Mastroroberto Marianna, Berardi Sonia, Fraticelli Lucilla, Pianta Paolo, Ercolani Giorgio, Cancellieri Alessandra, Sama Claudia
Unit of Liver Transplantation, Department of Digestive Diseases and Internal Medicine, Sant'Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
JOP. 2012 Jul 10;13(4):454-7. doi: 10.6092/1590-8577/867.
The sarcoidosis is an idiopathic multisystem inflammatory disease characterized by the presence of non-caseating granulomas in the affected organs. The clinical picture includes non-specific systemic symptoms and organ-specific symptoms, but it is frequently asymptomatic. Although not fully understood, a clear association between sarcoidosis and malignancies has been reported. In neoplastic patient, beside classical sarcoidosis, cases of sarcoid-like reaction have been extensively described, a condition characterized by the presence of non-caseating granulomas in the lymph nodes draining the tumor or, less commonly, in the distant lymph nodes; this is considered a benign non progressive condition, potentially regressive following neoplasm eradication.
We report the first case of sarcoidosis/sarcoid-like reaction associated with neuroendocrine tumors of the pancreas.
This clinical case highlights the difficulty and importance of differential diagnosis of lymphadenopathy in the management of neoplastic disease, and in view of the evolving clinical picture, if a distinction between sarcoidosis and sarcoid-like reaction is a clinical reality or if they is just represent different stage of the same disease. Therefore, we believe that a follow-up is necessary even in case of sarcoid-like reaction, since no data are reported in the literature on the long-term of this condition once treated the associated tumor.
结节病是一种特发性多系统炎症性疾病，其特征是在受影响的器官中存在非干酪样肉芽肿。临床表现包括非特异性全身症状和器官特异性症状，但通常无症状。尽管尚未完全了解，但结节病与恶性肿瘤之间已报道存在明确关联。在肿瘤患者中，除了经典的结节病外，类结节样反应的病例也有广泛描述，这种情况的特征是在引流肿瘤的淋巴结中存在非干酪样肉芽肿，或较少见地在远处淋巴结中存在；这被认为是一种良性非进行性疾病，在肿瘤根除后可能会消退。
我们报告了首例与胰腺神经内分泌肿瘤相关的结节病/类结节样反应病例。
该临床病例凸显了在肿瘤疾病管理中鉴别淋巴结病的困难和重要性，鉴于临床情况不断变化，结节病和类结节样反应之间的区别是临床实际情况，还是它们仅仅代表同一疾病的不同阶段。因此，我们认为即使是类结节样反应的病例也有必要进行随访，因为在相关肿瘤治疗后，关于这种情况的长期情况在文献中尚无报道。
