Sarcoid Like Reaction Confounding the Diagnosis of Pulmonary Adenocarcinoma

Naga Srinivas Sirikonda; Abdulmonam Ali

doi:doi:10.11648/j.ajim.20190705.13

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Sarcoid Like Reaction Confounding the Diagnosis of Pulmonary Adenocarcinoma

Naga Srinivas Sirikonda, Abdulmonam Ali

Published in American Journal of Internal Medicine (Volume 7, Issue 5)

Received: 29 August 2019 Accepted: 21 September 2019 Published: 10 October 2019

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Abstract

Sarcoidosis and other forms of co-existing granulomatous inflammation have been previously reported to occur along with bronchogenic carcinoma although rare. In addition, sarcoidosis has been reported as an independent risk factor for development of lung cancer. The histological findings of granulomatous inflammation can be misleading in patients with lung nodules and especially with a high pretest probability of lung cancer. We report a case of middle age Caucasian female with smoking history and obstructive lung disease who presented with multiple spiculated pulmonary nodules in both upper lobes. Pretest probability of lung cancer was high in this patient because of smoking history, location (upper lobe), appearance (spiculation) and abnormal Positron Emission Tomography (PET) scan. Initial needle biopsy by interventional radiologist revealed non-caseating granulomatous inflammation without any malignant cells leading to diagnosis of sarcoidosis. But patient underwent surgical lung biopsy because of no response to steroids that revealed the diagnosis of adenocarcinoma. Surgical lung biopsies also revealed coexisting granulomatous inflammation in the vicinity of the malignancy changes. It is difficult to establish whether the sarcoid finding in this case is an immunogenic reaction to malignancy or a precursor for malignancy. Sarcoid like reaction can rarely be seen in bronchogenic carcinoma misleading the diagnosis at times.

Published in	American Journal of Internal Medicine (Volume 7, Issue 5)
DOI	10.11648/j.ajim.20190705.13
Page(s)	124-126
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Bronchogenic Carcinoma, Granulomatous Inflammation, Immunological Reaction, Lung Nodules, Malignancy, Pulmonary Adenocarcinoma, Sarcoid Reaction

References

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[2]	Spiekermann, C., Kuhlencord, M., Huss, S., Rudack, C., Weiss, D."Coexistence of sarcoidosis and metastatic lesions: A diagnostic and therapeutic dilemma (Review)". Oncology Letters 14, no. 6 (2017): 7643-7652.
[3]	Key statistics for Lung cancer. American Cancer Society. https://www.cancer.org/cancer/non-small-cell-lung-cancer/about/key-statistics.html.
[4]	Baughman RP1, Culver DA, Judson MA. A concise review of pulmonary sarcoidosis. Am J Respir Crit Care Med. 2011 Mar 1; 183 (5): 573-81.
[5]	Hilario Nunes et al. Imaging of sarcoidosis of the airways and lung parenchyma and correlation with lung function. European Respiratory Journal 2012 40: 750-765.
[6]	Joon Seon Song, Seungkoo Lee, Yong Hee Kim et al. Sarcoidosis Associated with Adenocarcinoma of the Lung. The Korean Journal of Pathology 2008; 42: 108-12.
[7]	Kachalia AG, Ochieng P, Kachalia K, Rahman H. Rare coexistence of sarcoidosis and lung adenocarcinoma. Respir Med Case Rep. 2014 Mar 15; 12: 4-6.
[8]	Yamasawa H1, Ishii Y, Kitamura S. Concurrence of sarcoidosis and lung cancer. A report of four cases. Respiration. 2000; 67 (1): 90-3.
[9]	Laurberg P. Sarcoid reactions in pulmonary neoplasms. Scand J Respir Dis. 1975 May; 56 (1): 20-7.
[10]	QL Tan et al. Sarcoid-like reaction associated with lung adenocarcinoma: A case report. SAGE Journal. 2019, Vol. 28 (1) 68–70.
[11]	Reich JM. Neoplasia in the etiology of sarcoidosis. Eur J Intern Med. 2006 Mar; 17 (2): 81-7.
[12]	Brincker H, Wilbek E. The incidence of malignant tumours in patients with respiratory sarcoidosis. Br J Cancer. 1974 Mar; 29 (3): 247-51.
[13]	Sakula A. Bronchial Carcinoma and Sacoiodosis. Br J Cancer. 1963 Jun; 17: 206-12.
[14]	Ramadas et al. Lung cancer or sarcoidosis: A diagnostic dilemma. Journal of Cancer Therapeutics & Research ISSN 2049-7962\|Volume 5\|Article 2. 2016.
[15]	Wolbach, SB. A new type of cell inclusion, not parasitic, associated with disseminated granulomatous lesions. J Med Res 1911; 24: 243–261.

