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Sormani P, Ammirati E, Giannattasio C, Garascia A, Pedrotti P. A fearsome evolution of presumed cardiac sarcoidosis: The sarcoid-lymphoma syndrome. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VASCULATURE 2024; 54:101496. [PMID: 39280693 PMCID: PMC11395733 DOI: 10.1016/j.ijcha.2024.101496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 09/18/2024]
Affiliation(s)
- Paola Sormani
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | - Enrico Ammirati
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
- Department of Health Sciences, University of Milano-Bicocca, Milan, Italy
| | - Cristina Giannattasio
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
- Department of Health Sciences, University of Milano-Bicocca, Milan, Italy
| | - Andrea Garascia
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
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Moreno-Torres V, Martínez-Urbistondo M, Durán-del Campo P, Tutor P, Rodríguez B, Castejón R, Mellor-Pita S. Sarcoidosis and lymphoma mortality risk: An observational study from the Spanish National Registry. J Transl Autoimmun 2024; 8:100236. [PMID: 38426202 PMCID: PMC10901907 DOI: 10.1016/j.jtauto.2024.100236] [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: 12/13/2023] [Revised: 02/18/2024] [Accepted: 02/18/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Patients with sarcoidosis have a lower survival rate than the general population, in part due to cardiovascular disease, infections and neoplasms. Our objective was to evaluate the impact of haematological neoplasms (HN) and lymphomas on sarcoidosis patient mortality in a nation-wide analysis conducted in Spain, a country with a population of 47 million. Methods Retrospective and observational comparison of the HN related deaths in sarcoidosis patients and the general Spanish population reported in the Spanish Hospital Discharge Database. To determine the impact of sarcoidosis on the risk of dying from each HN lineage, a binary logistic regression considering age, female sex, tobacco and alcohol consumption, was performed. Results In the period 2016 and 2019, 139,531 in-hospital deaths from neoplasms were certified in Spain (77 in patients with sarcoidosis). Patients with sarcoidosis died at younger age than the general Spanish population (72.9 vs 77.6, p<0.001). Sarcoidosis patients presented a higher mortality risk from HN (20.8% vs 8.9%, p=0.001, OR=2.64, 95% CI 1.52-4.59), attributable to the higher proportion of deaths from non-Hodgkin lymphoma (NHL), (9.2% vs 2.9%, p=0.006, OR= 3.33, 95% CI 1.53-7.25) from both B cell (6.6% vs 2.5%, p=0.044, OR= 2.62, 95% 1.06-6.5) and T/NK cell lineages (2.6% vs 0.3%, p=0.024, OR= 7.88, 95% CI 1.92-32.29) as well as HN with uncertain behavior and myeloproliferative disorders (2.6% vs 0.3%, p=0.018, OR= 11.88, 95% CI 2.88-49.02). The mean age of sarcoidosis patients who died from HN (63.6 vs 71.9, p=0.032) and non-Hodgkin lymphoma (56.9 vs 71, p=0.009) was lower than that of the general population. Conclusion Patients with sarcoidosis present a higher risk of premature death from HN, including NHL from B, T/NK cell lineage and myeloproliferative disorders in comparison with the general Spanish population. In addition to developing strategies that might help to attenuate their occurrence and impact, such as decreasing the immunosuppressive burden, specific early-detection programs for these conditions should be investigated and considered carefully.
