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Historically, the immune environment was not considered an important target for breast cancer treatment. However, the association of lymphocytic infiltrates in triple negative and HER-2 over-amplified breast cancer subtypes with better outcomes, has provoked interest in evaluating the role of the immune system in the luminal B subtype that accounts for 39% of breast cancers and has a poor patient prognosis. It is unknown which immunosuppressive cell types or molecules (e.g., checkpoint molecules) are relevant, or where measurement is most informative. We hypothesize that a profound immunosuppressive tumor and/or lymph node milieu is prognostic and impacts on responses to therapies.

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We present a case of a 63-year-old female who initially presented with complaints of vulvar swelling and was subsequently found to have isolated retroperitoneal lymphadenopathy on imaging. Biopsy was performed and was indicative of weakly polarizable material that raised the consideration of joint prosthesis wear debris. Due to the patient's concern for an underlying malignancy of gynecologic origin, a laparoscopic lymphadenectomy was ultimately performed and final pathology was consistent with reactive changes due to joint wear and debris from the patient's bilateral total knee arthroplasties placed approximately 16 years prior. While this is a rare presentation, it is important to consider this in the differential of retroperitoneal lymphadenopathy as these patients are often referred to a gynecologic oncologist for further workup.

Cutaneous manifestations of sarcoidosis are common, but subcutaneous nodules are rare, originally described in 1904 by Darier and Roussy and thought to represent isolated skin disease. We present a 61‐year‐old male who presented with 3 months of subcutaneous nodules on the forearms and knees. Biopsy confirmed sarcoidosis. An [F‐18] fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) showed confluent uptake in the skin of forearms and knees, along with thighs and buttocks, mediastinal, hilar and upper abdominal lymph nodes, and multiple bones. He was well and treated with hydroxychloroquine 400 mg/day. The nodules resolved and a repeat FDG PET/CT at 5 months showed a significant decrease in the uptake at all involved sites. Although a PET scan can demonstrate extensive disease in a patient presenting with subcutaneous nodules, the literature suggests prognosis is good and treatment should start simply with the least toxic approach, such as with hydroxychloroquine therapy.