Pulmonary and mediastinal "sarcoidosis" following surgical resection of cancer.
Previous reports indicate that enlarged hilar and mediastinal lymph nodes caused by sarcoid-like reactions may develop after curative resection of cancer, and their presence does not necessarily denote neoplastic recurrence. Reports further suggest that coexisting pulmonary infiltrates in this setting may be related to sarcoidosis. In this study, we describe two patients who had resected lung and gastric cancer and who later developed pulmonary interstitial infiltrate, concurrent with progressive mediastinal lymphadenopathy initially thought to be caused by intrathoracic dissemination of their cancer. These changes were shown by open lung biopsy to be a benign, granulomatous reaction interpreted as sarcoidosis. Thus, it is important to recognize this clinical pattern when pulmonary infiltrates develop after complete treatment of cancer in an otherwise relapse-free patient and to encourage lung or lymph node biopsy in these particular settings in order to confirm a sarcoid-like reaction, thereby avoiding unnecessary chemotherapy for presumed tumor recurrence.
Parra
Edwin Roger
ER
Department of Pathology, University of São Paulo, Medical School, Av, Arnaldo 455, São Paulo 01246-903, Brazil.
Canzian
Mauro
M
Saber
Alexandre Muxfeldt Ab
AM
Coêlho
Ricardo Santos
RS
Rodrigues
Fabiola Gomes
FG
Kairalla
Ronaldo Adib
RA
de Carvalho
Carlos Roberto Ribeiro
CR
Capelozzi
Vera Luiza
VL
D000368:Aged; D003937:Diagnosis, Differential; D013505:Digestive System Surgical Procedures; D005260:Female; D006099:Granuloma / Q000473:pathology; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008477:Mediastinal Diseases / Q000473:pathology*; D008875:Middle Aged; D017565:Sarcoidosis, Pulmonary / Q000473:pathology*; D013274:Stomach Neoplasms / Q000601:surgery*; D019616:Thoracic Surgical Procedures; D014057:Tomography, X-Ray Computed