Abstract
Introduction
Sarcoidosis is a multisystem chronic granulomatous disease found predominantly in the lungs and lymph nodes. Its pathologic hallmark is the presence of systemic non-caseating granulomas; however, a variation of this disease known as “sarcoid-like reaction” has been described in patients with underlying cancer.
Report
Sarcoid-like reactions in patients with hepatopancreatobiliary (HPB) tumors are rare findings, with only 15 cases having been reported in the English language literature. These reactions can be found in local lymph nodes or in distant organs, and when present in patients with cancer, they can mimic metastatic disease on imaging, potentially resulting in incorrect cancer staging and management.
Discussion
We describe two cases of patients with HPB tumors who had distant organ disease on cross-sectional imaging suspicious for metastases, which on further workup were found to be sarcoid-like reactions. We also discuss malignancy-induced sarcoid-like reactions and provide a review of the literature of sarcoid-like reactions in the setting of HPB tumors.
References
Boeck C. Multiple benign sarcoid of the skin. J Cutan Genitourin Dis 1899;17:543–50
Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med. 2007;357(21):2153–65.
Rybicki BA, Major M, Popovich J Jr, Maliarik MJ, Iannuzzi MC. Racial differences in sarcoidosis incidence: a 5-year study in a health maintenance organization. Am J Epidemiol. 1997;145(3):234–41
Baughman RP, et al: Sarcoidosis. Lancet 2003; 361:1111.
Newman LS, Rose CS, Maier LA. Sarcoidosis. N Engl J Med. 1997 Apr 24;336(17):1224–34. Review. Erratum in: N Engl J Med 1997;337(2):139.
Brincker H. Sarcoid reactions in malignant tumours. Cancer Treat Rev. 1986;13(3):147–56.
Cohen PR, Kurzrock R. Sarcoidosis and malignancy. Clin Dermatol. 2007;25(3):326–33. Review. PubMed PMID: 17560310
Herxheimer G. Uber Karzinom und Tuberkulose. Z Tuberk 1917; 27:251–58
Chowdhury FU, Sheerin F, Bradley KM, Gleeson FV. Sarcoid-like reaction to malignancy on whole-body integrated (18)F-FDG PET/CT: prevalence and disease pattern. Clin Radiol. 2009;64(7):675–81.
Hunsaker AR, Munden RF, Pugatch RD, Mentzer SJ. Sarcoidlike reaction in patients with malignancy. Radiology. 1996;200(1):255–61.
Gherardi GJ. Localized lymph node sarcoidosis associated with carcinoma of the bile ducts; report of a case. AMA Arch Pathol. 1950;49(2):163–8,
Nadel EM, Ackerman LV. Lesions resembling Boeck’s sarcoid in lymph nodes draining an area containing a malignant neoplasm. Am J Clin Pathol. 1950;20(10):952–7.
Klein M, Kaminsky P, Deribener J, Cocciale MP, Duc M (1994) Sarcoid reactions in cystic duct carcinoma. Chest 106:1304–1305
Nakao A, Sato Y, Nakashima A (1996) A case of bile duct cancer with sarcoid reaction in the regional lymph nodes. Biliary Tract Pancreas 17:963–966
Shito M, Shintoku J, Miyazaki H (1997) Primary carcinoma of the cystic duct associated with sarcoid reactions: report of a case. Surg Today 27:1177–1181
Mao JT, Fisnbein MC. Metastatic pancreatic cancer masquerading as pulmonary sarcoidosis. Am J Med. 2000;109(7):598–9.
Van Steenbergen W, Fevery J, Vandenbrande P, Desmet V, Ponette E, Kerremans R, de Groote J (1987) Ulcerative colitis, primary sclerosing cholangitis, bile duct carcinoma, and generalized sarcoidosis. J Clin Gastroenterol 9:574–579
Onitsuka A, Katagiri Y, Kiyama S, Mimoto H, Nakamura T, Toda K, Shima H. Hilar cholangiocarcinoma associated with sarcoid reaction in the regional lymph nodes. J Hepatobiliary Pancreat Surg. 2003;10(4):316–20.
Brincker H. Interpretation of granulomatous lesions in malignancy. Acta Oncol. 1992;31(1):85–9.
Brincker H, Pedersen NT. Immunohistologic separation of B-cell-positive granulomas from B-cell-negative granulomas in paraffin-embedded tissues with special reference to tumor-related sarcoid reactions. APMIS. 1991;99(3):282–90.
Bassler, Birke, Histopathology of tumour associated sarcoid-like stromal reaction in breast cancer. An analysis of 5 cases with immunohistochemical investigations, Virchows Arch A Pathol Anat Histopathol. 1988;412(3):231–9
Sacks EL, Donaldson SS, Gordon J, Dorfman RF. Epithelioid granulomas associated with Hodgkin’s disease: clinical correlations in 55 previously untreated patients. Cancer. 1978;41(2):562–7
O’Connell MJ, Schimpff SC, Kirschner RH, Abt AB, Wiernik PH. Epithelioid granulomas in Hodgkin disease. A favorable prognostic sign? JAMA. 1975;233(8):886–9.
Juweid ME, Cheson BD. Positron-emission tomography and assessment of cancer therapy. N Engl J Med 2006;354:496–507.
Ito F, Cho CS, Rikkers LF, Weber SM. Hilar cholangiocarcinoma: current management. Ann Surg. 2009;250(2):210–8.
Merl MY, Abdelghany O, Li J, Saif MW. First-line treatment of metastatic pancreatic adenocarcinoma: can we do better? Highlights from the “2010 ASCO Annual Meeting”. Chicago, IL, USA. June 4-8, 2010. JOP. 2010;11(4):317–20.
Ten Seldam RE. Sarcoid-like lesions in lymph nodes draining carcinoma. Med J Aust. 1956;43(22):916–9.
Muto Y, Uchimura M, Waki S, Hayashi T, Sameshima Y, Okamoto K (1982) A case of common duct carcinoma with sarcoid reaction in the regional lymph nodes. Jpn J Gastroenterol Surg 15:512–515
Kurata A, Terado Y, Schulz A, Fujioka Y, Franke FE. Inflammatory cells in the formation of tumor-related sarcoid reactions. Hum Pathol. 2005;36(5):546–54.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fong, Z.V., Wong, J., Maley, W.R. et al. Sarcoid-Reaction Mimicking Metastatic Malignant Hepatopancreatobiliary Tumors: Report of Two Cases and Review of the Literature. J Gastrointest Surg 16, 1245–1250 (2012). https://doi.org/10.1007/s11605-011-1820-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-011-1820-3