulmonary sarcoidosis is most common, extrapulmonary involvement occurs in 50 to 74% of patients and can be the presenting abnormality in some patients. The diagnosis of sarcoidosis is based on a compatible clinical presentation in combination with granulomas on histology and exclusion of other causes. However, the absence of a diagnostic biomarker for sarcoidosis, in addition to the overlap of granulomatous inflammation and nonspecific clinical findings with other diseases, often results in a delayed diagnosis. Sarcoidosis overlap syndromes are typically described when sarcoidosis is diagnosed in the presence of another disease (concurrently or sequentially) with shared clinical and histologic features, or when sarcoidosis presents with clinical features typically observed in, but not diagnostic of, other diseases. Awareness of overlap syndromes is important for clinicians to avoid diagnostic errors and evaluate for concomitant diagnoses that may impact the management and outcome of sarcoidosis. This article is intended to provide an overview of these presentations and the most commonly associated diseases, with attention to their prevalence, clinical features, and reciprocal impacts on disease outcomes.
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Affiliation(s)
- W Ennis James
- Division of Pulmonary and Critical Care Medicine, Susan Pearlstine Sarcoidosis Center of Excellence, Medical University of South Carolina, Charleston, South Carolina
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41
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Larsson J, Graff P, Bryngelsson IL, Vihlborg P. Sarcoidosis and increased risk of comorbidities and mortality in sweden. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2020; 37:104-135. [PMID: 33093776 PMCID: PMC7569548 DOI: 10.36141/svdld.v37i2.9142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/18/2020] [Indexed: 11/04/2022]
Abstract
Introduction: Sarcoidosis is a systemic inflammatory disorder, with an unclear etiology, involving granuloma formation that in most cases affects the lungs and intrathoracic lymph nodes. Sarcoidosis occurs in an acute or chronic form, each with different clinical presentation and prognosis. Methods: Case-control study of comorbidity and mortality in people diagnosed with sarcoidosis (ICD10 code D86) from 2007 through 2016 in Sweden. Controls were matched to cases (2:1) based on age, sex and county at the time of diagnosis. Data was collected from the Swedish National Patient Register and The Cause of Death Register. All men and women aged 20-65 years old who were diagnosed with sarcoidosis (D86, ICD10) during the years of study were included, resulting 7828 cases and 15656 controls. Results: Patients with sarcoidosis had increased mortality compared to matched controls (hazard ratio 1.88; 95% CI 1.56 – 2.26) and the Swedish general population (standardized mortality ratios1.75; 95% CI 1.52 – 2.00). The sarcoid cases, compared to controls, also had a significantly greater number of inpatient visits within several different chapters of ICD10 e.g. cardiomyopathy, heart failure, pulmonary embolism and malignant neoplasm. Conclusion: Individuals with sarcoidosis are at higher risk of comorbidities and mortality than matched controls as well as the general population of Sweden. These findings are important knowledge for healthcare professionals who meet sarcoid patients, to encourage identification and treatment of comorbidities to reduce the risk of impaired quality of life and, eventually, premature death. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 104-135)
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Affiliation(s)
- Johanna Larsson
- Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden
| | - Pål Graff
- National Institute of Occupational Health, Department of Chemical and Biological Work Environment, Oslo, Norway
| | - Ing-Liss Bryngelsson
- Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden
| | - Per Vihlborg
- Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden
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Sesé L, Khamis W, Jeny F, Uzunhan Y, Duchemann B, Valeyre D, Annesi-Maesano I, Nunes H. Adult interstitial lung diseases and their epidemiology. Presse Med 2020; 49:104023. [PMID: 32437842 DOI: 10.1016/j.lpm.2020.104023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 10/23/2019] [Indexed: 02/07/2023] Open
