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Venkatram S, Duran M, Fortuzi K, Baqui A, Luong TH, Diaz-Fuentes G. Hypermetabolic Pulmonary and Mediastinal Lesions With Elevated Cancer Antigen (CA) 15-3 and CA 27-29 in a Patient With a History of Ovarian and Breast Cancer. Cureus 2024; 16:e55712. [PMID: 38586673 PMCID: PMC10998437 DOI: 10.7759/cureus.55712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 04/09/2024] Open
Abstract
Breast cancer affects around 13% of women. Breast cancer gene 1 (BRCA1) carriers are prone to lung and lymph node metastasis, while breast cancer gene 2 (BRCA2) carriers tend to have bone metastasis. Findings of pulmonary nodules, mediastinal lymphadenopathy, and elevated markers such as cancer antigen (CA) 15-3 and CA 27-29 suggest metastatic disease. Here, we present the case of a patient with BRCA1-positive breast cancer in remission and a history of ovarian cancer with mediastinal lymphadenopathy and pulmonary nodules, with avid fluorodeoxyglucose uptake on positron emission tomography (PET) scan and elevated CA 15-3 and CA 27-29. A 70-year-old female with a history of bilateral breast and ovarian cancer and a positive BRCA test presented with pulmonary nodules, mediastinal lymphadenopathy, and elevated CA 15-3 and CA 27-29. Imaging showed mediastinal and hilar lymphadenopathy. A PET scan revealed increased metabolic activity in the lymph nodes and pulmonary lesions. Fiberoptic bronchoscopy and endobronchial ultrasound lymph node sampling demonstrated granulomatous inflammation without malignant cells. The patient underwent a therapeutic trial of steroids with clinical improvement of symptoms and decreased hypermetabolic activity in chest lesions, as well as a decrease in tumor markers. The coexistence of sarcoidosis and breast cancer is rare; sarcoidosis can coexist, precede, or appear after breast cancer. In both conditions, tumor markers and PET avidity are seen, which makes diagnosis and management challenging. In case of ambiguity, biopsy is crucial. This case underscores the importance of integrating clinical, pathological, and imaging data to reach an accurate diagnosis and consider a therapeutic trial of steroids. Furthermore, the early PET response to treatment can be pivotal in differentiating between sarcoidosis and malignancy, especially in complex clinical scenarios. Proper differentiation is paramount to avoid therapeutic missteps and ensure appropriate patient management.
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Affiliation(s)
| | - Maria Duran
- Medicine, BronxCare Health System, Bronx, USA
| | - Ked Fortuzi
- Pulmonary and Critical Care Medicine, Bronxcare Health System, Bronx, USA
| | - Aam Baqui
- Pathology, BronxCare Health System, Bronx, USA
| | - Thanh-Ha Luong
- Oncology/Hematology, BronxCare Health System, Bronx, USA
| | - Gilda Diaz-Fuentes
- Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, USA
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Mehta AA, Pavithran K, Jose WM, Vallonthaiel AG, George DR, Sudhakar N. Case series of concurrent occurrence of sarcoidosis and breast cancer - A diagnostic dilemma. Respir Med Case Rep 2022; 35:101565. [PMID: 35004168 PMCID: PMC8717247 DOI: 10.1016/j.rmcr.2021.101565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/08/2021] [Accepted: 12/12/2021] [Indexed: 11/24/2022] Open
Abstract
Sarcoidosis is a multi-system granulomatous disorder characterized by involvement of multiple systems with or without lymphadenitis. Pulmonary complications are common and may lead to morbidity. Breast cancer is one of the commonest malignancy among women across the world. There is an increased risk of malignancies in sarcoidosis. This association with cancer creates a diagnostic dilemma due to the predominant involvement of nodes and organ systems in both conditions. Here we report three cases of sarcoidosis with breast cancer diagnosed over one year.
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Affiliation(s)
- Asmita A Mehta
- Department of Respiratory Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, P.O. AIMS Ponekkara, Kochi, 682041, Kerala, India
| | - Keechilat Pavithran
- Department of Medical Oncology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, P.O. AIMS Ponekkara, Kochi, 682041, Kerala, India
| | - Wesley M Jose
- Department of Medical Oncology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, P.O. AIMS Ponekkara, Kochi, 682041, Kerala, India
| | - Archana George Vallonthaiel
- Department of Pathology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, P.O. AIMS Ponekkara, Kochi, 82041, Kerala, India
| | - Dr Richie George
- Department of Respiratory Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, P.O. AIMS Ponekkara, Kochi, 682041, Kerala, India
| | - Nidhi Sudhakar
- Department of Respiratory Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, P.O. AIMS Ponekkara, Kochi, 682041, Kerala, India
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Sarcoidosis and breast cancer: A retrospective case series. Respir Med Case Rep 2020; 31:101190. [PMID: 32874910 PMCID: PMC7452135 DOI: 10.1016/j.rmcr.2020.101190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/21/2020] [Accepted: 08/08/2020] [Indexed: 01/18/2023] Open
Abstract
Background Sarcoidosis and breast cancer co-incidence is reported in the literature in the form of case reports. Aim To describe our experience from a single large sarcoidosis clinic. Methods Retrospective chart review of 1000 sarcoidosis cases seen in our clinic from 2003 to 2008. Results 429/1000 female sarcoidosis cases were identified. Among them 20/429 had a history of sarcoidosis and breast cancer. In 12/20 breast cancer preceded sarcoidosis by 52 months, in 4/20 sarcoidosis preceded breast cancer by 200 months and in 4/20 they presented concurrently. Mean age of sarcoidosis diagnosis was 53.9 (±12.4) years. Majority were of European decent (16/20), 3 were African-Americans and 1 Asian. Scadding radiography stages distribution was (n) 4/11/3/2/0 for stages 0/I/II/III/IV respectively. They had 3.4 (±1.3) organs involved, mainly with intrathoracic involvement. 10/20 were asymptomatic and 11/20 received chronic treatment. Compared to 409 cases of sarcoidosis sine breast cancer (mean age 46.7 ± 13.1), sarcoidosis-breast cancer cases had sarcoidosis diagnosed at a significantly later age (p = 0.01). Histological diagnosis applied in all co-incidence cases, in 5 via mediastinoscopy. Conclusions Older females with breast cancer may develop sarcoidosis, with features indistinguishable from stand-alone sarcoidosis. When sarcoidosis is suspected histological diagnosis is mandatory.
