Multiple pulmonary cavitating nodules in female with endometrium adenocarcinoma history – difficulties in differentiation between metastases, sarcoidosis and sarcoid-like reaction. Case report
 
More details
Hide details
1
Student Society of the Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
 
2
Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
 
 
Corresponding author
Alicja Gałeczka-Turkiewicz   

Student Society of the Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland, ul. Ks. Koziołka 1, 41-803 Zabrze
 
 
Ann. Acad. Med. Siles. 2023;77:1-6
 
KEYWORDS
TOPICS
ABSTRACT
Pulmonary cavitary lesions visible on a chest radiograph can be a diagnostic challenge. It is necessary to take into consideration a wide differential diagnosis and to conduct a wide range of examinations to confirm their exact cause. A 44-year-old woman with a history of endometrial adenocarcinoma was admitted to the pulmonology department to diagnose mediastinal lymphadenopathy with coexisting nodules in the lung parenchyma. The X-ray and positron emission tomography (PET) showed cavitating lesions in the lungs, which could correspond to metastases, but the laboratory and histopathological tests did not confirm any neoplastic features. In specimens obtained by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and video-assisted thoracoscopic surgery (VATs) non-caseating granulomas were found, which suggested sarcoidosis or a sarcoid-like reaction. At an advanced stage of pulmonary changes, the presence of neoplastic cells was revealed in the sputum. Despite chemotherapy the patient died. Multiple pulmonary metastases were confirmed in the post-mortem examination. This case is an example of a rare sarcoid-like reaction in the mediastinum and lung parenchyma due to cancer located below the diaphragm. Differentiating between sarcoidosis, a sarcoid-like reaction and lung metastases in similar cases may be difficult. For this reason, it should be advisable to repeat diagnostic procedures in patients with malignancies in the past, including EBUS-TBNA and VATs.
 
REFERENCES (29)
1.
Ryu J.H., Swensen S.J. Cystic and cavitary lung diseases: focal and diffuse. Mayo Clin. Proc. 2003; 78(6): 744–752, doi: 10.4065/78.6.744.
 
2.
Hong K.S., Jang J.G., Ahn J.H. Radial probe endobronchial ultrasound-guided transbronchial lung biopsy for the diagnosis of cavitary peripheral pulmonary lesions. Thorac. Cancer 2021; 12(11): 1735–1742, doi: 10.1111/1759-7714.13980.
 
3.
Murakami A., Hayashi T., Terao Y., Mori T., Kumasaka T., Seyama K. et al. Cystic, nodular and cavitary metastases to the lungs in a patient with endometrial stromal sarcoma of the uterus. Intern. Med. 2014; 53(9): 1001–1005, doi: 10.2169/internalmedicine.53.1946.
 
4.
Marchiori E., Hochhegger B., Zanetti G. Multiple cavitated nodules. J. Bras. Pneumol. 2017; 43(2): 85, doi: 10.1590/S1806-37562016000000295.
 
5.
Song J., Yu J., Ma Z., Lu S. Rare occurrence of cavitation of lung metastases following effective targeted therapy: A case report. Oncol. Lett. 2016; 11(2): 1589–1591, doi: 10.3892/ol.2016.4093.
 
6.
Chaudhuri M.R. Cavitary pulmonary metastases. Thorax 1970; 25(3): 375–381, doi: 10.1136/thx.25.3.375.
 
7.
Sewchuran T. Solid to cystic: A case report of imaging findings of atypical lung metastases. SA J. Radiol. 2019; 23(1), doi: 10.4102/sajr.v23i1.1663.
 
8.
Lowen W. Cavitating pulmonary metastases. Australas. Radiol. 1967; 11(3): 242–245, doi: 10.1111/j.1440-1673.1967.tb01530.x.
 
9.
Parkar A.P., Kandiah P. Differential diagnosis of cavitary lung lesions. J. Belg. Soc. Radiol. 2016; 100(1): 100, doi: 10.5334/jbr-btr.1202.
 
