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Atypical sarcoid reaction mimicking recurrence on F-18 FDG PET/CT in a patient with breast malignancy

Malignancy may lead to sarcoidosis, which is referred to as sarcoid reaction. This reaction is believed to be a host immune response to the release of soluble antigens from cancer cells. Studies have shown strong 2′-deoxy-2′-[F-18]fluoro-D-glucose (F-18 FDG) uptake in sarcoid reaction and in true sa...

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Autores principales: Jeong, Young Jin, Lim, Seok Tae, Jeong, Hwan-Jeong, Park, Ho Sung, Lee, Sun Young, Han, Yeon-Hee
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8551536/
https://www.ncbi.nlm.nih.gov/pubmed/34745400
http://dx.doi.org/10.1016/j.radcr.2021.09.032
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author Jeong, Young Jin
Lim, Seok Tae
Jeong, Hwan-Jeong
Park, Ho Sung
Lee, Sun Young
Han, Yeon-Hee
author_facet Jeong, Young Jin
Lim, Seok Tae
Jeong, Hwan-Jeong
Park, Ho Sung
Lee, Sun Young
Han, Yeon-Hee
author_sort Jeong, Young Jin
collection PubMed
description Malignancy may lead to sarcoidosis, which is referred to as sarcoid reaction. This reaction is believed to be a host immune response to the release of soluble antigens from cancer cells. Studies have shown strong 2′-deoxy-2′-[F-18]fluoro-D-glucose (F-18 FDG) uptake in sarcoid reaction and in true sarcoidosis. Therefore, in patients with malignancy, sarcoid reactions can mimic metastasis or recurrence on F-18 FDG positron emission tomography/computed tomography (PET/CT). Herein, we report the case of a 58-year-old woman with a history of left breast cancer whose FDG PET/CT evaluated at 3 months after adjuvant chemotherapy presented hypermetabolic lymphadenopathy in the right supraclavicular and right mediastinal areas. We interpreted these as metastases because the involved lymph nodes were intensely hypermetabolic and appeared newly. Pathologic evaluation of the excised lymph node revealed noncaseating chronic granulomas without malignant cells, indicating a sarcoid reaction. After appropriate steroid therapy, both the size and metabolic activity of the lymphadenopathy substantially decreased. Most sarcoid reactions present as bilateral hilar and peribronchial lymphadenopathies. Our patient presents an atypical example that a sarcoid reaction can also present in a unilateral pattern, making its diagnosis challenging. When interpreting FDG PET/CT images, considering that the sarcoid reaction pattern can vary is crucial.
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spelling pubmed-85515362021-11-04 Atypical sarcoid reaction mimicking recurrence on F-18 FDG PET/CT in a patient with breast malignancy Jeong, Young Jin Lim, Seok Tae Jeong, Hwan-Jeong Park, Ho Sung Lee, Sun Young Han, Yeon-Hee Radiol Case Rep Case Report Malignancy may lead to sarcoidosis, which is referred to as sarcoid reaction. This reaction is believed to be a host immune response to the release of soluble antigens from cancer cells. Studies have shown strong 2′-deoxy-2′-[F-18]fluoro-D-glucose (F-18 FDG) uptake in sarcoid reaction and in true sarcoidosis. Therefore, in patients with malignancy, sarcoid reactions can mimic metastasis or recurrence on F-18 FDG positron emission tomography/computed tomography (PET/CT). Herein, we report the case of a 58-year-old woman with a history of left breast cancer whose FDG PET/CT evaluated at 3 months after adjuvant chemotherapy presented hypermetabolic lymphadenopathy in the right supraclavicular and right mediastinal areas. We interpreted these as metastases because the involved lymph nodes were intensely hypermetabolic and appeared newly. Pathologic evaluation of the excised lymph node revealed noncaseating chronic granulomas without malignant cells, indicating a sarcoid reaction. After appropriate steroid therapy, both the size and metabolic activity of the lymphadenopathy substantially decreased. Most sarcoid reactions present as bilateral hilar and peribronchial lymphadenopathies. Our patient presents an atypical example that a sarcoid reaction can also present in a unilateral pattern, making its diagnosis challenging. When interpreting FDG PET/CT images, considering that the sarcoid reaction pattern can vary is crucial. Elsevier 2021-10-10 /pmc/articles/PMC8551536/ /pubmed/34745400 http://dx.doi.org/10.1016/j.radcr.2021.09.032 Text en © 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Jeong, Young Jin
Lim, Seok Tae
Jeong, Hwan-Jeong
Park, Ho Sung
Lee, Sun Young
Han, Yeon-Hee
Atypical sarcoid reaction mimicking recurrence on F-18 FDG PET/CT in a patient with breast malignancy
title Atypical sarcoid reaction mimicking recurrence on F-18 FDG PET/CT in a patient with breast malignancy
title_full Atypical sarcoid reaction mimicking recurrence on F-18 FDG PET/CT in a patient with breast malignancy
title_fullStr Atypical sarcoid reaction mimicking recurrence on F-18 FDG PET/CT in a patient with breast malignancy
title_full_unstemmed Atypical sarcoid reaction mimicking recurrence on F-18 FDG PET/CT in a patient with breast malignancy
title_short Atypical sarcoid reaction mimicking recurrence on F-18 FDG PET/CT in a patient with breast malignancy
title_sort atypical sarcoid reaction mimicking recurrence on f-18 fdg pet/ct in a patient with breast malignancy
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8551536/
https://www.ncbi.nlm.nih.gov/pubmed/34745400
http://dx.doi.org/10.1016/j.radcr.2021.09.032
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