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Irie T, Matsutani T, Hagiwara N, Ohashi R, Nomura T, Hanawa H, Mishima K, Taniai N, Yoshida H. Sarcoid-like reaction in lymphadenopathy associated with superficial esophageal squamous cell carcinoma. Clin J Gastroenterol 2020; 13:688-692. [PMID: 32519313 DOI: 10.1007/s12328-020-01156-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/23/2020] [Indexed: 10/24/2022]
Abstract
Correctly distinguishing metastasis and sarcoid-like reaction in patients with mediastinal lymphadenopathy is clinically important in esophageal cancer. A patient was a 52-year-old Japanese woman with superficial esophageal squamous cell carcinoma and rare case of sarcoid-like reaction. The patient was admitted with pharyngeal discomfort and an upper gastrointestinal endoscopy detected a superficial tumor in the middle thoracic esophagus. Biopsy confirmed a diagnosis of squamous cell carcinoma. Chest computed tomography (CT) showed enlarged lymph nodes around the trachea and in the bilateral hilum of the lung that were found to accumulate label on positron emission tomography CT. One course of chemotherapy in 5-fluorouracil, docetaxel and cisplatin did not affect the lymphadenopathy, which suggested that it was reactive rather than metastatic. The patient had undergone thoracoscopic esophagectomy with lymph node dissection. The pathohistology of the dissected lymph nodes showed noncaseating epithelioid-cell granuloma and no malignant cells. No clinical findings indicative of systemic sarcoidosis were observed, leading to a diagnosis of sarcoid-like reaction with the esophageal cancer. The patient has survived without recurrence for 4 years after beginning the initial treatment. Monitoring the response to chemotherapy may be helpful in distinguishing between metastasis and sarcoidosis-associated lymphadenopathy in esophageal cancer.
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Affiliation(s)
- Toshiyuki Irie
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Takeshi Matsutani
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan. .,Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-396, Kosugimachi, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan.
| | - Nobutoshi Hagiwara
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Ryuji Ohashi
- Department of Diagnostic Pathology, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Tsutomu Nomura
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Hidetsugu Hanawa
- Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-396, Kosugimachi, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Keisuke Mishima
- Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-396, Kosugimachi, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Nobuhiko Taniai
- Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-396, Kosugimachi, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
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5
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Wu JM, Turashvili G. Cystic neutrophilic granulomatous mastitis: an update. J Clin Pathol 2020; 73:445-453. [PMID: 32094275 DOI: 10.1136/jclinpath-2019-206180] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 02/07/2023]
Abstract
Cystic neutrophilic granulomatous mastitis (CNGM) is a rare subtype of granulomatous mastitis with a highly distinct histological pattern often associated with Corynebacterium species. CNGM is characterised by suppurative lipogranulomas that are composed of central lipid vacuoles rimmed by neutrophils and an outer cuff of epithelioid histiocytes. Some of the lipid vacuoles may contain sparse, rod-shaped, gram-positive bacilli that can be easily missed or dismissed. The surrounding mixed inflammatory infiltrate contains Langhans-type giant cells, lymphocytes and neutrophils. CNGM occurs in reproductive age women with a history of pregnancy and typically presents as a palpable mass that can be painful. CNGM has many mimickers, most significantly breast carcinoma. In many cases, CNGM has significant pathological and clinical overlap with other forms of granulomatous mastitis. Given the association with Corynebacterium species, early diagnosis of CNGM is essential in offering patients the most appropriate treatment. Prolonged antibiotic therapy specifically directed to corynebacteria is required, sometimes even beyond resolution of clinical symptoms. This comprehensive review of the existing literature on CNGM describes clinical-pathological features, microbiological findings, challenges associated with the microscopic differential diagnosis, clinical implications of this diagnosis and emerging treatment options. Morphological criteria and suggested comments to convey the degree of diagnostic certainty are also proposed for standard pathology reporting.
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Affiliation(s)
- Jessie M Wu
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gulisa Turashvili
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Iftikhar A, Cheema MAI, Ramachandran P, Sahni S. Sarcoid-like reaction associated with renal cell carcinoma - A case report. Respir Med Case Rep 2019; 27:100847. [PMID: 31024794 PMCID: PMC6476811 DOI: 10.1016/j.rmcr.2019.100847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/14/2019] [Accepted: 04/14/2019] [Indexed: 11/30/2022] Open
Abstract
Renal cell carcinoma (RCC) is a highly vascular tumor, which may spread to the lungs and other organs. It often presents with localized or systemic manifestation, including paraneoplastic syndromes. Sarcoidosis is a systemic granulomatous inflammatory disease characterized by non-caseating granulomas that typically afflicts the respiratory system. In the absence of any evidence of systemic sarcoidosis they are referred to as sarcoid-like reactions. Non-caseating epithelioid granulomas, also regarded to sarcoid-like granulomas have been described in association with certain malignancies such as carcinomas of the breast, colon, seminoma, and Hodgkin's lymphoma. However, sarcoid like reaction associated with renal cell carcinoma is uncommon. Herein we present a rare case of a patient with renal cell carcinoma with mediastinal lymphadenopathy initially thought to metastatic disease, though revealed a sarcoid-like reaction with review of literature.
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Affiliation(s)
- Asma Iftikhar
- New York - Presbyterian Queens, Division of Pulmonary, Critical Care and Sleep Medicine, Flushing, NY, 11355, USA
| | - Muhammad A I Cheema
- New York - Presbyterian Queens, Division of Pulmonary, Critical Care and Sleep Medicine, Flushing, NY, 11355, USA
| | - Preethi Ramachandran
- Brookdale University Hospital Medical Center, Division of Hematology and Oncology, Brooklyn, NY, 11212, USA
| | - Sonu Sahni
- Brookdale University Hospital Medical Center, Department of Internal Medicine, Brooklyn, NY, 11212, USA.,Touro College of Osteopathic Medicine, Department of Primary Care, New York, NY, 10027, USA
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7
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Cho KK, Lyes SM, Shetty A. Sarcoidosis following escalated BEACOPP chemotherapy for stage IV Hodgkin lymphoma. Intern Med J 2019; 49:547-548. [PMID: 30957369 DOI: 10.1111/imj.14246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 07/21/2018] [Accepted: 08/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Kenneth K Cho
- Department of Haematology, Nepean Hospital, Sydney, New South Wales, Australia
| | - Susannah M Lyes
- Department of Haematology, Nepean Hospital, Sydney, New South Wales, Australia
| | - Anita Shetty
- Department of Haematology, Nepean Hospital, Sydney, New South Wales, Australia
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8
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Wang Y, LeGolvan M, Chapin K, Mainiero M. Cystic neutrophilic granulomatous mastitis with corynebacterium and staphylococcus mimicking breast carcinoma. Clin Case Rep 2018; 6:2208-2210. [PMID: 30455922 PMCID: PMC6230645 DOI: 10.1002/ccr3.1801] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/19/2018] [Accepted: 08/13/2018] [Indexed: 11/11/2022] Open
Abstract
Cystic neutrophilic granulomatous mastitis (CNGM) is an increasingly recognized entity in the differential diagnosis of granulomatous inflammation involving the breast. We present the first case report of CNGM mimicking carcinoma of the breast with two mixed bacterial species as the causative pathogens (Corynebacterium and Staphylococcus spp.).