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Affiliation(s)
- Víctor Moreno-Torres
- Internal Medicine Department, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHIM) Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- UNIR Health Sciences School and Medical Center, Madrid, Spain
| | - María Martínez-Urbistondo
- Internal Medicine Department, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHIM) Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Pedro Durán-del Campo
- Internal Medicine Department, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHIM) Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Pablo Tutor
- Internal Medicine Department, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHIM) Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Begoña Rodríguez
- Nuclear Medicine Department, Internal Medicine Department, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHIM) Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Raquel Castejón
- Internal Medicine Department, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHIM) Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Susana Mellor-Pita
- Internal Medicine Department, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHIM) Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Pereira FG, Esteves G, Costa Rosa J, Cabeçadas J, Cravo M, Pereira MIMSB, Robson A. Granulomatous Slack Skin With Lung and Esophagus Involvement: A Case Report and Molecular Analysis. Am J Dermatopathol 2024:00000372-990000000-00329. [PMID: 38574048 DOI: 10.1097/dad.0000000000002697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
ABSTRACT Granulomatous slack skin (GSS) is a rare subtype of mycosis fungoides, and few cases have been known to spread to the blood, lymph nodes, or viscera. We present a case with early dissemination to the lung. A 27-year-old woman, previously healthy, presented with scattered disseminated scaly patches, associated with vulvar and intergluteal firm swelling and groin-skin induration for 1 year. She also reported mild fatigue and breathlessness on moderate exertion. The patient underwent blood tests, skin biopsies, and computed tomography scan. The skin biopsy showed a mildly atypical T-cell lymphoid infiltrate involving the dermis/hypodermis, with focal epidermotropism, associated with a granulomatous infiltrate and elastophagocytosis. The computed tomography scan revealed bilateral ground-glass lung nodular opacities. Positron emission tomography showed an increased signal in the skin and subcutis around the buttocks, inguinal and mediastinal lymph nodes, and lungs. The lung biopsy confirmed a dense T-cell infiltrate with numerous multinucleated giant cells. Subsequently, esophageal involvement was also observed following biopsy. Molecular analyses demonstrated identical T-cell clones in the skin and lung. After 6 cycles of chemotherapy/localized external radiotherapy, the patient had a partial skin response and stable lung disease. A preferred diagnosis of GSS with systemic spread was made based on clinical/histologic/molecular findings, after considering granulomatous mycosis fungoides and peripheral T-cell lymphoma, not otherwise specified. This case highlights the frequent diagnostic difficulty in distinguishing GSS from an inflammatory granulomatous dermatitis. Pulmonary and esophageal involvements are rare in GSS, and the simultaneous presentation of characteristic cutaneous GSS with systemic disease poses an additional classification challenge.
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Affiliation(s)
| | - Gonçalo Esteves
- Pathology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Portugal
| | - Joaninha Costa Rosa
- Pathology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Portugal
| | - José Cabeçadas
- Pathology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Portugal
| | - Mariana Cravo
- Dermatology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Portugal; and
| | | | - Alistair Robson
- Pathology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Portugal
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Judson MA. Granulomatous Sarcoidosis Mimics. Front Med (Lausanne) 2021; 8:680989. [PMID: 34307411 PMCID: PMC8295651 DOI: 10.3389/fmed.2021.680989] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/10/2021] [Indexed: 12/19/2022] Open
Abstract
Many granulomatous diseases can mimic sarcoidosis histologically and in terms of their clinical features. These mimics include infectious granulomatous diseases, granulomatous reactions to occupational and environmental exposures, granulomatous drug reactions, vasculitides and idiopathic granulomatous conditions. It is important to distinguish sarcoidosis from these mimics, as a misdiagnosis of these diseases may have serious consequences. This manuscript reviews numerous sarcoidosis mimics and describes features of these diseases that may allow them to be differentiated from sarcoidosis. Distinguishing features between sarcoidosis and its mimics requires a careful review of the medical history, symptoms, demographics, radiographic findings, histologic features, and additional laboratory data. Understanding the clinical characteristics of sarcoidosis and its mimics should lead to more accurate diagnoses and treatment of granulomatous disorders that should improve the care of these patients. As the diagnostic criteria of sarcoidosis are not standardized, it is possible that some of these sarcoidosis mimics may represent varied clinical presentations of sarcoidosis itself.
