Malignancy-Sarcoidosis Syndrome

Description

A sarcoid-like reaction can develop in a patient with a carcinoma, resulting in a syndrome resembling the sarcoidosis-lymphoma syndrome (see previous section). This reaction may be misdiagnosed as metastatic cancer unless a histologic examination is done.

Underlying malignancy may include:

(1) breast carcinoma

(2) lung carcinoma

(3) ovarian or testicular carcinoma

Manifestations:

(1) lymphadenopathy, which may be mediastinal or hilar

(2) parenchymal lung disease (pulmonary infiltrates with dyspnea and cough, decreased diffusing capacity and restrictive pattern to pulmonary function tests)

(3) no to limited systemic symptoms (fever, weight loss, arthritis)

(4) noncaseating granulomas on biopsy

(5) negative stains and cultures for acid fast bacilli, fungi and other micro-organisms

(6) negative for tumor (including lymphangitic spread)

Differential diagnosis:

(1) pre-existing sarcoidosis

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