SESSION TYPE: Cancer Cases III
PRESENTED ON: Wednesday, October 24, 2012 at 11:15 AM - 12:30 PM
INTRODUCTION: Sarcoid-like reactions (SLR) are a rare phenomenon, occurring in approximately 4% of malignancies(1). They are often seen with hematologic tumors and solid tumors of the lungs, testicles, stomach, colon, and uterus(1). They are even rarer following breast malignancies, with a reported incidence of 1 in 2000(2). The average latency period from breast malignancy resection to the diagnosis of SLR is 40 months(2). Here, we report a case of SLR associated with concurrent breast adenocarcinoma metastatic to lungs presenting eleven years after initial diagnosis and surgical resection.
CASE PRESENTATION: A 43 year old Caucasian female with a history of bilateral invasive ductal breast adenocarcinoma diagnosed in February 2000 followed by bilateral mastectomy, lymph nodes dissection, tramflap reconstruction, and four cycles of chemotherapy presents with an unintentional 20 pound weight loss, complaints of chest discomfort, cough and hoarseness. Physical exam revealed bilateral breast scars. Chest CT scan and PET scan revealed enlargement and uptake in multiple mediastinal lymph nodes. A video assisted thoracoscopy visualized multiple subcentimeter lung nodules not seen on radiographic imaging. Histopathologic analysis of wedge lung biopsy and lymph nodes reported lung nodules with metastatic breast cancer and lymph nodes with non-caseating granulomas.
DISCUSSION: SLRs in primary tumors are characterized by granuloma formation in reaction to either local tumor excision or antigenic triggers. The non-caseating granulomas found in SLR are histopathologically identical to those of sarcoidosis. However, patients with SLR usually lack the systemic signs and symptoms commonly associated with sarcoidosis. In SLRs, granulomas form secondary to a T-cell mediated host response to soluble antigenic tumor factors that, in turn activate macrophages to create granulomas. SLR patients can have subpleural nodules, nodular infiltrates, and ground glass opacities. Treatment of SLR is management of the underlying malignancy.
CONCLUSIONS: Breast cancer is known to induce a sarcoidosis-like granulomatous response. However, it is rare to discover metastatic adenocarcinoma to the lung with a concurrent SLR present eleven years post resection. Prognosis and outcomes of patients with SLR associated with breast cancer may be concluded with larger case studies.
1) Sarcoid reactions in malignant tumours. Brincker H. Cancer Treat Rev. 1986
2) Sarcoid-like reaction in breast cancer: a long-term follow-up series of eight patients. Martella S et al. Surg Today. 2012.
3) Sarcoid-Like Reactions. Nag S. Chapter 16. Sarcoidosis: Diagnosis and Management 2011.
DISCLOSURE: The following authors have nothing to disclose: Chaitali Gupte, Satbir Singh, Kamaldeep Sandhu, Pooja Raju, Nazly Shariati, Jennifer LaRosa
No Product/Research Disclosure InformationNewark Beth Israel Medical Center, Newark, NJ