Tissue Is the Issue!

1University of Illinois at Urbana‐Champaign, Urbana, IL
2Wayne State University/Detroit Medical Center, Detroit, MI

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 222

Case Presentation:

Our patient is a 42‐year‐old African American woman with a significant history of a locally advanced ductal cancer of left breast (T2N1M0) after a modified radical mastectomy 1 year earlier. She also received adjuvant chemotherapy with 3‐drug regimens of cyclophosphamide, doxorubicin, and 5‐fluorouracil and radiation completed 6 months ago; she is currently receiving no treatment. She presented to the cancer clinic with left upper‐extremity swelling for 3 days consistent with lymphedema. A chest CT revealed new mediastinal and bilateral hilar adenopathy. Further evaluation with a PET scan revealed multiple fludeoxyglucose (FDG)–avid lymph nodes in the neck, mediastinum, hila, and porta hepatis region, likely related to the breast cancer recurrence and/or metastasis. Fine‐needle aspiration under endobronchial ultrasound guidance of multiple lymph node groups was consistent with noncaseating granulomas without evidence of malignancy. Tuberculosis and fungal infection were ruled out with appropriate tests. She was diagnosed with cancer‐sarcoid syndrome and discharged from the hospital on no new medications and was advised to follow up every 3 months.

Discussion:

Breast cancer is the most common female cancer in the United States, the second most common cause of cancer death in women, and the main cause of death in women ages 40–59. Despite significant advances in primary and adjuvant treatment for local breast cancer, many patients suffer a systemic relapse with metastatic disease, which occurs in 1%–5% of women. Malignant involvement of the lymph nodes is common; however, benign causes are possible and must be considered. Here we have reported a case of benign lymphadenopathy in a cancer patient that is usually “managed” as recurrent cancer or metastasis.

Conclusions:

Sarcoidosis and breast carcinoma are 2 diseases that occur most commonly in young and middle‐aged women. The association between sarcoidosis and malignancy is a controversial one, with cases preceding, in concurrence, or after the diagnosis of cancer in place. With the increasing use of FDG PET/CT in the imaging of cancer patients, the potential of FDG uptake in sarcoid‐like reactions mimicking disseminated malignancy has recently been reported in increasing numbers. There is no consensus on a specific term for mediastinal and hilar adenopathy secondary to granulomatous inflammation in cancer patients, although commonly used terms are sarcoid‐like reaction, sarcoid‐like lymphadenopathy, or simply sarcoidosis. Attributing a new‐onset lymphadenopathy in a cancerous patient without tissue confirmation to “cancer recurrence” can lead to unnecessary, expensive, and toxic treatment. In the current era of increasing numbers of cancer survivors, avoiding misinterpretation of these findings for malignant disease could potentially lead to inappropriate management decisions. So further studies to define the precise etiology, natural history, and prognosis are warranted.

Disclosures:

P. Agarwal ‐ none; V. Ramalingam ‐ none; R. Sinnakirouchenan ‐ none; A. Soubani ‐ none

To cite this abstract:

Agarwal P, Ramalingam V, Sinnakirouchenan R, Soubani A. Tissue Is the Issue!. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 222. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/tissue-is-the-issue/. Accessed November 19, 2019.

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