Service de médecine interne, centre hospitalier universitaire de Besançon, Besançon, France.
Institut de cancérologie de Bourgogne, Auxerre, France.
Cancer Radiother. 2021 Feb;25(1):51-54. doi: 10.1016/j.canrad.2020.06.025. Epub 2020 Dec 26.
Bone location is uncommon in both sarcoidosis and in neck cancer (HNC). Diagnosis of a bone lesion is therefore challenging to distinguish its nature in a patient suffering from both diseases. We report the case of a 69-years-old woman referred for P16 positive HPV-HNC. Magnetic Resonance Imaging (MRI) showed T2 hypo-signal on iliac crest and spine. FDG-PET demonstrated radiotracer uptake on these locations suggesting bone metastasis. However, bone biopsy showed epithelioid granuloma without malignant cells compatible with sarcoidosis location. The diagnosis of both localized advanced HPV-HNC and systemic sarcoidosis (bone, central nervous system) were retained. The patient received corticosteroid regimen at 0.5mg/kg/day and Methotrexate for sarcoidosis and radiation and chemotherapy with platins for carcinoma. As granulomatous bone marrow infiltration may have an uptake on FDG-PET, bone sarcoidosis can mimic metastatic disease. In addition, MRI often fails to distinguish sarcoidosis lesions from metastatic lesion in bones. As no reliable imaging test can decipher both diseases, the description of our case reinforces the necessity to perform bone biopsy in a patient suffering from both conditions to expertise the nature of bone lesions.
骨部位在结节病和头颈部癌症（HNC）中都不常见。因此，对于同时患有这两种疾病的患者，诊断骨病变并区分其性质具有挑战性。我们报告了一例 69 岁女性，因 P16 阳性 HPV-HNC 而就诊。磁共振成像（MRI）显示髂嵴和脊柱 T2 低信号。FDG-PET 显示这些部位的放射性示踪剂摄取，提示骨转移。然而，骨活检显示无恶性细胞的上皮样肉芽肿，符合结节病部位。保留了局部晚期 HPV-HNC 和全身结节病（骨、中枢神经系统）的诊断。患者接受了 0.5mg/kg/天的皮质类固醇方案和甲氨蝶呤治疗结节病，以及顺铂为基础的化疗和放疗治疗癌。由于肉芽肿性骨髓浸润可能在 FDG-PET 上摄取，因此骨结节病可能模仿转移性疾病。此外，MRI 通常无法区分骨中的结节病病变和转移性病变。由于没有可靠的影像学检查可以区分这两种疾病，因此我们的病例描述强调了在同时患有这两种疾病的患者中进行骨活检以明确骨病变性质的必要性。
