Sarcoid-Like Reactive Lymphadenopathy in Metastatic Synovial Sarcoma

A 56-year-old male underwent treatment for sarcoma with metastases to the lungs. Follow-up imaging revealed multiple pulmonary nodules and masses with a favorable response on positron emission tomography (PET) scanning showing enlarging mediastinal lymph nodes concerning for progression of the disease. To evaluate the lymphadenopathy, the patient underwent bronchoscopy with endobronchial ultrasound and transbronchial needle aspiration. The lymph nodes were negative for cytology but showed granulomatous inflammation. Granulomatous inflammation is a rare occurrence in patients with concurrent metastatic lesions and is exceedingly rare in cancers that have not originated in the thorax. This case report highlights the clinical significance of sarcoid-like reactions in the mediastinal lymph nodes and the need for further investigation.