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Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine MC-91, Department of Medicine, Albany, NY, United States
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5
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Kim JS, Kim IH, Byun JM, Chang JH. Population-based study on the association between autoimmune disease and lymphoma: National Health Insurance Service-National Sample Cohort 2002-2015 in Korea. J Autoimmun 2021; 121:102647. [PMID: 33991884 DOI: 10.1016/j.jaut.2021.102647] [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: 02/18/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to evaluate the association between autoimmune disease (AID) and lymphoma incidence in the Korean population. We also aimed to compare the overall survival (OS) in patients with AID-associated lymphoma (AAL) with that in patients with lymphoma without AID. MATERIAL AND METHODS We used National Sample Cohort 2002-2015 provided by National Health Insurance Service. Among 1,011,638 patients, 994,496 were recruited for the final cohort: 130,987 patients (13.2%) in the AID group and 863,509 (86.8%) in control. Lymphoma was diagnosed in 1162 patients and 322 patients with accompanying AID, irrespective of the time point of diagnosis, were defined as AAL. Of those, patients who experienced lymphoma development at least one year after AID diagnosis were defined as post-AID lymphoma (N = 155). RESULTS The median follow-up duration was 13.7 years. AAL accounted for 0.03% of total and 27.7% of lymphoma cases. AID patients experienced more Epstein-Barr virus (0.02 vs. 0.01%, P = 0.027) or Helicobacter pylori infection (63.9 vs. 41.4%, P < 0.001) than the control group did. AID was associated with a 1.45-fold increased risk of lymphoma. The median time interval from AID to AAL was 10.9 months. The risk of lymphoma increased in the order of: psoriasis (adjusted odds ratio [AOR] 1.61), systemic lupus erythematosus (AOR 3.99), multiple sclerosis (AOR 4.52), and sarcoidosis (AOR 26.37). Sjogren syndrome was not related to lymphoma in this cohort. The 5-year OS in AAL was not different from that in lymphoma patients without AID (60.9 vs. 61.5%, P = 0.970). CONCLUSIONS The association patterns in AAL in Korean population were different from those of Western countries. Further studies on lymphomatogenesis from distinct baseline characteristics (e.g. chronic infection status) would elucidate the difference based on race and ethnicity.
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Affiliation(s)
- Jae Sik Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea; Department of Radiation Oncology, Seoul National University Hospital, Seoul, South Korea
| | - Il Han Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea
| | - Ja Min Byun
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Ji Hyun Chang
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea; Department of Radiation Oncology, Seoul National University Hospital, Seoul, South Korea.
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Dal Lago L, Sarrand J, Woff E, Awada A, Vouche M, Pepersack T. Sarcoidosis Versus Lymphoma? Eur J Case Rep Intern Med 2021; 8:002250. [PMID: 33768069 DOI: 10.12890/2021_002250] [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: 12/28/2020] [Accepted: 01/20/2021] [Indexed: 11/05/2022] Open
Abstract
An association between lymphoma and sarcoidosis was first suggested in 1960. We report a case of sarcoidosis-lymphoma syndrome, which is a diagnostically challenging condition. We conclude that an associated lymphoma should be considered in all patients with suspected sarcoidosis, especially those who do not respond to treatment or who present with persistent haematological abnormalities. Splenomegaly should prompt splenectomy to rule out lymphoma if a less invasive approach has failed to confirm the diagnosis. LEARNING POINTS Clinical consideration should be given to an associated lymphoma in all patients with sarcoidosis, especially those who do not respond to treatment or who present with persistent haematological abnormalities.Splenomegaly should raise the possibility of splenectomy to rule out associated lymphoma.
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Affiliation(s)
- Lissandra Dal Lago
- Medical Oncology Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Julie Sarrand
- Medical Oncology Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Erwin Woff
- Nuclear Medicine Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Ahmad Awada
- Medical Oncology Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Michaël Vouche
- Department of Radiology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Thierry Pepersack
- Medical Oncology Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
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Ahn JH, Jang MH. Delayed sarcoidosis onset mimicking mediastinal lymphoma recurrence after complete remission of diffuse large B cell lymphoma: A case report. Thorac Cancer 2021; 12:1231-1233. [PMID: 33615672 PMCID: PMC8046158 DOI: 10.1111/1759-7714.13885] [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: 01/04/2021] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 11/28/2022] Open
Abstract
Sarcoidosis‐lymphoma syndrome describes a pathological state wherein both sarcoidosis and lymphoma are present. Sarcoidosis and lymphoma may occur concurrently, or sarcoidosis may precede lymphoma. There are few reports which have previously described the temporal progression from lymphoma to sarcoidosis. Here, we present a patient with stage II diffuse large B‐cell lymphoma in the right breast. The patient achieved complete remission after chemotherapy. Five years after remission, the patient visited our clinic with newly developed enlarged mediastinal lymph nodes; lymphoma recurrence was suspected. However, mediastinal lymph node biopsy showed numerous noncaseating granulomas with no evidence of malignancy in the mediastinal lymph nodes. Consequently, a diagnosis of sarcoidosis was made. This case report highlights the need for pathological confirmation following biopsy when recurrence of lymphoma is suspected.
