Coexistent sarcoidosis mimics metastasis in a patient with early-stage non-small cell lung cancer: a case report Coexistent Sarcoidosis and NSCLC

Main Article Content

Xiang Zhao
Yuan Cheng
Wei Wang

Keywords

Sarcoidosis, NSCLC, Metastasis;

Abstract

Background and aim: Sarcoidosis is a granulomatous disease. Malignant tumors are accompanied rarely by granuloma reactions that mimic metastasis. Methods: We present the case of a patient with possible advanced lung cancer with metastases to the mediastinal lymph nodes and bilateral ilia. Results: Ilium biopsy revealed the presence of sarcoid-like reaction. Bronchoscopy and endobronchial ultrasound revealed an adenocarcinoma in the right upper lung lobe, with a negative mediastinal lymph node. The correct staging of lung cancer was achieved through pathological examination of the surgically removed lung tissues. Two years later, the lung cancer metastasized, and the patient underwent systemic treatment. Conclusions: Coexistent sarcoid-like reaction may mimic metastatic lung cancer. A multidisciplinary approach and sequential diagnostic biopsies can prevent unnecessary surgery or inadequate treatment by distinguishing between coexistent sarcoidosis and metastatic lung cancer.

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References

1. Zhou Y, Lower EE, Li H, Farhey Y, Baughman RP. Clinical characteristics of patients with bone sarcoidosis. Semin Arthritis Rheum 2017; 47: 143-8. doi:10.1016/j.semarthrit.2017.02.004
2. Moore S, Kransdorf MJ, Schweitzer ME, Murphey MD, Babb JS. Can Sarcoidosis and Metastatic Bone Lesions Be Reliably Differentiated on Routine MRI? Am J Roentgenol 2012; 198: 1387-93. doi:10.2214/AJR.11.7498
3. Herron M, Chong SG, Gleeson L, Nicholson S, Fahy RJ. Paraneoplastic sarcoidosis: a review. QJM 2019; 113: 17-9. doi:10.1093/qjmed/hcz207
4. Mukhopadhyay S, Wilcox BE, Myers JL, et al. Pulmonary Necrotizing Granulomas of Unknown Cause Clinical and Pathologic Analysis of 131 Patients With Completely Resected Nodules. Chest 2013; 144: 813-24. doi:10.1378/chest.12-2113
5. Albert D: Does Cancer Masquerade as Sarcoidosis? J Clin Rheumatol 2022; 28: 416-9. doi:10.1097/RHU.0000000000001900
6. Ji J, Shu X, Li X, Sundquist K, Sundquist J, Hemminki K. Cancer risk in hospitalized sarcoidosis patients: a follow-up study in Sweden. Ann Oncol 2009; 20: 1121-6. doi:10.1093/annonc/mdn767
7. Le Jeune I, Gribbin J, West J, Smith C, Cullinan P, Hubbard R. The incidence of cancer in patients with idiopathic pulmonary fibrosis and sarcoidosis in the UK. Respir Med 2007; 101: 2534-40. doi:10.1016/j.rmed.2007.07.012
8. Kamiyoshihara M, Hirai T, Kawashima O, Ishikawa S, Morishita Y. Sarcoid reactions in primary pulmonary carcinoma: report of seven cases. Oncol Rep 1998; 5: 177-257. doi:10.3892/or.5.1.177
9. Tomimaru Y, Higashiyama M, Okami J, et al. Surgical results of lung cancer with sarcoid reaction in regional lymph nodes. Jpn J Clin Oncol 2007; 37: 90-5. doi:10.1093/jjco/hyl141
10. Yamasawa H, Ishii Y, Kitamura S. Concurrence of sarcoidosis and lung cancer. A report of four cases. Respiration 2000; 67: 90-3. doi:10.1159/000029470
11. Kachalia AG, Ochieng P, Kachalia K, Rahman H. Rare coexistence of sarcoidosis and lung adenocarcinoma. Respir Med Case Rep 2014; 12: 4-6. doi:10.1016/j.rmcr.2013.12.008
12. Sakthivel P, Bruder D. Mechanism of granuloma formation in sarcoidosis. Curr Opin Hematol 2017; 24: 59-65. doi:10.1097/MOH.0000000000000301
13. Braun NA, Celada LJ, Herazo-Maya JD, et al. Blockade of the programmed death-1 pathway restores sarcoidosis CD4(+) T-cell proliferative capacity. Am J Respir Crit Care Med 2014; 190: 560-71. doi:10.1164/rccm.201401-0188OC
14. Oswald-Richter KA, Richmond BW, Braun NA, et al. Reversal of global CD4+ subset dysfunction is associated with spontaneous clinical resolution of pulmonary sarcoidosis. J Immunol 2013; 190: 5446-53. doi:10.4049/jimmunol.1202891
15. Broos CE, Hendriks RW, Kool M. T-cell immunology in sarcoidosis: Disruption of a delicate balance between helper and regulatory T-cells. Curr Opin Pulm Med 2016; 22: 476-83. doi:10.1097/MCP.0000000000000303