Kawai Hideki, Sarai Masayoshi, Toyama Hiroshi, Izawa Hideo
Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, Japan.
Department of Radiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, Japan.
Eur Heart J Case Rep. 2021 Jan 12;5(2):ytaa558. doi: 10.1093/ehjcr/ytaa558. eCollection 2021 Feb.
The high F-fluorodeoxyglucose (FDG) uptake in sarcoidosis lesions reflects infiltration of inflammatory cells such as macrophages. An increased incidence of cancer in patients with sarcoidosis has been suggested, and some combination of the following mechanisms has been proposed: chronic inflammation, immune dysfunction, shared aetiologic agents, and genetic susceptibility to both cancer and autoimmune diseases.
A 73-year-old man was admitted to our hospital due to effort dyspnoea. Initial investigations showed complete atrioventricular block on electrocardiography, basal thinning of the interventricular septum, and preserved left ventricular (LV) systolic function on echocardiography, and late gadolinium enhancement (LGE) in all layers of the basal interventricular septum on cardiac magnetic resonance imaging. FDG positron emission tomography/computerized tomography (FDG-PET/CT) showed no abnormal uptake in the whole-body including myocardium. After discussion, corticosteroid was not initiated then. One year later, he developed stomach adenocarcinoma. Repeated investigations demonstrated enlargement of the LV (LV diastolic diameter 63 mm) and diffuse systolic impairment of LV function (LV ejection fraction 31%) on echocardiography, and abnormal focal uptake at the lateral walls of LV and hilar lymph nodes on FDG-PET/CT imaging. One more year after the surgery for gastric cancer and corticosteroid initiation, echocardiography showed recovery of systolic function and FDG-PET/CT showed no uptake in either the myocardium or hilar lymph nodes.
In the present case, it is speculated that the first inflammation which left scarred areas showing LGE was already completed before the first FDG-PET/CT. The development of gastric cancer may be associated with the reactivation of cardiac sarcoidosis.
结节病病灶中高氟脱氧葡萄糖（FDG）摄取反映了巨噬细胞等炎性细胞的浸润。已有研究提示结节病患者癌症发病率增加，并提出了以下几种机制的某种组合：慢性炎症、免疫功能障碍、共同病因以及对癌症和自身免疫性疾病的遗传易感性。
一名73岁男性因劳力性呼吸困难入院。初步检查显示心电图提示完全性房室传导阻滞，超声心动图显示室间隔基底段变薄，左心室（LV）收缩功能正常，心脏磁共振成像显示室间隔基底段各层均有延迟钆增强（LGE）。FDG正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）显示全身包括心肌均无异常摄取。经讨论，当时未开始使用皮质类固醇。一年后，他患上了胃腺癌。重复检查显示超声心动图提示左心室扩大（左心室舒张直径63mm）及左心室功能弥漫性收缩功能障碍（左心室射血分数31%），FDG-PET/CT成像显示左心室侧壁和肺门淋巴结有异常局灶性摄取。胃癌手术后并开始使用皮质类固醇一年后，超声心动图显示收缩功能恢复，FDG-PET/CT显示心肌和肺门淋巴结均无摄取。
在本病例中，推测首次FDG-PET/CT检查前，留下显示LGE瘢痕区域的首次炎症已经完成。胃癌的发生可能与心脏结节病的再激活有关。