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Affiliation(s)
- Yihong Wang
- Department of Pathology and Laboratory MedicineRhode Island Hospital and Alpert Medical School of Brown UniversityProvidenceRhode Island
| | - Mark LeGolvan
- Department of Pathology and Laboratory MedicineRhode Island Hospital and Alpert Medical School of Brown UniversityProvidenceRhode Island
| | - Kimberle Chapin
- Department of Pathology and Laboratory MedicineRhode Island Hospital and Alpert Medical School of Brown UniversityProvidenceRhode Island
| | - Martha Mainiero
- Department of Diagnostic ImagingRhode Island Hospital and Alpert Medical School of Brown UniversityProvidenceRhode Island
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9
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Esophageal cancer associated with a sarcoid-like reaction and systemic sarcoidosis in lymph nodes: supportive findings of [18F]-fluorodeoxyglucose positron emission tomography-computed tomography during neoadjuvant therapy. Surg Case Rep 2018; 4:62. [PMID: 29943286 PMCID: PMC6020089 DOI: 10.1186/s40792-018-0473-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/14/2018] [Indexed: 01/23/2023] Open
Abstract
Background In patients with esophageal cancer, differentiation between lymph node metastasis and lymphadenopathies from sarcoidosis or sarcoid-like reactions of lymph nodes is clinically important. Herein, we report two esophageal cancer cases with lymph node involvement of sarcoid-like reaction or sarcoidosis. Case presentation One patient received chemotherapy and the other chemoradiotherapy as initial treatments. In both cases, [18F]-fluorodeoxyglucose positron emission tomography–computed tomography (FDG-PET/CT) was performed before and after chemo(radio)therapy. After the treatment, FDG uptake was not detected in the primary tumor, but it was slightly reduced in the hilar and mediastinal lymph nodes in both cases. These non-identical responses to chemo(radio)therapy suggest the presence of sarcoid-like reaction of lymph nodes associated with squamous cell carcinoma of the esophagus. Curative surgical resection was performed as treatment. Conclusions These FDG-PET/CT findings may be helpful to distinguish between metastasis and sarcoidosis-associated lymphadenopathy in esophageal cancer.
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10
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Suzuki Y, Katayama K, Ishikawa E, Mizoguchi S, Oda K, Hirabayashi Y, Haruki A, Ito T, Fujimoto M, Murata T, Ito M. Granulomatous interstitial nephritis due to chronic lymphocytic leukemia: a case report. BMC Nephrol 2017; 18:348. [PMID: 29197349 PMCID: PMC5712145 DOI: 10.1186/s12882-017-0775-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/23/2017] [Indexed: 11/15/2022] Open
Abstract
Background Renal failure due to the infiltration of chronic lymphocytic leukemia (CLL) cells into the tubulointerstitial area of the kidney is uncommon. Furthermore, granulomatous interstitial nephritis (GIN) is a rare histological diagnosis in patients undergoing a renal biopsy. We herein report a case of GIN due to the diffuse infiltration of CLL cells in a patient who developed progressive renal failure. Case presentation The patient was a 55-year-old man who had been diagnosed with CLL 4 years earlier and who had been followed up without treatment. Although his serum creatinine level had remained normal for three and a half years, it started to increase in the six months prior to his presentation. A urinalysis showed mild proteinuria without any hematuria at the time of presentation. A renal biopsy revealed the diffuse infiltration of CLL cells into the tubulointerstitial area with non-caseating epithelioid cell granulomas. Despite cyclophosphamide treatment, his renal function did not improve, and he ultimately required maintenance hemodialysis. Conclusion When progressive renal failure is combined with CLL, GIN due to the direct infiltration of CLL cells should be considered as a differential diagnosis.
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Affiliation(s)
- Yasuo Suzuki
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Kan Katayama
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Eiji Ishikawa
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Shoko Mizoguchi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Keiko Oda
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Yosuke Hirabayashi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Ayumi Haruki
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Takayasu Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Mika Fujimoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Tomohiro Murata
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masaaki Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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The Intranodal Presence of Coexisting Granulomatous Inflammation and Carcinoma During Transbronchial Needle Aspiration of Intrathoracic Lymphadenopathy. J Bronchology Interv Pulmonol 2017; 24:80-83. [PMID: 27479015 DOI: 10.1097/lbr.0000000000000218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The presence of intrathoracic lymphadenopathy in patients with suspected malignancy remains concerning, often prompting further evaluation with tissue sampling. The presence of nodal granulomatous inflammation in patients with underlying malignancy is well reported. However, review of 3 recent large trials of endobronchial ultrasound-guided transbronchial needle aspiration in patients with granulomatous inflammation and malignancy did not identify the presence of coexisting, intranodal malignancy, and granulomatous inflammation, rather these diagnoses remained nodally exclusive. We present a case of coexisting granulomatous inflammation and metastatic carcinoma within the same lymph node aspirates, reviewing the potential diagnostic pitfalls and implications of this rare occurrence.
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Kim H, Kim JW, Kim A, Chang H. Clear Cell Renal Cell Carcinoma with Intratumoral Granulomatous Reaction: A Case Report and Review of the Literature. J Pathol Transl Med 2017; 51:325-328. [PMID: 28288504 PMCID: PMC5445199 DOI: 10.4132/jptm.2016.09.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/26/2016] [Accepted: 09/07/2016] [Indexed: 11/23/2022] Open
Abstract
Granulomatous reaction associated with clear cell renal cell carcinoma (CCRCC) is a rare finding, and only a few cases have been described in the literature. It is postulated to occur due to cancer-related antigenic factors such as cancer cells themselves or soluble tumor antigens shed into the blood. Herein, we describe a case of a 56-year-old male patient diagnosed with CCRCC with intratumoral granulomatous inflammation.
