Sarcoid reaction in primary neuroblastoma: case report

Sarcoid reaction: a rare occurrence associated to colon adenocarcinoma (case report and literature review)

Granulomatous reactions are related to infectious and non infectious diseases, but more rarely, granulomas may occur in association to malignancies. The presence of sarcoid-like granulomas in lymph nodes draining malignant tumors is an uncommon but well known occurrence. However, their presence in the stroma of malignant tumors is much rarer. We have only found two previous cases reported in the Japanese and English literature. In this study we report a well differentiated adenocarcinoma of the right colon associated to a stromal granulomatous sarcoid-like reaction. Lymph nodes were not involved. The patient had a clinical history of tuberculosis treated 15 years ago, but there was no clinical, histomorphological, immunohistochemical or molecular evidence of disease at the moment of these findings. We have reviewed the literature to find the keys and the diagnostic challenges posed by granulomatous sarcoid-like reaction occurring in lymph nodes draining malignant neoplasms, peritumoral stroma and in other organs far from the primary tumor. The diagnosis of granulomatous sarcoid-like reactions associated to malignancies can be challenging and it can only be made after ruling out specific infectious and non infectious causes of granulomatous inflammation. The mechanisms involved in granuloma formation, their relationship with demographic and histopathological features, their possible association with autoimmune disorders, their cytokine profile and, more importantly, their prognostic significance in each type of tumor are still unclear and require studies with larger number of patients.

Immune modulators in disease: integrating knowledge from the biomedical literature and gene expression

OBJECTIVE

Cytokines play a central role in both health and disease, modulating immune responses and acting as diagnostic markers and therapeutic targets. This work takes a systems-level approach for integration and examination of immune patterns, such as cytokine gene expression with information from biomedical literature, and applies it in the context of disease, with the objective of identifying potentially useful relationships and areas for future research.

RESULTS

We present herein the integration and analysis of immune-related knowledge, namely, information derived from biomedical literature and gene expression arrays. Cytokine-disease associations were captured from over 2.4 million PubMed records, in the form of Medical Subject Headings descriptor co-occurrences, as well as from gene expression arrays. Clustering of cytokine-disease co-occurrences from biomedical literature is shown to reflect current medical knowledge as well as potentially novel relationships between diseases. A correlation analysis of cytokine gene expression in a variety of diseases revealed compelling relationships. Finally, a novel analysis comparing cytokine gene expression in different diseases to parallel associations captured from the biomedical literature was used to examine which associations are interesting for further investigation.

DISCUSSION

We demonstrate the usefulness of capturing Medical Subject Headings descriptor co-occurrences from biomedical publications in the generation of valid and potentially useful hypotheses. Furthermore, integrating and comparing descriptor co-occurrences with gene expression data was shown to be useful in detecting new, potentially fruitful, and unaddressed areas of research.

CONCLUSION

Using integrated large-scale data captured from the scientific literature and experimental data, a better understanding of the immune mechanisms underlying disease can be achieved and applied to research.

A sarcoidosis-like granuloma reaction in the lymph nodes of a patient with lung squamous cancer: from stasis to the invasive phase with FGFR1 gene amplification

BACKGROUND

Granulomatous inflammation is considered an immune mechanism against infection or certain non-neoplastic conditions. Sarcoidosis-like granuloma reactions (SGRs) in primary tumors or in regional lymph nodes are occasionally observed; however, they are rare in lung cancer.

CASE REVIEW

In this study, we reported on a case of squamous lung cancer with swollen mediastinal lymph nodes, similar to sarcoidosis. He was misdiagnosed as benign lymph node SGRs or tuberculosis for 2 years. Reexamination of the lymph node by immunohistochemistry confirmed the malignant disease. The lung cancer appeared to remain in the stasis phase for 2 years and then burst to stage IV with the amplification of the fibroblast growth factor receptor 1 gene.

CONCLUSIONS

Although tumor-induced draining lymph node granulomatous reactions are rare, they did exist in some of the patients. In this case, differential diagnoses with malignant granulomas should be performed carefully to avoid the misdiagnosis of a benign disease. The biological significance of such a granulomatous response in inducing tumor remission or in shielding tumor cells from host lymphocytes remains obscure.

Papilledema as the presenting manifestation of spinal schwannoma

A 63-year-old woman with headache, blurred vision, bilateral optic disc edema, and normal cranial magnetic resonance imaging scan underwent lumbar puncture that revealed an elevated opening pressure (290 mm water), a protein level of 114 mg/dl, and mild pleocytosis. Spinal magnetic resonance imaging later demonstrated a sacral tumor, which proved to be a schwannoma with sarcoid-like features. After surgical removal of the tumor, the patient's manifestations resolved. This case emphasizes that low spinal cord tumors can cause elevated intracranial pressure without causing markedly elevated cerebrospinal fluid protein or cells, or any myelopathic manifestations, perhaps by obstructing sacral cerebrospinal drainage. Comprehensive spine imaging should be a part of the evaluation of a patient with papilledema who has normal brain imaging but abnormal spinal fluid constituents.