Sarcoid-like reaction in a patient with uveitis and underlying cancer
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Abstract
Purpose
Sarcoidosis is a granulomatous disease of unknown etiology. Occasionally, triggering causes are identified, such as neoplasms, and they are termed sarcoid-like reactions, which may appear in any sarcoidotic target tissue. Choroidal metastases appear as part of widespread metastatic disease or as the first suggestion of neoplastic disease. They can also be a part of the differential diagnosis of a spectrum of inflammatory eye diseases. We present a case in which a lung carcinoma, pulmonary and eye sarcoid-like reactions, and choroidal metastasis take place in the same patient.
Case report
A 60-year-old male with a past history of pulmonary sarcoidosis and associated anterior uveitis was diagnosed with a lung carcinoma with no regional lymph nodes extension, so that the resection surgery was performed without additional systemic treatment. At the same time, he complained of visual acuity loss and pain in his right eye. An intense ocular inflammatory reaction and a choroidal mass compatible with metastasis were identified. A vitrectomy with an accompanied histological exam of the lesion was deemed inconclusive. Ocular symptoms progressively worsened showing mass growth, and as a result, an enucleation was performed and the histological study subsequently revealed metastasis from his lung carcinoma.
Conclusion
Sarcoid-like reactions may be due to incipient malignancies. Any diagnosis of sarcoidosis requires ruling out other diseases that can produce secondary sarcoid-like reactions. In addition, any choroidal mass suggestive of metastasis requires exclusion of metastatic disease even in the absence of clinical signs indicating tumor extension.
Keywords
Sarcoidosis Sarcoid-like reaction Lung cancer Uveitis Choroidal metastasisNotes
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
Informed consent was obtained from the patient included in the case report.
References
- 1.Valeyre D, Prasse A, Nunes H, Uzunhan Y, Brillet PY, Müller-Quernheim J (2014) Sarcoidosis. Lancet 383(9923):1155–1567CrossRefPubMedGoogle Scholar
- 2.Lau RK, Takasugi JE, David Godwin J, Pipavath SN (2015) Sarcoid-like reaction-computed tomography features in 12 patients. J Comput Assist Tomogr 39(2):143–148CrossRefPubMedGoogle Scholar
- 3.Tajima S, Koda K (2015) Granulomatous inflammation of pulmonary squamous cell carcinoma: a rare phenomenon. Int J Clin Exp Pathol 8(6):7547–7552PubMedPubMedCentralGoogle Scholar
- 4.Nazarullah A, Nilson R, Maselli DJ, Jagirdar J (2015) Incidence and aetiologies of pulmonary granulomatous inflammation: a decade of experience. Respirology 20(1):115–121CrossRefPubMedGoogle Scholar
- 5.Kin T, Shimano Y, Shinomiya Y, Nakano H (1999) Double cancers of the lung and esophagus associated with a sarcoid-like reaction in their regional lymph nodes: report of a case. Surg Today 29(3):260–263CrossRefPubMedGoogle Scholar
- 6.Arepalli S, Kaliki S, Shields CL (2015) Choroidal metastases: origin, features, and therapy. Indian J Ophthalmol 63(2):122–127CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Bonifazi M, Bravi F, Gasparini S, La Vecchia C, Gabrielli A, Wells AU, Renzoni EA (2015) Sarcoidosis and cancer risk: systematic review and meta-analysis of observational studies. Chest 147(3):778–791CrossRefPubMedGoogle Scholar
- 8.Balasubramaniam SC, Salomão DR, Davies JB, Ramsay RC, Habermann TM, Chow GK, Boorjian SA, Pulido JS (2015) Paraneoplastic sarcoid-like reactions and the eye. Retina 35(4):789–797CrossRefPubMedGoogle Scholar