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Affiliation(s)
- Hayeon Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Jong Wook Kim
- Department of Urology, Korea University Guro Hospital, Seoul, Korea
| | - Aeree Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Hyeyoon Chang
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
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Agrawal A, Sahni S, Iftikhar A, Talwar A. Pulmonary manifestations of renal cell carcinoma. Respir Med 2015; 109:1505-8. [PMID: 26525375 DOI: 10.1016/j.rmed.2015.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/22/2015] [Accepted: 10/05/2015] [Indexed: 12/15/2022]
Abstract
Renal cell carcinoma (RCC) accounts for majority of all primary renal neoplasms. Classic manifestations of RCC include the triad of flank pain, hematuria and a palpable renal mass. Patients with RCC can develop various extra renal manifestations including involvements of the lungs, inferior vena cava, liver and the bones. The pulmonary manifestations of renal cell carcinoma include metastatic disease including endobronchial, pleural, parenchymal or lymph node metastasis, pleural effusion or hemothorax. Pulmonary embolism and tumor embolism is another common manifestation of renal cell carcinoma. RCC is a highly vascular tumor and can cause pulmonary arterio-venous fistulas leading to high output failure. Rarely, RCC can also present with paraneoplastic presentations including cough or bilateral diaphragm paralysis. Drugs used to treat RCC have been associated with drug related pneumonitis and form an important differential diagnosis in patients with RCC on therapy presenting with shortness of breath. In this review we discuss the various pulmonary manifestations of RCC. A high index of suspicion with these presentations can lead to an early diagnosis and assist in instituting an appropriate intervention.
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Affiliation(s)
- Abhinav Agrawal
- Monmouth Medical Center, Department of Medicine, 300 Second Avenue Long Branch, NJ 07740, United States.
| | - Sonu Sahni
- North Shore-Long Island Jewish Health System, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd. Suite 107, New Hyde Park, NY 11040, United States; Feinstein Institute for Medical Research, Center for Heart and Lung Research, 350 Community Drive Manhasset, NY 11030, United States.
| | - Asma Iftikhar
- North Shore-Long Island Jewish Health System, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd. Suite 107, New Hyde Park, NY 11040, United States; Feinstein Institute for Medical Research, Center for Heart and Lung Research, 350 Community Drive Manhasset, NY 11030, United States.
| | - Arunabh Talwar
- North Shore-Long Island Jewish Health System, Department of Pulmonary, Critical Care and Sleep Medicine, 410 Lakeville Rd. Suite 107, New Hyde Park, NY 11040, United States; Feinstein Institute for Medical Research, Center for Heart and Lung Research, 350 Community Drive Manhasset, NY 11030, United States.
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14
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Abstract
BACKGROUND Sarcoid-like reactions have been reported and confirmed by histopathology in patients with malignant disease. This series demonstrates the complex relationship of malignancy and sarcoidosis as pertaining to the eye, which, to the best of our knowledge, has not been previously reported in the literature. METHODS Retrospective case study of five patients with sarcoid-like reactions. Patients 1 to 4 represent patients with ocular sarcoid-like reaction and systemic malignant disease. Patient 5 had ocular malignancy and systemic sarcoid-like reaction; workup revealed renal cell cancer. For each patient, other etiologies of nonnecrotizing granulomatous inflammation were excluded. RESULTS Sarcoid-like reactions have been described in the literature when nonnecrotizing granulomas occur in association with malignancy and in the absence of multiorgan involvement as seen with systemic sarcoid. In our series, sarcoid-like reactions involved the vitreous in three patients, retina in one patient, and the choroid and lung in one patient. Sarcoid-like reaction preceded the diagnosis of malignancy in two patients, was found concomitantly with malignancy in one patient, and followed malignancy in two patients. Two patients had hematologic malignancy, one patient had endometrial carcinoma, one had renal cell carcinoma, and one patient had both renal cell carcinoma and uveal melanoma. Four patients had findings of nonnecrotizing granulomas confirmed by histopathology. CONCLUSION Sarcoid-like reactions can occur in the eye, and ocular malignancies may incite sarcoid-like reaction. Ocular sarcoid-like reactions have paraneoplastic features in that they can occur at a site distant from malignancy and may precede, occur simultaneously with, or follow malignancy.
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Chen J, Carter R, Maoz D, Tobar A, Sharon E, Greif F. Breast Cancer and Sarcoidosis: Case Series and Review of the Literature. Breast Care (Basel) 2015. [PMID: 26195943 DOI: 10.1159/000381324] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sarcoidosis is a chronic inflammatory disease of unknown etiology, which can involve different organs and systems. Accordingly, sarcoidosis can mimic breast cancer, making the differential diagnosis very difficult. CASE REPORT 5 patients with a diagnosis of both sarcoidosis and breast cancer followed by the Rabin Medical Center between January 1993 and June 2012 were enrolled in this study. Additionally, a comprehensive literature review which identified 104 patients diagnosed with breast cancer and sarcoidosis was carried out. In both populations reviewed, the average age at diagnosis of sarcoidosis and breast cancer was 57 years. Among the 66 patients with both sarcoidosis and breast cancer, sarcoidosis preceded breast cancer in 31 cases, followed it in 23 cases, and appeared concurrently in 10 cases. CONCLUSION Based on our clinical cases and literature review, a histological study is recommended over imaging if sarcoidosis or breast cancer may be present. Furthermore, breast cancer is rarely associated with sarcoidosis or sarcoidosis-like reaction.
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Affiliation(s)
- Jacob Chen
- Department of Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; US Army Institute of Surgical Research, Fort Sam, Houston, TX, USA
| | - Robert Carter
- US Army Institute of Surgical Research, Fort Sam, Houston, TX, USA
| | - Daniel Maoz
- Department of Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ana Tobar
- US Army Institute of Surgical Research, Fort Sam, Houston, TX, USA
| | - Eran Sharon
- Department of Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Franklin Greif
- Department of Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sarcoid-Like Reaction in Sentinel Lymph Node Draining Conjunctival Melanoma. Ophthalmic Plast Reconstr Surg 2015; 31:e1-3. [DOI: 10.1097/iop.0000000000000018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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Luke JJ, Lezcano C, Hodi FS, Murphy GF. Antitumor granuloma formation by CD4+ T cells in a patient with rapidly progressive melanoma experiencing spiking fevers, neuropathy, and other immune-related toxicity after treatment with ipilimumab. J Clin Oncol 2014; 33:e32-5. [PMID: 24616309 DOI: 10.1200/jco.2013.49.7735] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Jason J Luke
- Melanoma Disease Center of Dana-Farber Cancer Institute; Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Cecilia Lezcano
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - F Stephen Hodi
- Melanoma Disease Center of Dana-Farber Cancer Institute; Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - George F Murphy
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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18
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D'Angelo FA, Magistri P, Antolino L, Socciarelli F. Granulomatous reaction within the thyroid metastases of a renal cell carcinoma. Int J Surg Pathol 2013; 22:87-9. [PMID: 23775018 DOI: 10.1177/1066896913491319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Metastases of non-thyroid malignancies to the thyroid gland have been reported in 1.4% to 3% of patients undergoing thyroid surgery for thyroid malignancy. We report a case of thyroid metastases from renal cell carcinoma in a 57-year-old man, who underwent a left nephrectomy 11 years earlier for a renal cell carcinoma. The histological examination demonstrated a CD-10 positive and thyroglobulin and thyroid transcription factor-1 negative tissue, with numerous noncaseating gigantocellular granulomas. These findings are interesting for the possible role of the immune response in metastatic localizations.
