Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
Department of Pathology, Chonnam National University Medical School, Gwangju, Republic of Korea.
BMC Pulm Med. 2020 Mar 21;20(1):71. doi: 10.1186/s12890-020-1105-2.
The 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.
A 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.
Although 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.
结节病和原发性肺癌同时存在的情况非常罕见。我们报告了一例非常罕见的病例，由于误诊为结节病恶化，导致原发性肺癌的诊断被延误。
一名 68 岁男性因胸部计算机断层扫描（CT）显示右肺门区肿块和隆突下及双侧肺叶间区淋巴结肿大而到门诊就诊。使用支气管内超声（EBUS）引导下经支气管针吸活检（TBNA）从隆突下和双侧肺叶间淋巴结获得了足够的核心样本。EBUS 由于角度较高而无法到达右肺门淋巴结。病理结果符合结节病。5 个月后，胸部 CT 显示右上气管旁淋巴结肿大加重。考虑到结节病恶化，他被开出口服皮质类固醇治疗 5 个月。然而，随访胸部 CT 显示新出现的右下气管旁淋巴结和右肺门淋巴结肿大加重。再次进行支气管镜检查和 EBUS。右上叶经支气管肺活检和右下气管旁淋巴结 EBUS-TBNA 显示来自肺部的腺癌。
尽管结节病和肺癌同时存在的情况非常罕见，但对于初始皮质类固醇治疗反应不佳的结节病患者，临床医生应考虑同时存在肺癌的可能性。