Affiliation(s)
- Lucile Sesé
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm 1272, « Hypoxie et Poumon: pneumopathies fibrosantes, modulations ventilatoires et circulatoires », université de Sorbonne Paris Nord, 93000 Bobigny, France; Service de physiologie, hôpital Avicenne, Assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Saint-Antoine Medical School, Sorbonne Universités, UPMC Université Paris 06, 75013 Paris, France
| | - Warda Khamis
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm 1272, « Hypoxie et Poumon: pneumopathies fibrosantes, modulations ventilatoires et circulatoires », université de Sorbonne Paris Nord, 93000 Bobigny, France
| | - Florence Jeny
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm 1272, « Hypoxie et Poumon: pneumopathies fibrosantes, modulations ventilatoires et circulatoires », université de Sorbonne Paris Nord, 93000 Bobigny, France
| | - Yurdagul Uzunhan
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm 1272, « Hypoxie et Poumon: pneumopathies fibrosantes, modulations ventilatoires et circulatoires », université de Sorbonne Paris Nord, 93000 Bobigny, France
| | - Boris Duchemann
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France
| | - Dominique Valeyre
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm 1272, « Hypoxie et Poumon: pneumopathies fibrosantes, modulations ventilatoires et circulatoires », université de Sorbonne Paris Nord, 93000 Bobigny, France
| | - Isabella Annesi-Maesano
- Inserm, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Saint-Antoine Medical School, Sorbonne Universités, UPMC Université Paris 06, 75013 Paris, France
| | - Hilario Nunes
- Service de pneumologie, centre de référence des maladies pulmonaires rares (site constitutif), centre de compétence des maladies auto-immunes et systémiques rares, hôpital Avicenne, assistance publique-Hôpitaux de Paris, 93000 Bobigny, France; Inserm 1272, « Hypoxie et Poumon: pneumopathies fibrosantes, modulations ventilatoires et circulatoires », université de Sorbonne Paris Nord, 93000 Bobigny, France.
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Talreja J, Bauerfeld C, Sendler E, Pique-Regi R, Luca F, Samavati L. Derangement of Metabolic and Lysosomal Gene Profiles in Response to Dexamethasone Treatment in Sarcoidosis. Front Immunol 2020; 11:779. [PMID: 32477331 PMCID: PMC7235403 DOI: 10.3389/fimmu.2020.00779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/06/2020] [Indexed: 12/14/2022] Open
Abstract
Glucocorticoids (GCs) play a central role in modulation of inflammation in various diseases, including respiratory diseases such as sarcoidosis. Surprisingly, the specific anti-inflammatory effects of GCs on different myeloid cells especially in macrophages remain poorly understood. Sarcoidosis is a systemic granulomatous disease of unknown etiology that occurs worldwide and is characterized by granuloma formation in different organs. Alveolar macrophages play a role in sarcoidosis granuloma formation and progressive lung disease. The goal of the present study is to identify the effect of GCs on transcriptomic profiles and the cellular pathways in sarcoidosis alveolar macrophages and their corresponding blood myeloid cells. We determined and compared the whole transcriptional signatures of alveolar macrophages from sarcoidosis patients and blood CD14+ monocytes of the same subjects in response to in vitro treatment with dexamethasone (DEX) via RNA-sequencing. In response to DEX, we identified 2,834 genes that were differentially expressed in AM. Predominant pathways affected were as following: metabolic pathway (FDR = 4.1 × 10−10), lysosome (FDR = 6.3 × 10−9), phagosome (FDR = 3.9 × 10−5). The DEX effect on AMs is associated with metabolic derangements involving glycolysis, oxidative phosphorylation and lipid metabolisms. In contrast, the top impacted pathways in response to DEX treatment in blood CD14+ monocytes were as following; cytokine-cytokine receptor interaction (FDR = 6 × 10−6) and transcriptional misregulation in cancer (FDR = 1 × 10−4). Pathways similarly affected in both cell types were genes involved in lysosomes, cytoskeleton and transcriptional misregulation in cancer. These data suggest that the different effects of DEX on AMs and peripheral blood monocytes are partly dictated by lineage specific transcriptional programs and their physiological functions.