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19
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Gessi M, Guerriero M, Denaro L, Lauriola L. Tibial nerve tumor in a 72-year-old man. Neuropathology 2012; 33:487-90. [PMID: 23025630 DOI: 10.1111/j.1440-1789.2012.01356.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marco Gessi
- Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany.
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20
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Abstract
Some inflammatory and reactive lesions of the breast present problems clinically but are treated without resort to biopsy. In others, biopsy is required to make the correct diagnosis and to distinguish the process from malignancy. Still others represent incidental microscopic findings that may create diagnostic problems. This article reviews a number of inflammatory and reactive conditions that are likely to be encountered in routine surgical pathology practice, as well as those that have been recently described.
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Affiliation(s)
- Jennifer S Kaplan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Stuart J Schnitt
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
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21
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Sarcoid-reaction mimicking metastatic malignant hepatopancreatobiliary tumors: report of two cases and review of the literature. J Gastrointest Surg 2012; 16:1245-50. [PMID: 22258875 DOI: 10.1007/s11605-011-1820-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 12/28/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Sarcoidosis is a multisystem chronic granulomatous disease found predominantly in the lungs and lymph nodes. Its pathologic hallmark is the presence of systemic non-caseating granulomas; however, a variation of this disease known as "sarcoid-like reaction" has been described in patients with underlying cancer. REPORT Sarcoid-like reactions in patients with hepatopancreatobiliary (HPB) tumors are rare findings, with only 15 cases having been reported in the English language literature. These reactions can be found in local lymph nodes or in distant organs, and when present in patients with cancer, they can mimic metastatic disease on imaging, potentially resulting in incorrect cancer staging and management. DISCUSSION We describe two cases of patients with HPB tumors who had distant organ disease on cross-sectional imaging suspicious for metastases, which on further workup were found to be sarcoid-like reactions. We also discuss malignancy-induced sarcoid-like reactions and provide a review of the literature of sarcoid-like reactions in the setting of HPB tumors.
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Abstract
Idiopathic granulomatous lobular mastitis (IGLM) is a rare breast condition with prominent skin findings. It is typically seen in young parous women. Painful breast masses, draining sinuses, scarring, and breast atrophy are the main clinical manifestations. IGLM can resemble a variety of other inflammatory and neoplastic processes of the breast. It is thought to result from obstruction and rupture of breast lobules. Extravasated breast secretions then induce an inflammatory reaction. Corynebacteria have also been implicated in the pathogenesis. Treatment is surgical, but systemic corticosteroids, methotrexate, and antibiotics also play a role.
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23
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Ouellet S, Albadine R, Sabbagh R. Renal cell carcinoma associated with peritumoral sarcoid-like reaction without intratumoral granuloma. Diagn Pathol 2012; 7:28. [PMID: 22424560 PMCID: PMC3359196 DOI: 10.1186/1746-1596-7-28] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 03/18/2012] [Indexed: 11/10/2022] Open
Abstract
Non-necrotizing epithelioid granulomas have been described in association with many primary tumors. In such cases, they are designated as sarcoid-like reaction. Although it is more seen in carcinomas than in sarcomas, it is very rarely reported in renal carcinoma. Here, we describe a rare association of prominent peritumoral sarcoid-like reaction without intratumoral granulomas and conventional clear cell renal carcinoma in a 62-year-old-male, without clinical or laboratory finding of sarcoidosis. At 30 months follow-up, he had no recurrence. Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4054525336657922.
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Affiliation(s)
- Simon Ouellet
- Department of Surgery, Division of Urology, Sherbrooke University, Centre hospitalier universitaire de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
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24
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Sarcoidal reactions in regional lymph nodes of patients with early stage non-small cell lung cancer predict improved disease-free survival: a pilot case-control study. Hum Pathol 2011; 43:333-8. [PMID: 21835432 DOI: 10.1016/j.humpath.2011.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 04/29/2011] [Accepted: 05/04/2011] [Indexed: 11/22/2022]
Abstract
Sarcoidal reactions occurring in regional lymph nodes of patients with non-small cell lung carcinoma appear to be limited to patients with stage I disease. The prognostic significance of this remains unknown. Such reactions are thought to represent a cell-mediated antitumor response and have been associated with improved outcomes in other solid organ malignancies. We performed a retrospective chart review of all patients undergoing lobectomy with curative intent for non-small cell lung carcinoma. Eligible cases were selected based on pathologic reports, with matched controls then drawn from the same surgical cohort. One hundred fifty-seven patients underwent lobectomy and lymph node dissection. Eight patients with sarcoidal granulomas present in regional lymph nodes were identified as cases and matched to 16 control subjects. All subjects were staged pN0. Disease recurrence was noted in no case subjects but in 7 (44%) of control subjects (P = .044, χ(2) = 4.051). The presence of sarcoidal reactions within regional lymph nodes of patients with non-small cell lung carcinoma predicts a lower rate of disease recurrence after definitive surgical resection. The exact mechanism by which antitumor immunity is achieved remains to be elucidated.
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25
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26
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Wegener's granulomatosis of the breast: a rare entity with daily clinical relevance. Ann Diagn Pathol 2009; 13:351-7. [PMID: 19751914 DOI: 10.1016/j.anndiagpath.2009.04.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 04/15/2009] [Indexed: 11/24/2022]
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27
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Hermann G, Nagi C, Mester J, Tierstein A. Unusual presentation of sarcoidosis of the breast. Br J Radiol 2008; 81:e231-3. [PMID: 18769011 DOI: 10.1259/bjr/11877313] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report a case of sarcoidosis with an unusual radiological appearance. The patient was a 41-year-old asymptomatic woman who presented for a baseline screening mammogram, which revealed an asymmetric, slightly increased density in the upper outer quadrant of her left breast. Ultrasonography failed to demonstrate any mass. Her past medical history was remarkable for sarcoidosis. Stereotactic core biopsy revealed sarcoidosis diffusely infiltrating the breast parenchyma.