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Affiliation(s)
- June Hong Ahn
- Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, South Korea
| | - Min Hye Jang
- Department of Pathology, Yeungnam University College of Medicine, Daegu, South Korea
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Optic nerve head sarcoidosis mimicking an intraocular tumour, and occurring as the first manifestation of neuro-ocular sarcoidosis. Am J Ophthalmol Case Rep 2020; 20:100988. [PMID: 33163694 PMCID: PMC7610040 DOI: 10.1016/j.ajoc.2020.100988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/20/2022] Open
Abstract
Purpose Sarcoidosis is a chronic idiopathic granulomatous inflammatory disease that can affect many major organ systems, primarily the lungs, and hence has remarkable clinical heterogeneity. At least 50% of patients with systemic sarcoidosis develop inflammatory eye disease, and in approximately 21% of cases, it may be the first clinical manifestation. Neuro-ocular involvement occurs in <3% of all sarcoidosis cases, and rarely involves the optic nerve. We describe an unusual case of an intraocular sarcoidosis presenting as an unclear optic nerve mass. Observations A 61-year-old male presented with painful gradual visual loss in the right eye. Previous history included Stage II Hodgkin lymphoma (HL) and concurrent mediastinal sarcoidosis, both in remission 5 years later. On examination, the right eye (RE) vision had no light perception, neovascular glaucoma, attenuated retinal vessels and a non-pigmented optic disc mass. The left eye was normal. The RE showed no response to oral steroids, was painful due to neovascular glaucoma and the concerns of recurrent HL with intraocular manifestations lead to RE enucleation. Macroscopic examination revealed a whitish mass at the optic disc, which histomorphologically showed a non-necrotising granulomatous inflammation consuming the optic nerve head and extending into the optic nerve resection margin. Special stains for microorganisms were negative. The uveal tract was free of inflammation. The morphological features were consistent with optic nerve sarcoidosis. A diagnosis of neuro-ocular sarcoidosis was made, and the patient was commenced on infliximab. Conclusion Neuro-ocular sarcoidosis is known as the ‘great imitator’ because it can cause a variety of non-specific clinical signs and symptoms, mimicking many other conditions, including lymphomas. Intraocular sarcoidosis is not unusual and typically affects the uvea. Isolated optic nerve sarcoidosis is rare. The challenging aspect of intraocular sarcoidosis is the requirement of prompt treatment to reverse any eye damage and prevent permanent visual loss. Here, optic nerve sarcoidosis was very advanced, and was associated with intracerebral manifestations. Importance Neuro-ocular sarcoidosis is a difficult condition to diagnose and treat. Our case was complicated by the previous history of HL and concurrent mediastinal sarcoidosis which were in remission. In patients with a history of sarcoidosis with new loss of vision and neurological weaknesses oculocerebral involvement must be included in the differential diagnosis even in the absence of typical manifestations of ocular sarcoidosis as in uveal tract involvement. Optic nerve head (ONH) sarcoidosis without uveal tract involvement is rare. ONH sarcoidosis can be the first manifestation of systemic sarcoidosis. ONH sarcoidosis may be the first manifestation of neuro-ocular sarcoidosis. ONH masses present diagnostic challenges due to the impact of tissue biopsy. ‘Sarcoid-like’ reaction or sarcoid-lymphoma syndrome may occur with concurrent lymphoma.
