Sekine Chikako, Kawase Kazumi, Yoshida Kazuhiko
Department of Surgery, The Jikei University School of Medicine Katsushika Medical Center, 6-41-2 Aoto, Katsushika ward, Tokyo 125-8506, Japan; Department of Breast Surgery, International University of Health and Welfare, Narita Hospital, 852 Hatakeda Narita, Chiba 286-8520, Japan.
Department of Surgery, The Jikei University School of Medicine Katsushika Medical Center, 6-41-2 Aoto, Katsushika ward, Tokyo 125-8506, Japan.
Int J Surg Case Rep. 2021 Aug;85:106280. doi: 10.1016/j.ijscr.2021.106280. Epub 2021 Aug 4.
Sarcoid-like reaction is a systemic granulomatous reaction that may develop in the lymph nodes and organs of cancer patients. Distinguishing a sarcoid-like reaction from metastasis is difficult. Accurate diagnosis of this reaction is key to preventing overtreatment.
A 51-year-old woman presented with a lump in her left breast and swollen lymph nodes in her left axilla and infraclavicular fossa. A core biopsy was performed, leading to the diagnosis of grade 2 infiltrating ductal carcinoma, clinical stage T2N3M0 with estrogen and progesterone receptor negativity and human epidermal growth factor receptor-2 positivity. After neoadjuvant therapy, the tumor in her left breast reduced in size, but the lymph nodes remained swollen. Mastectomy and axillary lymph node dissections were performed. In the pathological findings, epithelioid cell granuloma was observed in the lymph nodes. Based on these findings, lymph node swelling was attributed to a sarcoid-like reaction.
SLRs have been reported in 4-14% of cancer patients. Although there are various imaging modalities for detecting swollen lymph nodes, the differential diagnosis of cancer metastasis is often difficult.
Histological evaluation of swollen lymph nodes is required to prevent overtreatment; especially in cases where the tumor size is reduced by chemotherapy, but the lymph nodes remain swollen.
结节病样反应是一种全身性肉芽肿反应，可在癌症患者的淋巴结和器官中发生。将结节病样反应与转移瘤区分开来很困难。准确诊断这种反应是避免过度治疗的关键。
一名51岁女性，左乳出现肿块，左腋窝和锁骨下窝淋巴结肿大。进行了粗针活检，诊断为2级浸润性导管癌，临床分期为T2N3M0，雌激素和孕激素受体阴性，人表皮生长因子受体-2阳性。新辅助治疗后，左乳肿瘤缩小，但淋巴结仍肿大。遂行乳房切除术和腋窝淋巴结清扫术。病理检查发现，淋巴结中可见上皮样细胞肉芽肿。基于这些发现，淋巴结肿大归因于结节病样反应。
4%至14%的癌症患者中曾有结节病样反应的报道。尽管有多种影像学方法可检测肿大的淋巴结，但癌症转移的鉴别诊断往往很困难。
为避免过度治疗，需要对肿大的淋巴结进行组织学评估；特别是在化疗后肿瘤大小缩小但淋巴结仍肿大的情况下。
