Jeong Young Jin, Lim Seok Tae, Jeong Hwan-Jeong, Park Ho Sung, Lee Sun Young, Han Yeon-Hee
Department of Nuclear Medicine, Dong-A University College of Medicine, Busan, Republic of Korea.
Department of Nuclear Medicine, Molecular Imaging & Therapeutic Medicine Research Center, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School and Hospital, 20, Geonjiro, Jeonju, Jeonbuk 54907, Republic of Korea.
Radiol Case Rep. 2021 Oct 10;16(12):3834-3837. doi: 10.1016/j.radcr.2021.09.032. eCollection 2021 Dec.
Malignancy may lead to sarcoidosis, which is referred to as sarcoid reaction. This reaction is believed to be a host immune response to the release of soluble antigens from cancer cells. Studies have shown strong 2'-deoxy-2'-[F-18]fluoro-D-glucose (F-18 FDG) uptake in sarcoid reaction and in true sarcoidosis. Therefore, in patients with malignancy, sarcoid reactions can mimic metastasis or recurrence on F-18 FDG positron emission tomography/computed tomography (PET/CT). Herein, we report the case of a 58-year-old woman with a history of left breast cancer whose FDG PET/CT evaluated at 3 months after adjuvant chemotherapy presented hypermetabolic lymphadenopathy in the right supraclavicular and right mediastinal areas. We interpreted these as metastases because the involved lymph nodes were intensely hypermetabolic and appeared newly. Pathologic evaluation of the excised lymph node revealed noncaseating chronic granulomas without malignant cells, indicating a sarcoid reaction. After appropriate steroid therapy, both the size and metabolic activity of the lymphadenopathy substantially decreased. Most sarcoid reactions present as bilateral hilar and peribronchial lymphadenopathies. Our patient presents an atypical example that a sarcoid reaction can also present in a unilateral pattern, making its diagnosis challenging. When interpreting FDG PET/CT images, considering that the sarcoid reaction pattern can vary is crucial.
恶性肿瘤可能导致结节病，这被称为结节病反应。这种反应被认为是机体对癌细胞释放的可溶性抗原的免疫反应。研究表明，结节病反应和真正的结节病中2'-脱氧-2'-[F-18]氟-D-葡萄糖（F-18 FDG）摄取强烈。因此，在恶性肿瘤患者中，结节病反应在F-18 FDG正电子发射断层扫描/计算机断层扫描（PET/CT）上可模拟转移或复发。在此，我们报告一例58岁有左乳腺癌病史的女性病例，其在辅助化疗3个月后进行的FDG PET/CT检查显示右锁骨上和右纵隔区域有代谢增高的淋巴结病。我们将这些解释为转移，因为受累淋巴结代谢强烈增高且为新发。切除淋巴结的病理评估显示为非干酪样慢性肉芽肿，无恶性细胞，提示为结节病反应。经过适当的类固醇治疗后，淋巴结病的大小和代谢活性均显著降低。大多数结节病反应表现为双侧肺门和支气管周围淋巴结病。我们的患者是一个非典型例子，即结节病反应也可以单侧形式出现，这使其诊断具有挑战性。在解读FDG PET/CT图像时，考虑到结节病反应模式可能不同至关重要。