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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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10
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Atypical Sarcoid-like Granulomatous Reactions in Lymphoma: Natural History and Effect on Management. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 20:e11-e14. [PMID: 31699656 DOI: 10.1016/j.clml.2019.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 11/21/2022]
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Yang K, Algird AR, Lu JQ. Dural-Based Marginal Zone Lymphoma in a Patient with Sarcoidosis. World Neurosurg 2018; 122:569-572. [PMID: 30476667 DOI: 10.1016/j.wneu.2018.11.125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Primary dural-based lymphoma is a rare disease entity. It has been hypothesized that patients with sarcoidosis are at increased risk of developing lymphoma, an association known as "sarcoidosis-lymphoma syndrome," although dural disease has not yet been reported in the literature. CASE DESCRIPTION Here we report the first case of dural-based lymphoma in a 60-year-old man with a history of sarcoidosis, in keeping with sarcoidosis-lymphoma syndrome. His dural-based tumor was surgically resected. Pathology examination revealed a marginal zone B-cell lymphoma. Subsequent neural and systemic staging confirmed a localized lymphoma. The patient received local radiotherapy to control leptomeningeal disease. CONCLUSIONS Given the association between sarcoidosis and lymphoma, we suggest lymphoma to be considered as one of the top differentials for a dural-based mass lesion in patients with sarcoidosis.
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Affiliation(s)
- Kaiyun Yang
- Division of Neurosurgery, Department of Pathology and Molecular Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.
| | - Almunder R Algird
- Division of Neurosurgery, Department of Pathology and Molecular Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Jian-Qiang Lu
- Neuropathology Section, Department of Pathology and Molecular Medicine, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
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Lopez-Sublet M, Caratti di Lanzacco L, Danser AHJ, Lambert M, Elourimi G, Persu A. Focus on increased serum angiotensin-converting enzyme level: From granulomatous diseases to genetic mutations. Clin Biochem 2018; 59:1-8. [PMID: 29928904 DOI: 10.1016/j.clinbiochem.2018.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/29/2018] [Accepted: 06/15/2018] [Indexed: 12/19/2022]
Abstract
Angiotensin I-converting enzyme (ACE) is a well-known zinc-metallopeptidase that converts angiotensin I to the potent vasoconstrictor angiotensin II and degrades bradykinin, a powerful vasodilator, and as such plays a key role in the regulation of vascular tone and cardiac function. Increased circulating ACE (cACE) activity has been reported in multiple diseases, including but not limited to granulomatous disorders. Since 2001, genetic mutations leading to cACE elevation have also been described. This review takes advantage of the identification of a novel ACE mutation (25-IVS25 + 1G > A) in two Belgian pedigrees to summarize current knowledge about the differential diagnosis of cACE elevation, based on literature review and the experience of our centre. Furthermore, we propose a practical approach for the evaluation and management of patients with elevated cACE and discuss in which cases search for genetic mutations should be considered.
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Affiliation(s)
| | - Lorenzo Caratti di Lanzacco
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - A H Jan Danser
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Rotterdam, The Netherlands
| | - Michel Lambert
- Division of Internal Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ghassan Elourimi
- Internal Medicine Department, University Hospital Avicenne, Bobigny, AP-HP, France
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium; Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
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Sweeney A, Hammer R, Evenski A, Crim J. Fulminant musculoskeletal and neurologic sarcoidosis: case report and literature update. Skeletal Radiol 2016; 45:1571-6. [PMID: 27596753 DOI: 10.1007/s00256-016-2463-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/23/2016] [Accepted: 08/12/2016] [Indexed: 02/02/2023]
Abstract
We report a case of fulminant sarcoidosis in a 28-year-old man presenting with skin nodules, multifocal small and large joint arthralgias, and blurred vision. Characteristic bone, soft tissue, articular, and CNS findings were evident on multimodality imaging. Bony abnormalities included near-complete destruction of a distal phalanx, "lace-like" lucent lesions, erosive arthritis, lytic lesions with and without sclerotic margins, and bone marrow replacement visible only on MRI. The extent of bony disease at time of presentation was unusual. We review the widely varying reported prevalence of imaging findings of bony sarcoidosis in the literature, and discuss reasons for this variability. We found that musculoskeletal findings at US and MRI were less specific than radiographic and CT findings, but were useful in quantifying extent of disease.
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Affiliation(s)
| | | | | | - Julia Crim
- University of Missouri at Columbia, Columbia, MO, USA.