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APA Style

Naga Srinivas Sirikonda, Abdulmonam Ali. (2019). Sarcoid Like Reaction Confounding the Diagnosis of Pulmonary Adenocarcinoma. American Journal of Internal Medicine, 7(5), 124-126. https://doi.org/10.11648/j.ajim.20190705.13

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ACS Style

Naga Srinivas Sirikonda; Abdulmonam Ali. Sarcoid Like Reaction Confounding the Diagnosis of Pulmonary Adenocarcinoma. Am. J. Intern. Med. 2019, 7(5), 124-126. doi: 10.11648/j.ajim.20190705.13

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AMA Style

Naga Srinivas Sirikonda, Abdulmonam Ali. Sarcoid Like Reaction Confounding the Diagnosis of Pulmonary Adenocarcinoma. Am J Intern Med. 2019;7(5):124-126. doi: 10.11648/j.ajim.20190705.13

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@article{10.11648/j.ajim.20190705.13,
  author = {Naga Srinivas Sirikonda and Abdulmonam Ali},
  title = {Sarcoid Like Reaction Confounding the Diagnosis of Pulmonary Adenocarcinoma},
  journal = {American Journal of Internal Medicine},
  volume = {7},
  number = {5},
  pages = {124-126},
  doi = {10.11648/j.ajim.20190705.13},
  url = {https://doi.org/10.11648/j.ajim.20190705.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20190705.13},
  abstract = {Sarcoidosis and other forms of co-existing granulomatous inflammation have been previously reported to occur along with bronchogenic carcinoma although rare. In addition, sarcoidosis has been reported as an independent risk factor for development of lung cancer. The histological findings of granulomatous inflammation can be misleading in patients with lung nodules and especially with a high pretest probability of lung cancer. We report a case of middle age Caucasian female with smoking history and obstructive lung disease who presented with multiple spiculated pulmonary nodules in both upper lobes. Pretest probability of lung cancer was high in this patient because of smoking history, location (upper lobe), appearance (spiculation) and abnormal Positron Emission Tomography (PET) scan. Initial needle biopsy by interventional radiologist revealed non-caseating granulomatous inflammation without any malignant cells leading to diagnosis of sarcoidosis. But patient underwent surgical lung biopsy because of no response to steroids that revealed the diagnosis of adenocarcinoma. Surgical lung biopsies also revealed coexisting granulomatous inflammation in the vicinity of the malignancy changes. It is difficult to establish whether the sarcoid finding in this case is an immunogenic reaction to malignancy or a precursor for malignancy. Sarcoid like reaction can rarely be seen in bronchogenic carcinoma misleading the diagnosis at times.},
 year = {2019}
}

