A 53 year old woman developed a cutan-ẽ ous tumour implant in the needle track after transcutaneous fine needle biopsy of a pulmonary adenocarcinoma. The tumour implant was completely excised.The value of fine needle biopsy in the diagnosis of discrete lung shadows seen on chest radiographs is firmly established."2 The procedure is not, however, entirely without immediate or long term risk. Case reportA nervous 53 year old housewife presented withjoint pains, a dry cough, and a chest radiograph showing a left upper zone mass. Computed tomography showed the mass to be irregular, 3 cm in diameter, and in the periphery of the left upper lobe. There was no evidence of enlarged mediastinal nodes or invasion of local structures. Despite the typical appearances of a primary carcinoma of the lung, the patient would not consider thoracotomy without histological proof of malignancy and consequently a fine needle biopsy was performed by an experienced radiologist, using a 20 gauge screw biopsy needle and an anterior approach. The procedure was difficult as the patient's cooperation was poor and both histological and cytological appearances were inconclusive. The patient eventually agreed to thoracotomy two months later and the left upper lobe was removed. Subsequent histological examination showed a completely excised, poorly differentiated adenocarcinoma.Two months after leaving hospital the patient was referred back with a painful and rapidly enlarging lump on her anterior chest wall (figure). This had appeared at the exact site of puncture for the fine needle biopsy and seemed to be attached to the scar from the biopsy. A wide surgical excision of this lesion was performed. Histological examination of the resected specimen showed invasion of subcutaneous fat by a metastatic, poorly differentiated adenocarcinoma identical in appearance to that removed from the lung two months previously. Excision was complete.The patient remained symptom free until her death, one year later, from a myocardial infarct. Necropsy showed no evidence of recurrence of the tumour.

No abstract

INTRODUCTION: Gastrointestinal involvement in sarcoidosis is quite rare, in which it either presents as systemic disease or as an isolated case. It can mimic other disease processes, including malignancy, gastritis, and peptic ulcer disease. We present a 28-year-old female who had weight loss, epigastric pain, and early satiety found to have symptomatic gastric sarcoidosis that rapidly improved with steroid treatment. CASE DESCRIPTION/METHODS: A 28-year-old with no past medical history presented to the emergency department with complains of epigastric pain, weight loss, and early satiety. She had onset of pain in epigastrium described “like ringing out a washrag”, better with eating and marked early satiety. She was found to have an iron level of 11 with period less heavy than years ago. Vitals showed Wt 142 lb, BP 118/66, Pulse 85, and O2 sat 98% on room air. Physical exam was significant for only epigastric tenderness and bilateral edema. Labs showed hemoglobin 8.9, MCV 57, iron level 11, Na 138, Cl 108, and CO2 20. EGD showed body and antrum with markedly thickened, pale appearing, firm/friable folds. Colonoscopy showed no abnormalities. Gastric fold biopsies showed noncaseating epithelioid granulomatous infiltrate suggestive of sarcoidosis. AFB and GMS fungal stains showed no microorganisms and H. Pylori was negative. The patient was initially started on prednisone 40 mg daily tapering dose and had near immediate resolution of symptoms with increase in weight. DISCUSSION: Sarcoidosis is a systemic disease characterized by pathognomonic formation of noncaseating granulomas with rare gastrointestinal involvement. Infection, malignant, and inflammatory causes must be ruled out as part of the broad differential before making diagnosis of sarcoidosis. Patients typically have symptoms of early satiety, nausea, and weight loss. Gross findings on endoscopy typically include mucosal nodularity, thickened and enlarged irregular folds, and deformity of the antrum. For recurrence of symptoms, surveillance endoscopy is warranted to examine extent of disease. As in our patient, there is excellent response to glucocorticoid treatment and patients should be monitored clinically with tapering doses.