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Hypercalcemia associated with isolated bone marrow sarcoidosis in a patient with underlying monoclonal gammopathy of undetermined significance: case report and review of literature. Biomark Res 2016; 4:18. [PMID: 27651903 PMCID: PMC5024499 DOI: 10.1186/s40364-016-0072-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/06/2016] [Indexed: 11/10/2022] Open
Abstract
Background Bone marrow sarcoidosis is extremely rare. The association between sarcoidosis and lymphoproliferative disorders has been previously speculated, although the diagnosis of sarcoidosis often precedes any hematological derangements. Case presentation Here, we report for the first time, a case of a 57-year-old Caucasian woman with a previous diagnosis of monoclonal gammopathy of undetermined significance (MGUS) developing hypercalcemia and renal failure with workup notable for isolated bone marrow sarcoidosis and not multiple myeloma as expected. The patient was successfully managed with prednisone taper therapy with resolution of her hypercalcemia and repeat bone marrow biopsies demonstrating resolving granulomas. Conclusions Our case illustrates the diagnostic challenges associated with bone marrow sarcoidosis and suggest that chronic immune stimulation in the bone marrow in the setting of MGUS may be associated with the development of localized sarcoidosis. The long term consequences of steroid therapy targeting sarcoidosis in this patient with underlying MGUS remain unknown. Greater surveillance and closer followup is planned in light of the increased risk of malignant transformation of MGUS into multiple myeloma in the setting of bone marrow sarcoidosis.
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Cho H, Yoon DH, Kim JH, Ko YB, Kwon BS, Song IH, Suh C. Occurrence of sarcoidosis after chemotherapy for non-Hodgkin lymphoma. Korean J Intern Med 2016; 31:605-7. [PMID: 26968186 PMCID: PMC4855092 DOI: 10.3904/kjim.2014.305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/18/2014] [Accepted: 12/26/2014] [Indexed: 11/27/2022] Open
MESH Headings
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/therapeutic use
- Doxorubicin/administration & dosage
- Doxorubicin/therapeutic use
- Female
- Genital Neoplasms, Female/complications
- Genital Neoplasms, Female/diagnosis
- Genital Neoplasms, Female/drug therapy
- Humans
- Lymph Nodes/diagnostic imaging
- Lymph Nodes/pathology
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Middle Aged
- Positron-Emission Tomography
- Prednisone/administration & dosage
- Prednisone/therapeutic use
- Remission Induction
- Rituximab/administration & dosage
- Sarcoidosis/diagnostic imaging
- Sarcoidosis/etiology
- Sarcoidosis/pathology
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- Vincristine/administration & dosage
- Vincristine/therapeutic use
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Affiliation(s)
- Hyungwoo Cho
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jwa Hoon Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Bo Ko
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byoung Soo Kwon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Hye Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Cheolwon Suh, M.D. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3209 Fax: +82-2-3010-6961 E-mail:
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16
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Galimberti F, Fernandez AP. Sarcoidosis following successful treatment of pemphigus vulgaris with rituximab: a rituximab-induced reaction further supporting B-cell contribution to sarcoidosis pathogenesis? Clin Exp Dermatol 2016; 41:413-6. [DOI: 10.1111/ced.12793] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2015] [Indexed: 02/03/2023]
Affiliation(s)
- F. Galimberti
- Cleveland Clinic Lerner College of Medicine; Cleveland OH USA
| | - A. P. Fernandez
- Departments of Dermatology and Pathology; Cleveland Clinic; Cleveland OH USA
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17
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Giralt L, Sánchez-Font A, Sánchez-González B, Balcells E. [Sarcoidosis-lymphoma syndrome]. Med Clin (Barc) 2015; 145:276-7. [PMID: 25579775 DOI: 10.1016/j.medcli.2014.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 11/20/2014] [Accepted: 11/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Laia Giralt
- Servei de Pneumologia, Hospital del Mar-Parc de Salut Mar, Universitat Autònoma de Barcelona, Universitat Pompeu Fabra, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Barcelona, España
| | - Albert Sánchez-Font
- Servei de Pneumologia, Hospital del Mar-Parc de Salut Mar, Universitat Autònoma de Barcelona, Universitat Pompeu Fabra, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Barcelona, España.
