Department of Breast Surgery, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-8503, Japan.
Department of Breast Oncology, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan.
J Med Case Rep. 2022 May 19;16(1):194. doi: 10.1186/s13256-022-03428-1.
Sarcoidosis is a benign systemic granulomatous disorder of unknown etiology. Cell-mediated immunity disorder is often found in sarcoidosis patients, and an association between malignant tumors and sarcoidosis has been suggested. Sarcoidosis and malignant disease can occur simultaneously or sequentially, leading to misdiagnosis and mistreatment. Sarcoidosis is diagnosed clinically, radiologically, and histologically. We report herein a case of sarcoidosis diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration from the mediastinal lymph nodes of a breast cancer patient.
The patient was a 70-year-old Asian woman who presented with right breast tumor. A 20-mm movable mass was identified in the inferolateral quadrant of the right breast, and mammography revealed a spiculated mass with calcification. Ultrasonography revealed a mass with internal hypoechogenicity, and biopsy revealed estrogen receptor-positive, human epidermal growth factor receptor 2-positive invasive ductal carcinoma. Positron emission tomography/computed tomography showed multiple lymphadenopathy including mediastinal lymph nodes, with fluorodeoxyglucose accumulation in those nodes suggesting breast cancer metastases. Endobronchial ultrasound-guided transbronchial needle aspiration of a mediastinal lymph node revealed noncaseous epithelioid granuloma. Due to a history of uveitis and elevated soluble interleukin 2 receptor, lymphadenopathy due to sarcoidosis and stage IIA breast cancer were diagnosed. Right partial mastectomy and axillary lymph node dissection were performed after preoperative chemotherapy. No exacerbation of sarcoidosis symptoms has been observed during treatment.
We report a case of breast cancer in which sarcoidosis could be diagnosed based on endobronchial ultrasound-guided transbronchial needle aspiration, a history of uveitis, and elevated soluble interleukin 2 receptor despite fluorodeoxyglucose positron emission tomography/computed tomography suggesting multiple lymph node metastases. This report emphasizes the importance of differential diagnosis of lymph node involvements in cancer patients.
结节病是一种病因不明的良性全身肉芽肿性疾病。结节病患者常存在细胞介导免疫紊乱，且已有结节病与恶性肿瘤之间关联的报道。结节病和恶性疾病可同时或先后发生，导致误诊和误治。结节病的诊断依据包括临床、影像学和组织学。本文报告了一例经支气管内超声引导经支气管针吸活检（EBUS-TBNA）从乳腺癌患者纵隔淋巴结中诊断出的结节病病例。
患者为 70 岁亚洲女性，因右侧乳房肿瘤就诊。右侧乳房下外侧象限可触及 20mm 可移动肿块，乳房 X 线摄影显示有分叶状肿块伴钙化。超声检查显示肿块内部低回声，活检显示雌激素受体阳性、人表皮生长因子受体 2 阳性的浸润性导管癌。正电子发射断层扫描/计算机断层扫描（PET/CT）显示包括纵隔淋巴结在内的多处淋巴结肿大，这些淋巴结中氟脱氧葡萄糖摄取提示乳腺癌转移。纵隔淋巴结的经支气管内超声引导经支气管针吸活检显示非干酪样上皮样肉芽肿。由于有葡萄膜炎病史和可溶性白细胞介素 2 受体升高，诊断为结节病伴 IIA 期乳腺癌和淋巴结肿大。在术前化疗后进行了右侧部分乳房切除术和腋窝淋巴结清扫。在治疗过程中，未观察到结节病症状恶化。
本文报告了一例乳腺癌病例，尽管氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描提示存在多处淋巴结转移，但基于支气管内超声引导经支气管针吸活检、葡萄膜炎病史和可溶性白细胞介素 2 受体升高，可诊断为结节病。该病例强调了对癌症患者淋巴结受累情况进行鉴别诊断的重要性。