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Affiliation(s)
- Jaya Talreja
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine and Detroit Medical Center, Wayne State University, Detroit, MI, United States
| | - Christian Bauerfeld
- Division of Critical Care, Department of Pediatrics, School of Medicine and Detroit Medical Center, Wayne State University, Detroit, MI, United States
| | - Edward Sendler
- Center for Molecular Medicine and Genetics, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Roger Pique-Regi
- Center for Molecular Medicine and Genetics, School of Medicine, Wayne State University, Detroit, MI, United States.,Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Francesca Luca
- Center for Molecular Medicine and Genetics, School of Medicine, Wayne State University, Detroit, MI, United States.,Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Lobelia Samavati
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine and Detroit Medical Center, Wayne State University, Detroit, MI, United States.,Center for Molecular Medicine and Genetics, School of Medicine, Wayne State University, Detroit, MI, United States
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44
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Renal Sarcoidosis With Multiple Organ Involvement. J Clin Rheumatol 2020; 26:e55. [DOI: 10.1097/rhu.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jeon MH, Kang T, Yoo SH, Swan HS, Kim HJ, Ahn HS. The incidence, comorbidity and mortality of sarcoidosis in Korea, 2008-2015: a nationwide population-based study. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2020; 37:24-26. [PMID: 33093766 PMCID: PMC7569540 DOI: 10.36141/svdld.v37i1.7660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/10/2020] [Indexed: 01/13/2023]
Abstract
Background: Few national level, population-based studies are present on the epidemiology of sarcoidosis and it is unclear whether these patients have higher mortality than the general population. The objective of this study was to investigate the nationwide epidemiology, comorbidity and mortality in sarcoidosis in Korea. Material and Methods: For the period between 2008 to 2015, we used the national population-based database operated by Rare Intractable Disease registration program in which patients’ diagnosis are based on uniform criteria. All sarcoidosis patients were identified and followed-up using the National Health Insurance database to determine their incidence, comorbidity, mortality, causes of death and standardised mortality ratio (SMR). Results: During the study period, we identified 3,259 new sarcoidosis patients. The average annual incidence was 0.81 per 100,000. The annual mortality rate was 9.26 per 1,000 person-years. The mortality rate were significantly higher than those of the general population (SMR 1.91, 95% confidence interval 1.62-2.25). The major comorbidities of sarcoidosis patients were the diseases of the respiratory system (17.64%), heart (5.43%), eyes (4.27%) and cancer (2.3%). Mortality was higher in patients with lung involvement. Of the 84 deaths identified in this study from 2008-2013, the most common cause of death was cancer (41.7%), followed by respiratory disease (13.1%), sarcoidosis (13.1%) and heart disease (8.3%). Conclusions: We reported a nationwide incidence of sarcoidosis as 0.81 per 100,000 in Korea. The mortality of sarcoidosis patients was higher compared to the general population and the major causes of death were cancer, respiratory disease and sarcoidosis. Sarcoidosis patients with comorbid diseases showed increased mortality. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (1): 24-36)
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Affiliation(s)
- Mi Hye Jeon
- Department of Public Health, Graduate School, Korea University
| | - Taeuk Kang
- Department of Public Health, Graduate School, Korea University
| | - Sang Hoon Yoo
- Division of Pulmonology, Department of Internal Medicine, College of Medicine, Daejeon St.Mary's Hospital, The Catholic University of Korea
| | - Heather S Swan
- School of Sociology and Anthropology, University of Ottawa
| | - Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea University
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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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Corrales L, Rosell R, Cardona AF, Martín C, Zatarain-Barrón ZL, Arrieta O. Lung cancer in never smokers: The role of different risk factors other than tobacco smoking. Crit Rev Oncol Hematol 2020; 148:102895. [PMID: 32062313 DOI: 10.1016/j.critrevonc.2020.102895] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/21/2020] [Accepted: 01/29/2020] [Indexed: 12/16/2022] Open
Abstract
Lung cancer (LC), the leading cause of cancer-related deaths worldwide, is a complex and highly heterogeneous disease. Additional to its biological complexity, LC patients are often confronted with a high degree of stigma, mostly from the association of the disease with tobacco. Nonetheless, a proportion of LC patients are never-smokers, a population which we are beginning to comprehensively explore. Several risk factors have been linked to LC in never-smokers. Studies have consistently shown that radon exposure and domestic fuel smoke increase LC risk. Additionally, infections such as Mycobacterium tuberculosis, and Human Papilloma Virus are also risk factors. Other less conclusive associations include inflammatory diseases such as asthma and sarcoidosis. Moreover, we are now aware that molecular characteristics of LC vary widely according to smoking history, with important therapeutic implications. This review comprehensively assesses the current knowledge in terms of risk factors and disease characteristics in the never-smoker lung cancer population.
