Sarcoidosis is a frequent benign cause of lymphadenopathy in neoplastic patients

Background:

The clinical and radiographic aspects of sarcoidosis and malignancy might mimic one another, making the distinction between the two difficult in some cases. Cancer and sarcoidosis have been associated in some case series from the literature but this association remains controversial.

Objectives:

A descriptive retrospective study has been conducted to evaluate the incidence of the diagnosis of sarcoidosis in patients followed-up for previous cancer and referred for hilar/mediastinal lymphadenopathies, with no pulmonary lesions.

Methods:

We conducted a retrospective chart review of all patients who were referred to our pulmonology department in the period between January 2007 and December 2011 with a new onset hilar/mediastinal lymphadenopathies during follow-up for previous neoplasms.

Results:

48 patients (31 males, 17 females) of mean age 63 years underwent EBUS/EUS trans-bronchial needle aspiration (TBNA). Patients had been followed-up for lung cancer (n=10), lymphoma (n=9), breast cancer (n=7), urologic cancer (n=6), gastro-intestinal tumors (n=6), larynx/pharynx tumors (n=4), gynaecologic tumors (n=3), other cancer (n=8). 6 patients had a history of two tumors or more in the past.

Procedure was diagnostic in 45 patients (94%) and diagnosis was sarcoidosis in 12 patients (26,7%), metastasis in 13 patients (28,9%) and hyperplastic non-specific lymphadenopathy in 20 patients (44,4%). Negative samples were confirmed by follow-up for at least 1 year (17) or surgical intervention (3).

Conclusions:

This study suggests that sarcoidosis should be considered in the differenzial diagnosis of patients with a history of malignancy who develop hilar mediastinal lymphadenopathies; a tissue diagnosis should be obtained before instituting therapy for presumed cancer recurrence.