Abstract
Granulomatous inflammation has been associated with malignancies such as breast, testicular, renal cell, and lymphoma. The coexistence of granulomatous inflammation in mediastinal/hilar lymph node with primary lung malignancy has been described in case reports. Our goal was to examine the frequency of granulomatous reaction in mediastinal/hilar lymph node in the patients who had undergone surgical resection of lung cancer. We performed a retrospective analysis of 40 patients (1) aged ≥ 18 years and (2) who underwent lobectomy or pneumonectomy from August 1, 2012 to October 31, 2016 at Saint Louis University Hospital and (3) had pathology suggestive of cancer. Of those 40 patients, 3 (7.5%) had granulomatous inflammation in the lymph nodes. None of these 3 individuals had evidence of metastasis in the particular lymph nodes with granulomatous inflammation. Our small cohort revealed that the presence of granulomatous inflammation in a lymph node can be safely taken as an evidence of the absence of metastasis to the lymph node. This finding can obviate the need for further sampling for the particular lymph node with granulomatous inflammation and can decrease the sampling time.
Highlights
Granulomatous inflammation has been associated with malignancies such as breast, testicular, renal cell, and lymphoma
Our goal is to examine the granulomatous reaction to carcinoma in patients who have undergone lung resection and determine the frequency of coexisting of granulomatous inflammation with malignancy in mediastinal or hilar lymph nodes
Our study aimed to identify the concurrence of granulomatous inflammation and malignancy in patients who underwent lobectomy or pneumonectomy for early stage lung cancer
Summary
Granulomatous inflammation has been associated with malignancies such as breast, testicular, renal cell, and lymphoma. Conclusion: Our small cohort revealed that the presence of granulomatous inflammation in a lymph node can be safely taken as an evidence of the absence of metastasis to the lymph node. Granulomatous inflammation has been associated with breast and testicular malignancies, renal cell cancer, and lymphoma [1,2,3]. Historical studies have shown an increased risk of cancer in patients previously diagnosed with sarcoidosis, especially lung cancer and lymphoma [4] This association had previously been termed sarcoid-like reaction and sarcoid cancer syndrome [5]. It is theorized that a T-cell mediated immunological hypersensitivity reaction to tumor cell antigens leads to granuloma formation [8] These granulomatous reactions may occur within neoplasms or regional lymph nodes that are either affected or unaffected by tumor [1]. The frequency of such sarcoid reactions in carcinomas is 4.4% [9]
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