Lung Cancer: Student/Resident Case Report Poster - Lung Cancer I |

Coal Worker’s Pneumoconiosis and a Sarcoid-Like Reaction Mimicking Lymph Node Metastases in a Patient With Lung Cancer: A Case Report FREE TO VIEW

Chad Duncan, BA; Cynthia Jumper, MD; Suzanne Graham, MD; Lukman Tijani, MD; Ruc Tran, MD
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Texas Tech University Health Sciences Center, Lubbock, TX

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):744A. doi:10.1016/j.chest.2016.08.839
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SESSION TITLE: Student/Resident Case Report Poster - Lung Cancer I

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Sarcoid like reactions are a rare phenomenon that occur in a small percentage of cancer patients1. This reaction causes the formation of non-caseating granulomas inside regional lymph nodes, which causes them to appear hypermetabolic when viewed with FDG-PET. This is clinically important, because it could be confused with metastasis of the tumor, and could affect the staging and the treatment of the cancer. In addition to sarcoid like reactions and metastasis, there are other disease processes which can cause lymph nodes to appear hypermetabolic on FDG-PET, including Coal Worker’s Pneumoconiosis (CWP)2.

CASE PRESENTATION: We present the case of a 61 year old coal miner who was diagnosed with lung cancer. FDG-PET showed increased uptake in mediastinal lymph nodes on both the ipsilateral and contralateral side, however bronchoscopy and endobronchial ultrasound guided biopsy (EBUS) were negative. Because the mediastinal lymph node biopsy was negative, the patient was taken for surgical resection, and had a left upper lobectomy and left mediastinal lymph node dissection. The PET findings were originally thought to be due to metastasis from the tumor, however, pathology of the ipsilateral nodes showed the presence of silicotic changes due to CWP, and non-caseating granulomas, from a sarcoid like reaction. Because the ipsilateral lymph nodes had shown no evidence of metastasis, it was unlikely that the changes in the contralateral nodes were due to metastasis, and no adjuvant treatment was offered. At more than one year postoperatively the patient remains stable with no evidence of recurrence of the cancer, and we have clinical assurance that the changes in the lymph nodes were due to the sarcoid like reaction and CWP, and not metastasis.

DISCUSSION: FDG-PET is useful for detection and clinical staging of lung cancer, but cannot replace pathological staging. There are many other disease processes which can cause lymph nodes to appear hypermetabolic, including sarcoid like reactions and CWP. This needs to be taken into consideration in patients with exposure to coal dust or other possible infections, like tuberculosis and fungal infections.

CONCLUSIONS: There are many other disease processes that can co-occur in a patient with lung cancer which can cause lymph nodes to appear hypermetabolic when visualized with FDG-PET. Coal Worker’s Pneumoconiosis and sarcoid like reactions, though rare, may be associated with lung cancer and can appear hypermetabolic on FDG-PET. Pathology is ultimately necessary for staging and determining the best course of treatment.

Reference #1: Chowdhury FU, Sheerin F, Bradley KM, Gleeson FV. Sarcoid-like reaction to malignancy on whole-body integrated (18)F-FDG PET/CT: prevalence and disease pattern. Clin Radiol. 2009;64(7):675-681.

Reference #2: Hewitt RJ, Wright C, Adeboyeku D, et al. Primary nodal anthracosis identified by EBUS-TBNA as a cause of FDG PET/CT positive mediastinal lymphadenopathy. Respiratory Medicine Case Reports. 2013;10:48-52.

DISCLOSURE: The following authors have nothing to disclose: Chad Duncan, Cynthia Jumper, Suzanne Graham, Lukman Tijani, Ruc Tran

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