The reported frequency of coincidence between sar- coidosis and malignancy varies depending on the country of origin and the type of study. The most fre- quent type of cancer associated with sarcoidosis is ade- nocarcinoma. It is possible that this association is simply a coincidence because adenocarcinoma is frequent, and its incidence is increasing.1–5
The well-known sarcoid reaction, or sarcoid-like reac- tion, characterized by granuloma formation may be found in the regional lymph nodes draining a carcinoma.
Occasionally, a neoplasm may produce bilateral hilar adenopathy creating a diagnostic problem.
Malignant tumors of organs other than lung have been reported in sarcoidosis. There are two putative explanations for this association6an immunologic abnor- mality in sarcoidosis may promote the development of cancer or malignant disease may produce a local sarcoid- like reaction or initiate directly manifestations of systemic sarcoidosis.
Patients with sarcoidosis developed breast cancer at the expected frequency.7 Physical examinations and mammograms are unable to distinguish between sar- coidosis and malignancy, acquiring a biopsy specimen of all suspicious lesions in the patients with sarcoidosis is recommended.1
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CHAPTER 20
Sarcoidosis and Malignancy
FIGURE 20.1 A chest X-ray film shows diffuse infiltrates in both lungs. Before the diagnosis of lung sarcoidosis, this patient had been operated on for the adenocarcinoma of the GIT. Her main symptom was abdominal pain. After the operation, she experienced breathlessness and fatigue. Her chest X-ray revealed the parenchy- mal lesions, as well as bilateral hilar lymphadenopathy. The first diagnosis, however, was susceptible for “lymphangitis carcino- matosa,” but the transbronchial biopsy showed noncaseating granulomas.
FIGURE 20.2 Computed tomography (CT) scans of the same patient shown in Figure 20.1. To treat her sarcoidosis, she was given corticosteroids.
FIGURE 20.3 Adenocarcinoma of the colon. (Courtesy of Dr.
Vesna Cemerikic, MD, PhD, Clinical Center, Pathology Depart- ment, Belgrade, Serbia.)
FIGURE 20.4 A chest X-ray eight months after the treatment with corticosteroids shows no abnormality.
FIGURE 20.5 Sarcoidosis patient with breast cancer, which she developed four years after a chronic form of lung disease.
Chapter 20: Sarcoidosis and Malignancy 111
FIGURE 20.6 Mammograms of the same patient shown in Figure 20.5.
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