The North Pacific Surgical Association
Sarcoidosis as a benign cause of lymphadenopathy in cancer patients

https://doi.org/10.1016/j.amjsurg.2009.01.004Get rights and content

Abstract

Background

Cancer and sarcoidosis have been associated in several small case series. This association makes the cancer patient with lymphadenopathy a diagnostic dilemma: malignant involvement of the lymph nodes is common, but benign diagnoses are possible and must be considered.

Methods

We conducted a retrospective chart review of all patients with a diagnosis of sarcoidosis or mediastinal adenopathy who underwent mediastinoscopy at the Swedish Medical Center and Cancer Institute from 2004 to 2008.

Results

Five hundred sixty-five mediastinoscopies were performed. There were 41 cases of biopsy-proven sarcoidosis. Twenty-one cases of sarcoidosis were diagnosed after a diagnosis of cancer. No primary cancer type was predominant. Cancers were of all stages, with and without lymph node involvement. The most common positron emission tomography combined with a computed tomography scan (PET CT) finding was bilateral hilar adenopathy with symmetric standardized uptake values (SUV) in the 4 to 15 range (62%), but many other PET CT patterns were present.

Conclusions

Hypermetabolic lymphadenopathy on staging or surveillance imaging presents a diagnostic dilemma. Sarcoidosis must be considered in the differential diagnosis of patients with a history of malignancy who develop lymphadenopathy. It is imperative to obtain a tissue diagnosis before instituting therapy for presumed cancer recurrence.

Section snippets

Methods

We conducted a retrospective chart review of all patients with a diagnosis of sarcoidosis or mediastinal adenopathy who underwent mediastinoscopy at Swedish Medical Center and Cancer Institute from 2004 to 2008. Patients were identified by a database query using the International Classification of Diseases codes of sarcoidosis or mediastinal adenopathy and the Current Procedural Terminology code for mediastinoscopy. The charts of all identified patients were reviewed, and data were obtained and

Results

A total of 565 mediastinoscopies were performed by 3 surgeons during the study period. There were 41 cases of sarcoidosis. Twenty-one cases of sarcoidosis developed after a diagnosis of cancer.

The patients with sarcoidosis and cancer were predominantly female. Less than one third were smokers. The average time that elapsed between cancer diagnosis and sarcoidosis diagnosis was 3 years (range from concurrent diagnosis to 12 years). Patients with sarcoidosis found on mediastinoscopy but no

Comments

An association between sarcoidosis and cancer has been the subject of a long-standing debate. Several epidemiologic studies have asserted an increased incidence of sarcoidosis in cancer patients, but others have not confirmed this association.8, 19, 20, 21, 22 In our series of 565 consecutive mediastinoscopies, 53% of the biopsy-proven cases of sarcoidosis occurred in patients with prior malignancy. This is a highly selected population of patients referred to a tertiary care center for an

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