SESSION TITLE: Metastatic and Other Primary Lung Tumors SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Sarcoidosis is a disease characterized by the presence of noncaseating granulomas in affected organs, most commonly lung and lymph nodes with symptoms commonly manifesting in the skin, joints, and eyes.1 The variability of symptoms mimic a long list of other disorders, making the disease challenging to diagnose and manage, even confounding the diagnosis of other disease processes in a patient with Sarcoidosis. We present a case of a patient with Sarcoidosis diagnosed with primary lung adenocarcinoma that was discovered secondary to complaints of a rapidly growing mandibular mass. CASE PRESENTATION: A 64 year old male, former smoker, with a PMHx of Sarcoidosis with uveitis, skin, and joint involvement on chronic prednisone therapy presented to his pulmonologist for cough with phlegm production, fatigue, and a chronic toothache for three months. He was recently seen by his dentist for complaints of toothache in a right lower molar. No improvement was noted even after tooth extraction. His chest x-ray showed a small right pleural effusion with no other acute findings so the patient was treated for bronchitis. He returned one week later with worsening fatigue and hemoptysis. His steroid dose was increased and he was given antibiotics. He presented to his PCP four days later for sudden worsening of his tooth pain and new lesion on his right mandible. The lesion was biopsied and pathology demonstrated adenocarcinoma, poorly differentiated, CK7+ suggesting lungs as a primary source. Secondary to concerns of a pulmonary primary, investigation was initiated with a CT chest that was significant for right pleural effusion and a pleural nodularity possibly representing Sarcoidosis vs malignant neoplasia. Thoracentesis, bronchoscopy with washings, and EBUS studies were then obtained. Cells with similar histology and staining pattern were found in his pleural fluid and right hilar lymph node. PET scan revealed primary malignancy in the right lower lung with further metastatic disease in lung, mediastinum, liver, bone and retroperitoneal space. While treatment was initially aggressive, the patient’s condition continued to deteriorate and he eventually transitioned to hospice care. DISCUSSION: Our patient, who had relatively well-controlled Sarcoidosis, presented with new onset tooth pain, cough, phlegm production progressing to hemoptysis and joint pain. All were easily attributable to Sarcoidosis but in fact represented fairly advanced metastatic adenocarcinoma. CONCLUSIONS: We highlight this case first as an example of a rare presentation of adenocarcinoma presenting as dental pain in a patient with Sarcoidosis. Secondly, as an illustration that the varied presentation of Sarcoidosis can act as an imposter distracting the clinician from the diagnosis of an important underlying pathology. Reference #1: N/A. (2013, June 14). National Heart, Lung, and Blood Institute. Retrieved 2017, from What Is Sarcoidosis?: https://www.nhlbi.nih.gov/health/health-topics/topics/sarc DISCLOSURE: The following authors have nothing to disclose: Jason Taylor, Nooreen Hussain, Subramanyam Chittivelu No Product/Research Disclosure Information