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Affiliation(s)
- Luis Corrales
- Centro de Investigación y Manejo del Cáncer (CIMCA), San José, Costa Rica; Hospital San Juan de Dios, San José, Costa Rica
| | - Rafael Rosell
- Catalan Institute of Oncology, Germans Trias i Pujol Research Institute and Hospital Campus Can Ruti Barcelona, Spain
| | - Andrés F Cardona
- Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Clinical and Traslational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia
| | - Claudio Martín
- Medical Oncology Department, Thoracic Oncology Section, Instituto Fleming, Buenos Aires, Argentina
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Tsuchiya K, Karayama M, Sato T, Yasui H, Hozumi H, Suzuki Y, Furuhashi K, Enomoto N, Fujisawa T, Nakamura Y, Inui N, Sugimura H, Yasuda H, Suda T. Simultaneous Occurrence of Sarcoidosis and Anti-neutrophil Cytoplasmic Antibody-associated Vasculitis in a Patient with Lung Cancer. Intern Med 2019; 58:3299-3304. [PMID: 31327832 PMCID: PMC6911755 DOI: 10.2169/internalmedicine.3004-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 71-year-old woman with abnormal pulmonary shadows and multiple enlarged thoracic lymph nodes was diagnosed with stage IIB lung adenocarcinoma, pulmonary sarcoidosis, and sarcoidosis-associated lymphadenopathy after biopsies from multiple organ sites. She also had rapidly progressive renal dysfunction, microhematuria, and high myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) concentrations. A renal biopsy revealed granulomatous tubulointerstitial nephritis and necrotizing glomerulonephritis with crescent formation. She was diagnosed with nephritis caused by both sarcoidosis and ANCA-associated vasculitis. Oral prednisolone was administered to treat her nephritis, resulting in improvement in both her renal dysfunction and her sarcoidosis-associated lymphadenopathy.
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Affiliation(s)
- Kazuo Tsuchiya
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
- Department of Tumor Pathology, Hamamatsu University School of Medicine, Japan
| | - Masato Karayama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Japan
| | - Taichi Sato
- First Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Hideki Yasui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Kazuki Furuhashi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Haruhiko Sugimura
- Department of Tumor Pathology, Hamamatsu University School of Medicine, Japan
| | - Hideo Yasuda
- First Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
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Cadranel J, Canellas A, Matton L, Darrason M, Parrot A, Naccache JM, Lavolé A, Ruppert AM, Fallet V. Pulmonary complications of immune checkpoint inhibitors in patients with nonsmall cell lung cancer. Eur Respir Rev 2019; 28:28/153/190058. [DOI: 10.1183/16000617.0058-2019] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/23/2019] [Indexed: 12/13/2022] Open
Abstract
Immune checkpoint inhibitor-related pneumonitis (ICI-P) during cancer treatment is rarely observed (<5%). ICI-P is more often observed in patients with nonsmall cell lung cancer (NSCLC) than in those with other cancers. Likewise, it is more common in those receiving programmed cell death (PD)-1/PD-1 ligand inhibitors rather than cytotoxic T-lymphocyte antigen (CTLA)-4 inhibitors alone. The frequency of ICI-P is higher when anti-PD-1 and anti-CTLA-4 are administered concomitantly. Despite the low fatality rate (≈13%), ICI-P is the leading cause of ICI-related deaths. This narrative review focuses on the epidemiology, clinical and radiological presentation and prognosis of ICI-P occurring in patients, especially those with advanced NSCLC. Emphasis is placed on the differences in terms of frequency or clinical picture observed depending on whether the ICI is used as monotherapy or in combination with another ICI or chemotherapy. Other pulmonary complications observed in cancer patients, yet not necessarily immune-related, are reviewed, such as sarcoid-like granulomatosis, tuberculosis or other infections. A proposal for pragmatic management, including differential diagnosis and therapeutic strategies, is presented, based on the ICI-P series reported in the literature and published guidelines.
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50
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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.
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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
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