Lung cancer with a sarcoid-like reaction in the primary tumor

Abstract

An 80-year-old woman was admitted to the hospital because of a nodular lesion in the right upper lobe of the lung. Transbronchial biopsy was performed and adenocarcinoma of the lung was confirmed by pathological examination. The tumor was resected by right upper lobectomy and was found to be a moderately differentiated tubular adenocarcinoma. Numerous non-caseating epithelioid cell granulomas were also found intermingled with the cancer cells. Metastasis was apparent in several regional lymph nodes but no granulomatous lesions were found in any lymph node, regardless of metastasis. These findings were compatible with a "sarcoid-like reaction" because there was no clinical evidence of generalized sarcoidosis or pulmonary mycobacterial infection. Although sarcoid-like reactions are occasionally associated with cancer, formation of an epithelioid cell granuloma inside the primary tumor is very rare. All the reported cases of a sarcoid-like reaction within the primary lung tumor so far were with adenocarcinoma. The sarcoid-like reaction may be a local immune response to the cancer cells.