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Affiliation(s)
- G Hermann
- Department of Radiology, Division of Pulmonary and Critical Care Medicine, Mount Sinai School of Medicine, 1 Gustave L Levy Place, New York, NY 10029, USA.
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28
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de Souza Azevedo R, Abrahão AC, de Albuquerque EB. Synchronous orofacial granulomatosis and mucoepidermoid carcinoma: paraneoplastic syndrome or coincidence? ACTA ACUST UNITED AC 2008; 106:e40-5. [PMID: 18554941 DOI: 10.1016/j.tripleo.2008.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 04/13/2008] [Accepted: 04/17/2008] [Indexed: 01/10/2023]
Abstract
Some malignant neoplasias induce the appearance of local or systemic manifestations at distant sites, which can act as indicators of their presence in a process named paraneoplastic syndrome. Granulomatous reactions have already been described related to malignancies. This report describes a case of synchronous orofacial granulomatosis and mucoepidermoid carcinoma and discusses the significance of this association.
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Affiliation(s)
- Rebeca de Souza Azevedo
- Lato Sensu Postgraduate Program, Stomatology Specialization, Department of Oral Pathology and Diagnosis, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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29
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Risbano MG, Groshong SD, Schwarz MI. Lung nodules in a woman with a history of breast cancer. Diagnosis: a sarcoid-like reaction in metastatic breast cancer. Chest 2008; 132:1697-701. [PMID: 17998374 DOI: 10.1378/chest.07-1388] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Michael G Risbano
- Department of Medicine, University of Colorado Health Sciences Center, SOM, Room 5525, 4200 East Ninth Ave, C272, Denver, CO 80262, USA.
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30
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Pavic M, Debourdeau P, Vacelet V, Rousset H. Place de la pathologie granulomateuse au cours des cancers. Rev Med Interne 2008; 29:39-45. [DOI: 10.1016/j.revmed.2007.09.041] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Accepted: 09/22/2007] [Indexed: 10/22/2022]
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31
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Abstract
Malignancy in patients with sarcoidosis occurs in 3 settings. The first setting relates to patients with hematologic malignancies. It includes the sarcoidosis-lymphoma syndrome, which refers to the development of lymphoma at least 1 to 2 years after the diagnosis of sarcoidosis. It also includes patients with sarcoidosis who develop other hematologic malignancies. In addition, this subset of individuals includes patients with cancer and hematologic malignancies who subsequently develop sarcoidosis. The second setting consists of patients with sarcoidosis who develop solid tumors and oncologic patients in whom sarcoidosis subsequently appears; in addition to melanoma and nonmelanoma skin cancer, the neoplasms most commonly associated involve the cervix, liver, lung, testicles, and uterus. The third setting of malignancy-related sarcoidosis occurs when sarcoidosis presents as a paraneoplastic syndrome for the associated cancer, specifically when the discovery of cancer is concurrent with or within 1 year of the diagnosis of sarcoidosis or vis-a-vis. Antineoplastic treatment of either the hematologic malignancy or the solid tumor has also been observed to either induce the initial onset or flare the activity of sarcoidosis. Malignancy can also be associated with the occurrence of sarcoid reactions that typically are restricted to the regional lymph nodes or the visceral organ of tumor origin; rarely, the sarcoid reaction can also be observed in the skin or is only limited to the skin.
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32
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Pavic M, Le Pape E, Debourdeau P, Rabar D, Crevon L, Colle B, Rousset H. [Non-tuberculous systemic granulomatosis mimicking sarcoidosis but related to a specific etiology. Study of 67 cases]. Rev Med Interne 2007; 29:5-14. [PMID: 17602803 DOI: 10.1016/j.revmed.2007.05.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Accepted: 05/21/2007] [Indexed: 11/26/2022]
Abstract
PURPOSE Systemic granulomatosis (SG) are frequently encountered in internal medicine. Despite a large list of aetiologies, the investigations remain often negative leading to the diagnosis of atypical sarcoidosis. The spectrum of the causes, as well as evolution of these SG is not clearly delineated in the literature. METHOD We analyzed the case reports of all but tuberculous GS submitted at the National Meetings of the National French Society of Internal Medicine from 1990 to 2006. RESULTS Sixty-seven cases were included in the study. The average age at the beginning of the symptoms was 47.8 years and 28.4% of the patients were female. The median diagnostic delay was one year. General symptoms were present in 73.1% of the cases. The involved organs were the liver (46.3%), lungs (25.4%), lymph nodes (22.4%), digestive tract (16.4%), skin (16.4%), spleen (14.9%). The granuloma were detected mainly in the liver (38.8%), lymph nodes (17.9%), bone marrow (16.4%) and lungs (11.9%). Elevated erythrocyte sedimentation rate or increased C reactive protein serum levels were noted in 65.6% of the patients. Before diagnosis, 19.4% of the patients received a corticotherapy. The most common diagnoses were infections (65.6%) followed by drugs (19.5%), "toxic substances" or various foreign bodies (5.9%), neoplasias (5.9%) and immune deficiencies (3%). The evolution was favourable in 80% of the cases but 8.3% of the patients died. The disease course of the patients having received a corticotherapy prior to the diagnosis was more unfavourable with a death rate of 45%. CONCLUSION In atypical sarcoidosis (fever, advanced age, increased acute phase reactants...) a specific aetiology and especially an infectious disease should be ruled out before considering the diagnosis of sarcoidosis. Corticotherapy is a factor of poor prognosis.
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Affiliation(s)
- M Pavic
- Service de médecine interne-oncologie, hôpital d'instruction des armées Desgenettes, 108 boulevard Pinel, Lyon, France.
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Abdel-Galiil K, Anand R, Sharma S, Brennan PA, Ramchandani PL, Ilankovan V. Incidence of sarcoidosis in head and neck cancer. Br J Oral Maxillofac Surg 2006; 46:59-60. [PMID: 17174454 DOI: 10.1016/j.bjoms.2006.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2006] [Indexed: 11/21/2022]
Abstract
Sarcoidosis and sarcoid-like reactions have been reported to be associated with malignancies, particularly testicular cancer and lymphoma. They occur either synchronously or metachronously, and may also occur after chemotherapy. We know of only two other case reports of granulomatous reactions in head and neck cancer. The present case highlights the association of sarcoidosis with head and neck cancer, and the importance of considering the diagnosis in patients who may have metastatic disease.
