Pulmonary and mediastinal “sarcoidosis” following surgical resection of cancer

• Published in: Pathology, research and practice Vol. 200; no. 10; pp. 701 - 705
• Main Authors: Roger Parra, Edwin, Canzian, Mauro, Muxfeldt Ab’ Saber, Alexandre, Santos Coêlho, Ricardo, Gomes Rodrigues, Fabiola, Adib Kairalla, Ronaldo, Roberto Ribeiro de Carvalho, Carlos, Capelozzi, Vera Luiza
• Format: Journal Article
• Language: English
• Published: Germany Elsevier GmbH 01-01-2004; Elsevier Science Ltd
• Subjects: Aged; Diagnosis, Differential; Diffuse pulmonary infiltrate; Digestive System Surgical Procedures; Female; Granuloma - pathology; Hilar and mediastinal enlargement; Humans; Lung Neoplasms - pathology; Lung Neoplasms - secondary; Lung Neoplasms - surgery; Lymph Nodes - pathology; Male; Mediastinal Diseases - pathology; Middle Aged; Sarcoid reaction; Sarcoidosis; Sarcoidosis after cancer; Sarcoidosis mimicking pulmonary metastases; Sarcoidosis, Pulmonary - pathology; Stomach Neoplasms - surgery; Thoracic Surgical Procedures; Tomography, X-Ray Computed; Sarcoidosis mimicking pulmonary metastases; Sarcoid reaction; Sarcoidosis; Sarcoidosis after cancer; Hilar and mediastinal enlargement; Diffuse pulmonary infiltrate
• ISSN: 0344-0338; 1618-0631
• DOI: 10.1016/j.prp.2004.05.006

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.