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TY - JOUR
T1 - Sarcoid Like Reaction Confounding the Diagnosis of Pulmonary Adenocarcinoma
AU - Naga Srinivas Sirikonda
AU - Abdulmonam Ali
Y1 - 2019/10/10
PY - 2019
N1 - https://doi.org/10.11648/j.ajim.20190705.13
DO - 10.11648/j.ajim.20190705.13
T2 - American Journal of Internal Medicine
JF - American Journal of Internal Medicine
JO - American Journal of Internal Medicine
SP - 124
EP - 126
PB - Science Publishing Group
SN - 2330-4324
UR - https://doi.org/10.11648/j.ajim.20190705.13
AB - Sarcoidosis and other forms of co-existing granulomatous inflammation have been previously reported to occur along with bronchogenic carcinoma although rare. In addition, sarcoidosis has been reported as an independent risk factor for development of lung cancer. The histological findings of granulomatous inflammation can be misleading in patients with lung nodules and especially with a high pretest probability of lung cancer. We report a case of middle age Caucasian female with smoking history and obstructive lung disease who presented with multiple spiculated pulmonary nodules in both upper lobes. Pretest probability of lung cancer was high in this patient because of smoking history, location (upper lobe), appearance (spiculation) and abnormal Positron Emission Tomography (PET) scan. Initial needle biopsy by interventional radiologist revealed non-caseating granulomatous inflammation without any malignant cells leading to diagnosis of sarcoidosis. But patient underwent surgical lung biopsy because of no response to steroids that revealed the diagnosis of adenocarcinoma. Surgical lung biopsies also revealed coexisting granulomatous inflammation in the vicinity of the malignancy changes. It is difficult to establish whether the sarcoid finding in this case is an immunogenic reaction to malignancy or a precursor for malignancy. Sarcoid like reaction can rarely be seen in bronchogenic carcinoma misleading the diagnosis at times.
VL - 7
IS - 5
ER -

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Author Information

Naga Srinivas Sirikonda

Department of Pulmonary and Critical Care Medicine, Good Samaritan Hospital, Mount Vernon, USA
Abdulmonam Ali

Department of Pulmonary and Critical Care Medicine, Good Samaritan Hospital, Mount Vernon, USA

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APA Style

Naga Srinivas Sirikonda, Abdulmonam Ali. (2019). Sarcoid Like Reaction Confounding the Diagnosis of Pulmonary Adenocarcinoma. American Journal of Internal Medicine, 7(5), 124-126. https://doi.org/10.11648/j.ajim.20190705.13

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ACS Style

Naga Srinivas Sirikonda; Abdulmonam Ali. Sarcoid Like Reaction Confounding the Diagnosis of Pulmonary Adenocarcinoma. Am. J. Intern. Med. 2019, 7(5), 124-126. doi: 10.11648/j.ajim.20190705.13

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AMA Style

Naga Srinivas Sirikonda, Abdulmonam Ali. Sarcoid Like Reaction Confounding the Diagnosis of Pulmonary Adenocarcinoma. Am J Intern Med. 2019;7(5):124-126. doi: 10.11648/j.ajim.20190705.13

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@article{10.11648/j.ajim.20190705.13,
  author = {Naga Srinivas Sirikonda and Abdulmonam Ali},
  title = {Sarcoid Like Reaction Confounding the Diagnosis of Pulmonary Adenocarcinoma},
  journal = {American Journal of Internal Medicine},
  volume = {7},
  number = {5},
  pages = {124-126},
  doi = {10.11648/j.ajim.20190705.13},
  url = {https://doi.org/10.11648/j.ajim.20190705.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20190705.13},
  abstract = {Sarcoidosis and other forms of co-existing granulomatous inflammation have been previously reported to occur along with bronchogenic carcinoma although rare. In addition, sarcoidosis has been reported as an independent risk factor for development of lung cancer. The histological findings of granulomatous inflammation can be misleading in patients with lung nodules and especially with a high pretest probability of lung cancer. We report a case of middle age Caucasian female with smoking history and obstructive lung disease who presented with multiple spiculated pulmonary nodules in both upper lobes. Pretest probability of lung cancer was high in this patient because of smoking history, location (upper lobe), appearance (spiculation) and abnormal Positron Emission Tomography (PET) scan. Initial needle biopsy by interventional radiologist revealed non-caseating granulomatous inflammation without any malignant cells leading to diagnosis of sarcoidosis. But patient underwent surgical lung biopsy because of no response to steroids that revealed the diagnosis of adenocarcinoma. Surgical lung biopsies also revealed coexisting granulomatous inflammation in the vicinity of the malignancy changes. It is difficult to establish whether the sarcoid finding in this case is an immunogenic reaction to malignancy or a precursor for malignancy. Sarcoid like reaction can rarely be seen in bronchogenic carcinoma misleading the diagnosis at times.},
 year = {2019}
}

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