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Abstract
AIMS The presence of granulomas within the stroma of carcinomas and in the lymph nodes draining carcinomas has been well described. To date, however, there have been few studies examining the occurrence and relevance of necrobiotic granulomas occurring in association with breast carcinoma. METHODS/RESULTS Four cases of breast carcinoma with necrobiotic granulomas were examined using periodic acid Schiff and Ziehl Neelsen stains for fungi and tubercle bacilli and with immunohistochemistry using CAM 5.2, cytokeratin 7, and cytokeratin AE1/3 for tumour cells. In one case the stroma was involved, in the other three cases the lymph nodes contained necrobiotic granulomas. In two of the cases, one with stromal and one with lymph node involvement, the necrobiotic granulomas contained necrotic tumour cells. CONCLUSION In this study the features of four cases of breast carcinomas with necrobiotic granulomas are examined and their relevance explored. Close scrutiny of such granulomas is necessary to avoid underdiagnosis of metastatic disease.
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Affiliation(s)
- J D Coyne
- Department of Pathology, Wythenshawe Hospital, Wythenshawe, Manchester, M23 9LT, UK.
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35
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Kurata A, Terado Y, Schulz A, Fujioka Y, Franke FE. Inflammatory cells in the formation of tumor-related sarcoid reactions. Hum Pathol 2005; 36:546-54. [PMID: 15948122 DOI: 10.1016/j.humpath.2005.02.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Tumor-related sarcoid reactions were analyzed in 14 lymph nodes in comparison with sarcoidosis using immunohistochemical markers to lymphocytes (CD3, CD4, CD8, and CD20), myeloid-related protein (MRP) 8 and MRP14 (S100A8 and S100A9), angiotensin I-converting enzyme (CD143), and mature or immature dendritic cells (S100, HLA-DR, fascin, CD83, and CD1a). We found that solitary epithelioid cell granuloma (ECG) first occur between lymph sinus and T-zone and that multiple ECGs mainly occur within T-zone, whereas confluent types often occupy the whole lymph node except some residual lymphoid follicles. This pattern suggests a continuous spread and growth of ECGs in sarcoid reactions along T-zone, where antigen presentation mainly takes place. Irrespective of granuloma type, a constant invasion of freshly recruited MRP8 + and MRP14 + macrophages was observed. Similar to sarcoidosis, angiotensin I-converting enzyme expression was a constant finding in epithelioid and giant cells, suggesting a common inflammatory pathway. An increasing ratio of CD4 + to CD8 + T lymphocytes (r = 0.789, P = .001) and a decreasing number of S100 + and CD83 + dendritic cells (r = 0.787, P = .001) within ECGs correlated with granuloma growth, whereas CD1a + immature dendritic cells were never observed inside ECGs. Our findings show that sarcoid reactions represent a T-cell-mediated immune response, leading to histological appearance and cell distribution similar to sarcoidosis and other granulomatous conditions, but the mechanism is different from dendritic cell-based tumor vaccination. Furthermore, mature dendritic cells occur inside ECGs especially of early sarcoid reactions but may not be required for the enlargement and further maintenance of ECGs, in contrast to CD4 + lymphocytes.
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Affiliation(s)
- Atsushi Kurata
- Department of Patholofy, Kyorin University School of Medicine, Tokyo, Japan.
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36
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Sabaté JM, Clotet M, Gómez A, De las Heras P, Torrubia S, Salinas T. Radiologic Evaluation of Uncommon Inflammatory and Reactive Breast Disorders. Radiographics 2005; 25:411-24. [DOI: 10.1148/rg.252045077] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kovacs J, Varga A, Bessenyei M, Gomba S. Renal cell cancer associated with sarcoid-like reaction. Pathol Oncol Res 2004; 10:169-71. [PMID: 15448754 DOI: 10.1007/bf03033747] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Accepted: 08/03/2004] [Indexed: 11/29/2022]
Abstract
An unusual granulomatous reaction within a conventional clear cell renal cancer in a 62 year-old woman is reported. Using immunohistochemical evaluation, cells of the granuloma were CD68 (Kp1), carboxypeptidase M and CD3 positive. No signs of sarcoidosis were found in other organs. According to the few publications that mention cancer associated sarcoid-like reaction, such lesions do not influence the prognosis. Our patient is still well for a 15 months follow-up.
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Affiliation(s)
- Judit Kovacs
- Department of Pathology, University of Debrecen, Medical and Health Science Center, Debrecen, H-4012, Hungary
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38
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Cai G, Simsir A, Cangiarella J. Invasive mammary carcinoma with osteoclast-like giant cells diagnosed by fine-needle aspiration biopsy: Review of the cytologic literature and distinction from other mammary lesions containing giant cells. Diagn Cytopathol 2004; 30:396-400. [PMID: 15176026 DOI: 10.1002/dc.20069] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Invasive carcinoma with osteoclast-like giant cells is an unusual type of mammary adenocarcinoma with few cases reported in the cytology literature. We present the cytologic findings in a case of invasive cribriform carcinoma of the breast containing osteoclast-like giant cells diagnosed by fine-needle aspiration biopsy. The smears displayed three-dimensional cohesive cluster cells of uniform epithelial cells admixed with numerous multinucleated giant cells that morphologically resembled osteoclasts. Core biopsy confirmed the cytologic diagnosis. Immunohistochemical studies indicated that the multinucleated giant cells were of histocytic origin. Knowledge of the bland cytologic pattern and the admixture of giant cells seen in invasive cribriform carcinoma with osteoclast-like giant cells should avoid making a false negative diagnosis on aspiration biopsy.
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Affiliation(s)
- Guoping Cai
- Department of Pathology, Division of Cytopathology, New York University School of Medicine, New York, New York 10016, USA
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39
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Abstract
Sarcoidosis is a multisystemic disease that may involve the breast parenchyma and can be confused with benign or malignant tumors. A recent case of sarcoidosis of the breast treated in our institution prompted us to review the world literature on the topic. From 1921 to 1997, 45 cases relating to sarcoidosis of the breast were reported; 10 of these cases were excluded from our review because of the lack of histological proof of sarcoidosis. The data were organized according to clinical presentation, diagnostic studies, treatment plan, and follow-up care. The mean age at presentation was 47 years (range 20–72 years) and all patients were female. Seven patients (20%) had a breast mass as primary presentation of sarcoidosis without any clinical evidence of systemic sarcoidosis. Thirty-one patients (89%) presented with a self-detected mass and three patients (8%) demonstrated skin dimpling and peau d'orange appearance mimicking cancer. The size of the breast lesions ranged from 0.25 to 5 cm in diameter. One patient presented with bilateral breast lesions and one with more than one lesion in the same affected breast. A single breast mass was found in the rest of the patients. Of the seven patients evaluated by mammography, only one revealed changes suspicious for malignancy. Fine-needle aspiration was used only in four cases; the results of two were compatible with sarcoidosis and two required an excisional biopsy as a result of inconclusive results. Seventeen cases reported excisional biopsy as the diagnostic procedure. In 11 patients the type of biopsy was not stated. In two cases of radical mastectomies for breast adenocarcinoma, sarcoidosis was an incidental finding, either in the remaining breast tissue or in the axillary nodes. One patient underwent a partial mastectomy revealing sarcoidosis as the definitive diagnosis. Ultrasound was used in two cases; one revealed a suspicious lesion and one was inconclusive. Although sarcoidosis of the breast constitutes a rare entity it should be considered in the differential diagnosis of breast cancer even in patients without clinical evidence of systemic sarcoidosis. These patients should undergo a biopsy to rule out malignancy because clinical findings, mammography, and ultrasound results can be misleading or inconclusive.
