Abstract
BackgroundThe concurrence of sarcoidosis and primary lung cancer is very rare. We report a very rare case with a delayed diagnosis of primary lung cancer due to its misdiagnosis as worsening of pulmonary sarcoidosis.Case presentationA 68-year-old man presented to the outpatient department for evaluation of a mass in the right hilar area with lymphadenopathies in subcarinal and both interlobar areas on chest computed tomography (CT). Sufficient core samples were obtained from subcarinal and bilateral interlobar lymph nodes using endobronchial ultrasonography (EBUS) guided transbronchial needle aspiration (TBNA). EBUS could not reach the right hilar lymph node due to its high angle. The pathologic findings were consistent with sarcoidosis. After 5 months, chest CT revealed aggravation of the right upper paratracheal lymphadenopathy. Assuming worsening of sarcoidosis, he was prescribed an oral corticosteroid for 5 months. However, follow-up chest CT showed a newly developed right lower paratracheal lymphadenopathy and worsening right hilar lymphadenopathy. Bronchoscopy and EBUS were performed once again. Transbronchial lung biopsy from the right upper lobe and EBUS-TBNA from the right lower paratracheal lymph node revealed adenocarcinoma from the lung.ConclusionsAlthough coexistence of sarcoidosis and lung cancer is very rare, the clinician should consider the possibility of accompanying lung cancer in sarcoidosis patients who are not responding to initial corticosteroid therapy.
Highlights
BackgroundSarcoidosis is characterized by noncaseating granulomatous inflammation involving multiple organs [1,2,3]
The concurrence of sarcoidosis and primary lung cancer is very rare
Conclusions: coexistence of sarcoidosis and lung cancer is very rare, the clinician should consider the possibility of accompanying lung cancer in sarcoidosis patients who are not responding to initial corticosteroid therapy
Summary
Sarcoidosis is characterized by noncaseating granulomatous inflammation involving multiple organs [1,2,3]. Case presentation A 68-year-old man presented to the outpatient department (OPD) with chest computed tomography (CT) scan abnormality He was an ex-smoker with 4.5 packyears. A chest CT scan was performed at a local clinic before the patient presented to our OPD. Lymphadenopathies were observed in the subcarinal, right hilar and bilateral interlobar areas (Fig. 1a-c) on the chest CT scan performed at the local clinic. At 3 months follow-up, chest CT revealed waxing and waning of the right hilar lymphadenopathy (Fig. 3a). At 2 months follow-up, the chest CT scan showed a newly developed right lower paratracheal lymphadenopathy and worsening right hilar lymphadenopathy, despite improvement of subcarinal and both interlobar lymphadenopathies (Fig. 3b). Transbronchial lung biopsy from the right upper lobe and EBUS-TBNA from the right lower paratracheal lymph node were performed. He was transferred to a cancer center for treatment of lung cancer
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