Simultaneous occurrence of metastasis and sarcoidosis in a patient with sinonasal adenocarcinoma

Introduction:

Sarcoidosis is a chronic, inflammatory, granulomatous disease that is associated with an increased risk and enhanced mortality for cancer. Diagnosis and therapy of tumors in sarcoidosis patients is extremely difficult as differentiation between tumors or metastasis and sarcoidosis or sarcoid-like lesions is hardly feasible.

Methods:

We here report a case of a 61-year old patient suffering from sinonasal adenocarcinoma after occupational exposure to wood dust. Restaging of this tumor was greatly impeded by simultaneous occurrence of cervical metastasis and sarcoidosis. 12 months after initial tumor resection, an unclear, left cervical swelling was observed that was identified by histopathology as a metastasis of the known adenocarcinoma. 18FDG-PET-CT revealed further high-uptake lesions which could be identified as sarcoidosis by endobronchial, ultrasound based and mediastinoscopic biopsies.

Results:

Based on the cervical metastasis, a risk of malignant tissue that was hidden by the applied diagnostic tools remained, leading to the interdisciplinary decision to continue treatment with steroids and adjuvant chemotherapy.

Conclusion:

This case report impressively demonstrates the problematic of diagnosis and subsequent treatment of patients simultaneously suffering from cancer and sarcoidosis. While 18FDG-PET-CT and histopathological diagnosis offers only limited information on the presence of malignant lesions. Further diagnostic approaches, such as the use of tumor-specific tracers, is strongly indicated in these comorbid patients and should be taken into consideration by the treating physician.

Publication History

Publication Date:
18 April 2018 (online)