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Affiliation(s)
- Herminio Ojeda
- Department of Surgery, St. Agnes Health Care, Baltimore, Maryland
| | - Armando Sardi
- Department of Surgery, St. Agnes Health Care, Baltimore, Maryland
| | - Adil Totoonchie
- Department of Surgery, St. Agnes Health Care, Baltimore, Maryland
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40
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Abstract
A 67-year-old woman sought medical treatment of cardiomyopathy, which had been diagnosed 2 years earlier; the causative factor was sarcoidosis. A screening mammogram revealed multiple spiculated masses in both breasts. A review of previous films obtained elsewhere showed that these masses had been increasing in prominence during the past 3 years. The patient had no visible axillary nodal abnormalities. Sarcoidosis was considered a diagnostic possibility, and a large-core needle biopsy was done with stereotactic guidance. The histological diagnosis was non-necrotizing granulomatous inflammation, consistent with sarcoidosis.
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Affiliation(s)
- J J Gisvold
- Department of Diagnostic Radiology, Mayo Clinic Rochester, MN 55905, USA
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41
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Kamiyoshihara M, Hirai T, Kawashima O, Ishikawa S, Morishita Y. Pulmonary small cell carcinoma associated with sarcoid reactions: report of a case. Surg Today 1999; 29:382-4. [PMID: 10211576 DOI: 10.1007/bf02483070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 45-year-old male was admitted to our hospital for investigation of a nodular shadow in segment 5 of the right lung on a chest computed tomogram. A right middle lobectomy with mediastinal lymph node dissection was performed under a diagnosis of lung cancer, and histologic examination confirmed small cell carcinoma. There were sarcoid reactions in the resected lymph nodes and the lung parenchyma, but no signs of systemic sarcoidosis were evident. Sarcoid reactions are rarely observed in the regional lymph nodes draining malignant tumors. Moreover, while they are most common in squamous cell carcinoma of the lung, they extremely rare in small cell carcinoma. To our knowledge, this is only the third report of this unusual entity in the English and Japanese literature.
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Affiliation(s)
- M Kamiyoshihara
- Department of Surgery, National Sanatorium, Nishi-Gunma Hospital, Shibukawa, Gunma, Japan
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Kin T, Shimano Y, Shinomiya Y, Nakano H. Double cancers of the lung and esophagus associated with a sarcoid-like reaction in their regional lymph nodes: report of a case. Surg Today 1999; 29:260-3. [PMID: 10192738 DOI: 10.1007/bf02483017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A case of double cancers of the lung and esophagus associated with a sarcoid-like reaction in their regional lymph nodes is reported. A 73-year-old man with hemosputum was found to have a mass in his right lower lung field on a chest X-ray. Based on a diagnosis of lung cancer, a right middle and lower lobectomy with a dissection of the lymph nodes was performed. Microscopically, a well developed granulomatous reaction was seen in the dissected mediastinal and hilar lymph nodes. Three years after the pulmonary resection, he was admitted to our hospital because of dysphagia. A diagnosis of lower esophageal cancer was made. A lower esophagectomy with a total gastrectomy was performed. A sarcoid-like reaction comprising epithelioid cells and giant cells was seen in the regional lymph nodes. No clinical findings indicative of systemic sarcoidosis were observed. This rare condition may therefore help to improve our overall understanding of the relationship between malignant neoplasms and sarcoid-like reactions in the regional lymph nodes.
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Affiliation(s)
- T Kin
- Department of Surgery, Tenri City Hospital, Tenri, Nara, Japan
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Abstract
We report 12 cases of granulomatous lobular mastitis occurring in young women, between ages 30 and 47 years, diagnosed at King Faisal Specialist Hospital and Research Centre (KFSH&RC) from 1987 to 1995. The disease was unilateral in 10 cases, while there was a history of involvement of the contralateral breast in two patients. At the time of diagnosis, two patients were lactating, two were pregnant, and two were pregnant and lactating. Histopathological examination in all cases revealed centrilobular granulomas and microabscess formation. Immunohistochemical staining in seven cases for T and B cell markers showed a predominance of T cells in the infiltrate in all cases. The treatment comprised surgical removal of the mass, debridement and antibiotics in some of the cases. In one patient referred from another institution, mastectomy had been performed on the basis of an erroneous histopathologic diagnosis of carcinoma. Preoperative diagnosis was carcinoma in seven cases and benign disease in the remaining five cases. Follow-up of the patients was uneventful in all cases. Granulomatous lobular mastitis is a rare inflammatory disease of the breast, which may clinically and pathologically mimic carcinoma, sometimes leading to misdiagnosis resulting in unnecessary surgery.
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Affiliation(s)
- H Kfoury
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Yano K, Nishida M, Yamamoto T, Tangoku A, Shimizu R, Uchiyama T, Oka M, Murakami T, Suzuki T, Yamashita Y. A case of hepatocellular carcinoma with tuberculoma within tumor tissue. ACTA ACUST UNITED AC 1994. [DOI: 10.1007/bf02391084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Houn HY, Granger JK. Granulomatous mastitis secondary to histoplasmosis: report of a case diagnosed by fine-needle aspiration biopsy. Diagn Cytopathol 1991; 7:282-5. [PMID: 1879265 DOI: 10.1002/dc.2840070314] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A case of unilateral histoplasmal "granulomatous" mastitis diagnosed by fine-needle aspiration biopsy (FNAB) is presented. The clinical presentation and mammographic findings were strongly suspicious for carcinoma. FNAB cytology showed a picture of necrotizing granuloma secondary to histoplasmosis. The lesion was treated with surgical excision and appropriate antifungal therapy. The differential diagnosis of granulomatous mastitis is discussed.
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Affiliation(s)
- H Y Houn
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock 72205
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