Sarcoidosis as a benign cause of lymphadenopathy in cancer patients

Hunt, Ben M.; Vallières, Eric; Buduhan, Gordon; Aye, Ralph W.; Louie, Brian E.

doi:10.1016/j.amjsurg.2009.01.004

Cited by 65 publications

(53 citation statements)

References 23 publications

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“…In a recent retrospective study of 565 consecutive mediastinoscopies, 41 cases of sarcoidosis were identified, of which 21 (53%) had a previous diagnosis of cancer. The most prevalent malignancy was breast cancer (48%) [31] . In another retrospective study, the authors collected data from 2,048 consecutive PET-CT studies performed in cancer patients undergoing staging or restaging of solid-organ malignancy.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Sarcoidosis in Patients with Previous Malignancy: Causality or Coincidence?

Arish¹,

Kuint²,

Sapir

et al. 2017

Respiration

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Background: The association between sarcoidosis and malignancy is poorly defined. Sarcoidosis can precede, be diagnosed concurrently with, or follow malignancy. Objectives: We describe the clinical and radiological features of patients with sarcoidosis following malignancy to determine whether this association is causal or coincidental. Methods: We performed a search for all patients with confirmed sarcoidosis following malignancy in our institution during 2001-2015. Clinical and radiological features, bronchoscopic findings, bronchoalveolar lavage cell counts, and pulmonary function tests (PFTs) were reviewed to evaluate patterns of disease involvement. Details of the histological type of cancer, staging, treatment, and follow-up were reviewed. Results: Twenty-nine patients were identified. The most prevalent malignancies were breast cancer and lymphoma (24% each). Based on the incidence of these malignancies, we estimated the incidence of sarcoidosis was 175 times higher after lymphoma and 38 times higher after breast cancer as compared to the general population. Most patients had early stage cancer (stage I, II) (75%), and only 2 patients (7%) had recurrence of their malignancy after diagnosis of sarcoidosis. Sarcoidosis was diagnosed within 5 years of malignancy in over half the patients, 76% were asymptomatic and 69% had normal PFTs. Mediastinal lymphadenopathy was present in 81% of cases, hilar lymphadenopathy in 67%, and pulmonary parenchymal involvement in 41%. Fifty percent of patients had received Adriamycin, 38% cyclophosphamide, and 33% vincristine. Conclusions: Sarcoidosis following malignancy is indistinguishable from “idiopathic” sarcoidosis, although it is frequently asymptomatic. The high frequency of sarcoidosis after specific cancers but not others, suggests a causative association between malignancy and development of sarcoidosis.

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Section: Discussionmentioning

confidence: 99%

Characteristics of Sarcoidosis in Patients with Previous Malignancy: Causality or Coincidence?

Arish¹,

Kuint²,

Sapir

et al. 2017

Respiration

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“…There are various diagnostic modalities for staging mediastinal lymph nodes, including mediastinoscopy [13,14] videoassisted thoracoscopic surgery (VATS) [14][15][16], transesophageal endoscopic ultra-sound fine-needle aspiration (EUS-FNA) [17] and endobronchial ultra-sound transbronchial needle aspiration (EBUS-TBNA) [6,18]. Each method has its own set of advantages and disadvantages, depending on the clinical context (patient comorbidities, lymph node stations of interest, availability, experience, etc).…”

Section: Discussionmentioning

confidence: 99%

Untitled

2015

JCPCR

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Sarcoid-like reactions in lymph nodes have been described in cancer patients lacking systemic symptoms and signs of sarcoidosis. They are hypothesized to represent immune host response against the neoplastic cells. Their presence may hinder proper staging resulting in serious therapeutic ramifications, either in the form of overtreatment or less often under treatment. We present two cases of mediastinal lymphadenopathy in cancer patients that was presumed to be due to metastatic disease. Despite the administration of chemotherapy, the lesions persisted necessitating a biopsy that revealed their true nature. These clinical cases emphasize the importance of differential diagnosis of lymphadenopathy in the context of malignant disease.

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“…Tumor-related sarcoid reactions may be found in lymph nodes draining an area containing malignant tumor, in the tumor itself, or even in non regional tissues (Segawa et al, 1996). The association of sarcoidal reaction and cancer makes the cancer patient with lymphadenopathy a diagnostic dilemma: malignant involvement of the lymph nodes is common, but benign diagnoses are possible and must be considered (Hunt et al, 2009). Sarcoidal reactions in the setting of lung cancer (NSCLC) have been identified in two Japenese studies of lung cancer, with an incidence rates of 1,2% and 1,3% (Kamiyoshihara et al, 1998;Tomimaru et al, 2007).…”

Section: Lung Cancersmentioning

confidence: 99%

“…Sarcoidosis must be considered in the differential diagnosis of patients with a history of malignancy who develop lymphadenopathy. It is imperative to obtain a tissue diagnosis before instituting therapy for presumed cancer recurrence (Hunt, et al, 2009). …”

Section: Lung Cancersmentioning

confidence: 99%