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Correspondence |

Concurrent Sarcoidosis and Lung Cancer FREE TO VIEW

Jerome M. Reich, MD, FCCP
Author and Funding Information

Earl A. Chiles Research Institute Portland, OR

Correspondence to: Jerome M. Reich, MD, FCCP, Earl A. Chiles Research Institute, 5251 NE Glisan, Building A, Portland, OR 97213-2967; e-mail: Reichje@dnamail.com


The author has reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(3):943. doi:10.1378/chest.09-0711
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To the Editor:

McNeill et al1 reported a patient whose sarcoidosis and lung cancer coexisted, raising the question of causality and, secondarily, of cause vs effect. The Ptolemaic (sarcocentric) viewpoint, advanced by Brincker and Wilbek,2 posits that the disease sarcoidosis can induce the development of solid neoplasms by an unspecified mechanism. The Copernican (oncocentric) viewpoint posits that sarcoidosis is an etiologically diverse syndrome,3 and that when systemic granulomas coexist with neoplasia, they constitute an immunologic response.4

The following considerations favor the Copernican viewpoint:

  1. Temporal sequence. Thirty-five tumor volume doublings are required to achieve a diameter of 3 cm.5 (The patient's tumor measured 4.5 × 2.5 cm.1) The mean tumor volume doubling time for squamous cell lung cancer is 88 days.5 Thus, since induction, about 8.5 years would be required for the cancer to attain this dimension. Assuming that induction required 5 years, the putative inciting event, intrathoracic sarcoidosis (undetected), would have had to be present for about 14 years. This seems unlikely for a military aviator in whom periodic chest radiographs are required.

  2. Intratumoral granulomas, and granulomatous changes in local lymph nodes and in regional organs (eg, liver or spleen) are each acknowledged to represent responses to neoplasia. To reverse the assignment of cause and effect when systemic granulomas exist creates an unjustified and illogical discontinuity. It violates Occam's dictum, lex parsimoniae. It is implausible, for it assumes the existence of an impermeable barrier beyond regional organs that prevents the systemic expression of the granulomatous response.

In summary, assuming a causal relationship, it appears more likely than not that systemic granulomas are a response to the pulmonary neoplasm.

McNeill M, Zanders TB, Morris MJ. A 49-year-old man with concurrent diagnoses of lung cancer, sarcoidosis, and multiple regions of adenopathy on positron emission tomography. Chest. 2009;135:546-549. [PubMed] [CrossRef]
 
Brincker H, Wilbek E. The incidence of malignant tumors in patients with respiratory sarcoidosis. Br J Cancer. 1974;29:247-251. [PubMed]
 
Judson M. The etiologic agent of sarcoidosis: what if there isn't one [editorial]? Chest. 2003;124:6-8. [PubMed]
 
Reich JM. Neoplasia in the etiology of sarcoidosis. Eur J Intern Med. 2006;17:81-87. [PubMed]
 
Geddes DM. The natural history of lung cancer: a review based on rates of tumour growth. Br J Dis Chest. 1979;73:1-17. [PubMed]
 

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References

McNeill M, Zanders TB, Morris MJ. A 49-year-old man with concurrent diagnoses of lung cancer, sarcoidosis, and multiple regions of adenopathy on positron emission tomography. Chest. 2009;135:546-549. [PubMed] [CrossRef]
 
Brincker H, Wilbek E. The incidence of malignant tumors in patients with respiratory sarcoidosis. Br J Cancer. 1974;29:247-251. [PubMed]
 
Judson M. The etiologic agent of sarcoidosis: what if there isn't one [editorial]? Chest. 2003;124:6-8. [PubMed]
 
Reich JM. Neoplasia in the etiology of sarcoidosis. Eur J Intern Med. 2006;17:81-87. [PubMed]
 
Geddes DM. The natural history of lung cancer: a review based on rates of tumour growth. Br J Dis Chest. 1979;73:1-17. [PubMed]
 
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