title: Benefit of a second opinion: From metastatic disease to resectable lung cancer with sarcoid-like reaction.
abstract: BACKGROUND
  Mediastinal lymphadenopathy in combination with lung cancer is suggestive for lymph node metastases but can also have other origins.
  
  
  METHODS
  We describe a patient diagnosed with stage IV lung cancer presenting with parenchymal lesions and enlarged mediastinal lymph nodes. A second opinion including FDG-PET scan review and a mediastinoscopy followed by surgery revealed tumor specimens originating from a single primary tumor with a sarcoid-like reaction in the mediastinal lymph nodes, changing the diagnosis from metastasized to resectable lung cancer.
  
  
  CONCLUSIONS
  PET positive lesions are not always synonymous with metastatic disease in the presence of a malignant tumor. Conscientious review of FDG-PET scans and tissue sampling are therefore mandatory to determine definitive staging and subsequent interventions.
authors.affiliation: Department of Pulmonary Diseases, VU University Medical Center Amsterdam, The Netherlands.
authors.forename: Romane M
authors.initials: RM
authors.lastname: Schook
authors.affiliation: Department of Pathology, VU University Medical Center Amsterdam, The Netherlands.
authors.forename: Lyan
authors.initials: L
authors.lastname: Koudstaal
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center Amsterdam, The Netherlands.
authors.forename: Emile F
authors.initials: EF
authors.lastname: Comans
authors.affiliation: Department of Pulmonary Diseases, VU University Medical Center Amsterdam, The Netherlands.
authors.forename: Pieter E
authors.initials: PE
authors.lastname: Postmus
authors.affiliation: Department of Pathology, VU University Medical Center Amsterdam, The Netherlands.
authors.forename: Katrien
authors.initials: K
authors.lastname: Grünberg
authors.affiliation: Department of Cardiothoracic Surgery, VU University Medical Center Amsterdam, The Netherlands.
authors.forename: Marinus A
authors.initials: MA
authors.lastname: Paul
authors.affiliation: Department of Pulmonary Diseases, VU University Medical Center Amsterdam, The Netherlands.
authors.forename: Egbert F
authors.initials: EF
authors.lastname: Smit
authors.affiliation: Department of Pulmonary Diseases, VU University Medical Center Amsterdam, The Netherlands.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Sutedja
keywords: Mediastinal enlargement; Non-small cell lung cancer; Sarcoid-like reaction; Second opinion