Coincidence of seminoma and sarcoidosis: A myth or fact?

Abstract

A patient with a stage II seminoma of the testis was treated with a routine orchidectomy and irradiation. One and a half years later enlarged mediastinal lymph nodes were noted. Additional staging showed no other abnormalities and a mediastinoscopy was performed. The initial histologic examination confirmed the clinically suspected diagnosis of sarcoidosis. However, additional immunohistochemical analysis unexpectedly demonstrated that there was also a microscopic relapse of the testis tumor. The literature concerning the co-incidence of non-caseating granulomas and testis tumors is reviewed. It is not clear, whether the granulomas indicate the presence of genuine idiopathic sarcoidosis or whether they reflect a sarcoid-like reaction against tumor antigens. The immunopathogenesis of sarcoid formation and its possible biologic significance in obtaining a spontaneous tumor remission is discussed.

Mediastinal Seminoma with an Elevated Level of Serum Angiotensin-converting Enzyme

“…In addition, sarcoid-like reactions may present with various manifestations in regards to the distribution and time course. The adjacent coexistence of tumor cells and sarcoid granulomas in a single organ, as observed in this case, has also been previously reported (3,10). Furthermore, sarcoid-like reactions may occur simultaneously with the causative tumor as well as paradoxically during or even after tumor resolution (11,12).…”

Paradoxical Development of a Sarcoid-Like Reaction during Successful Chemotherapy for Seminoma

“…Possibly, a sarcoid-like reaction at distant sites may represent micrometastases. Tjan-Heijnen et al reported a case of sarcoid-like reaction in mediastinal lymph nodes that was accompanied by a microscopic relapse of seminoma, which was detected not by the initial histopathological examination but by an additional immunohistochemical analysis (6). In such a case, the sarcoid-like reaction may have been protective against the spread of tumor.…”

Untitled

“…Contrariwise, it is possible for a sarcoidlike reaction to encompass micrometastatic disease that can be missed and treatment be withheld. Therefore, adequate material from multiple biopsy sites, a comprehensive pathologic examination and immunohistological analysis are all necessary to avoid potential pitfalls [12].…”