| | - Blanca Sánchez-González
- Servei d'Hematologia, Hospital del Mar-Parc de Salut Mar, Universitat Autònoma de Barcelona, Universitat Pompeu Fabra, Barcelona, España
| | - Eva Balcells
- Servei de Pneumologia, Hospital del Mar-Parc de Salut Mar, Universitat Autònoma de Barcelona, Universitat Pompeu Fabra, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Barcelona, España
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18
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19
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Sharquie KE, Al-Hayani RK, Abdulwahhab WS, Mohammed AAS. Sarcoidosis-Lymphoma Syndrome: A Spectrum of One Disease. JOURNAL OF COSMETICS, DERMATOLOGICAL SCIENCES AND APPLICATIONS 2015; 05:181-188. [DOI: 10.4236/jcdsa.2015.53022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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20
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Torchio M, Bottaro G, Bertolino G, Comolli G, Bello BD, Invernizzi R, Danova M. Late-onset sarcoidosis in a patient with gastric mucosa-associated lymphoid tissue non-Hodgkin lymphoma: A case report. Oncol Lett 2014; 8:1299-1301. [PMID: 25120711 PMCID: PMC4114627 DOI: 10.3892/ol.2014.2241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 01/16/2014] [Indexed: 11/21/2022] Open
Abstract
The simultaneous presence of hematological malignancies and sarcoidosis, defined as sarcoidosis-lymphoma syndrome, has been reported in 79 patients in the literature to date. The majority of these patients were affected by sarcoidosis and developed non-Hodgkin lymphoma or acute leukemia after 1–2 years; however, in <20 cases the malignancy developed first. This report presents the case of an 83-year-old male with a clinical history of Helicobacter pylori-positive gastric mucosa-associated lymphoid tissue lymphoma. The patient developed sarcoidosis 10 years after the first diagnosis, which caused the diagnostic work-up and differential diagnosis between a lymphoma relapse and de novo sarcoidosis to be challenging.
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Affiliation(s)
- Martina Torchio
- Department of Internal Medicine and Medical Oncology, Civic Hospital of Vigevano, Pavia I-27029, University of Pavia, Pavia I-27100, Italy
| | - Giorgio Bottaro
- Department of Internal Medicine and Medical Oncology, Civic Hospital of Vigevano, Pavia I-27029, University of Pavia, Pavia I-27100, Italy
| | | | - Giuditta Comolli
- Department of Biotechnology Research Laboratory and Microbiology and Virology, IRCCS Foundation Policlinico San Matteo, University of Pavia, Pavia I-27100, Italy
| | | | | | - Marco Danova
- Department of Internal Medicine and Medical Oncology, Civic Hospital of Vigevano, Pavia I-27029, University of Pavia, Pavia I-27100, Italy
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21
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Do TD, Neurohr C, Michl M, Reiser MF, Zech CJ. An unusual case of primary hepatic lymphoma mimicking sarcoidosis in MRI. Acta Radiol Short Rep 2014; 3:2047981613493625. [PMID: 25298864 PMCID: PMC4184379 DOI: 10.1177/2047981613493625] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 05/22/2013] [Indexed: 11/17/2022] Open
Abstract
Sarcoidosis is a granulomatous disease, in which liver affection is common, contrary to a primary hepatic lymphoma that is very rarely seen. On MRI both present with almost the same imaging features: hypointense in T1-weighted and hyperintense in T2-weighted sequences. Our patient with a histologically confirmed sarcoidosis in the lungs showed liver lesions that were similar to sarcoidosis manifestations of the liver. Due to size, progression and overlapping features with secondary malignant liver lesions within an interval of 5 months, a biopsy was conducted and confirmed a primary hepatic lymphoma with diffuse large b-cells. Thus, we would recommend performing a biopsy in ambiguous lesions with indistinguishable characteristics and progression within a short follow-up interval.
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Affiliation(s)
- Thuy D Do
- Department of Clinical Radiology and Interventional Medicine, Heidelberg University, Heidelberg, Germany ; Department of Clinical Radiology, Ludwig Maximilians-University, Munich, Germany
| | - Claus Neurohr
- Department of Pneumology, Ludwig Maximilians-University Munich, Germany
| | - Marlies Michl
- Department of Hematology and Oncology, Ludwig-Maximilians-University Munich, Germany
| | - Maximilian F Reiser
- Department of Clinical Radiology, Ludwig Maximilians-University, Munich, Germany
| | - Christoph J Zech
- Department of Clinical Radiology, Ludwig Maximilians-University, Munich, Germany ; Department of Radiology and Nuclear Medicine, University Basel, Switzerland
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22
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Inoue K, Goto R, Shimomura H, Fukuda H. FDG-PET/CT of sarcoidosis and sarcoid reactions following antineoplastic treatment. SPRINGERPLUS 2013; 2:113. [PMID: 23543853 PMCID: PMC3610027 DOI: 10.1186/2193-1801-2-113] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 02/25/2013] [Indexed: 11/10/2022]
Abstract
Sarcoidosis or sarcoid reactions, which appear as FDG-avid lesions in oncologic patients, need to be differentiated from disseminated malignancies. We aimed to promote awareness of development of sarcoidosis or sarcoid reactions after antineoplastic therapy to avoid diagnostic errors with FDG-PET/CT findings and assess the utility of FDG-PET/CT for follow-up. We retrospectively reviewed radiological reports of FDG-PET/CT scans performed between January 2009 and December 2011. Among oncologic patients with more than 2 FDG-PET/CT scans, those with nearly symmetrical increases in FDG uptake in the hilar or mediastinal lymph nodes were identified, and those with known sarcoidosis, concurrent diagnoses of sarcoidosis with malignancy, or histopathologically proven malignancies were excluded. Then, only those cases were selected for which sarcoidosis or sarcoid reactions were diagnosed. Four of 376 oncologic cases met the criteria. At 9 months to 6 years after antineoplastic therapy, abnormal FDG uptakes were observed in the hilar, mediastinal, abdominal, pelvic, and inguinal nodes, and/or spleen and lung parenchyma with SUVmax up to 17.7. On the basis of these findings, 1 patient received anticancer chemotherapy because of tumor recurrence suspicion. A gradual decrease in FDG uptake was observed on subsequent PET/CT scans. Sarcoidosis or sarcoid reactions should be considered in differential diagnosis of oncologic patients who have developed FDG-avid lesions any time after antineoplastic therapy. FDG-PET/CT can be used for follow-up in nondiagnostic situations to detect decreases in FDG uptake due to presence of sarcoidal granulomas.
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Affiliation(s)
- Kentaro Inoue
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aoba-ward, Sendai, 980-8575 Japan
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Dual diagnosis of sarcoidosis and lymphoma. Ir J Med Sci 2012; 182:283-6. [DOI: 10.1007/s11845-012-0854-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
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24
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Iqbal K, Bott J, Greenblatt D, Robson A, Kapur N, Dadzie OE, Whittaker S. Subcutaneous panniculitis-like T-cell lymphoma in association with sarcoidosis. Clin Exp Dermatol 2011; 36:677-9. [DOI: 10.1111/j.1365-2230.2011.04048.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Abstract
18-F-fluorodeoxyglucose (FDG) –positron emission tomography (PET), and more recently PET/computed tomography (CT), is the most sensitive and specific imaging technique currently available for patients with lymphoma. Nevertheless, despite being increasingly used in pretreatment assessment, midtreatment evaluation of response, post-treatment restaging, and surveillance during follow-up of patients with lymphoma, its impact on clinical outcome in most clinical situations remains to be confirmed. PET/CT provides its greatest clinical benefit in the post-treatment evaluation of Hodgkin's lymphoma and diffuse large B-cell lymphoma; however, the role of metabolic imaging in other indications and in other histologies remains to be demonstrated. Ongoing risk-adapted studies will hopefully provide evidence for clinical improvement on the basis of altering treatment as a result of interim PET results. Efforts are ongoing to better standardize the conduct and interpretation of FDG-PET scans. FDG-PET has the potential to improve lymphoma patient management; however, its usefulness will likely vary by histology, stage, therapy, and clinical setting.
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