10.
Gunasekaran K., Baskaran B., Rahi M.S., Parekh J., Rudolph D. Cavitating pulmonary metastases from a renal cell carcinoma. Clin. Pract. 2020; 10(1): 1234, doi: 10.4081/cp.2020.1234.
 
11.
Morikawa K., Misumi S., Fukuda T. A case of pulmonary tuberculosis with multiple nodules mimicking lung metastases. BJR Case Rep. 2019; 5(3): 20180124, doi: 10.1259/bjrcr.20180124.
 
12.
Yoo S.H., Kim S.R., Choi J.Y., Choi J.W., Ko Y.M., Jang S.H. et al. Multiple cavitary pulmonary nodules caused by Mycobacterium intracellulare. Korean J. Fam. Med. 2016; 37(4): 248–252, doi: 10.4082/kjfm.2016.37.4.248.
 
13.
Hours S., Nunes H., Kambouchner M., Uzunhan Y., Brauner M.W., Valeyre D. et al. Pulmonary cavitary sarcoidosis: clinico-radiologic characteristics and natural history of a rare form of sarcoidosis. Medicine (Baltimore) 2008; 87(3): 142–151, doi: 10.1097/MD.0b013e3181775a73.
 
14.
Handa A., Dhooria S., Sehgal I.S., Agarwal R. Primary cavitary sarcoidosis: A case report, systematic review, and proposal of new diagnostic criteria. Lung India 2018; 35(1): 41–46, doi: 10.4103/lungindia.lungindia_225_17.
 
15.
Rockoff S.D., Rohatgi P.K. Unusual manifestations of thoracic sarcoidosis. AJR Am. J. Roentgenol. 1985; 144(3): 513–528, doi: 10.2214/ajr.144.3.513.
 
16.
Koo H.J., Kim M.Y, Shin S.Y., Shin S., Kim S.S., Lee S.W. et al. Evaluation of mediastinal lymph nodes in sarcoidosis, sarcoid reaction, and malignant lymph nodes using CT and FDG-PET/CT. Medicine (Baltimore) 2015; 94(27): e1095, doi: 10.1097/MD.0000000000001095.
 
17.
Brincker H. Sarcoid reactions in malignant tumours. Cancer Treat. Rev. 1986; 13(3): 147–156, doi: 10.1016/0305-7372(86)90002-2.
 
18.
Hammen I., Sherson D.L., Davidsen J.R. Systemic sarcoidosis mimic-king malignant metastatic disease. Eur. Clin. Respir. J. 2015; 2(1): 26761, doi: 10.3402/ecrj.v2.26761.
 
19.
Brincker H., Pedersen N.T. Immunohistologic separation of B-cell-positive granulomas from B-cell-negative granulomas in paraffin-embedded tissues with special reference to tumor-related sarcoid reactions. APMIS 1991; 99(3): 282–290, doi: 10.1111/j.1699-0463.1991.tb05151.x.
 
20.
Haddadi S., Adkinson B.C., Holt G.E., Mirsaeidi M. Sarcoidosis or cancer? That is the question. Respir. Med. Case Rep. 2021; 33: 101426, doi: 10.1016/j.rmcr.2021.101426.
 
21.
Fritscher-Ravens A., Ghanbari A., Topalidis T., Pelling M., Kon O.M., Patel K. et al. Granulomatous mediastinal adenopathy: can endoscopic ultrasound-guided fine-needle aspiration differentiate between tuberculosis and sarcoidosis? Endoscopy 2011; 43(11): 955–961, doi: 10.1055/s-0031-1271110.
 
22.
Tyan C.C., Machuca T., Czarnecka K., Ko H.M., da Cunha Santos G., Boerner S.L. et al. Performance of endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of isolated mediastinal and hilar lymphadenopathy. Respiration 2017; 94(5): 457–464, doi: 10.1159/000479745.
 
23.
Vayısoğlu Şahin G., Karadeniz G., Polat G., Demirci Üçsular F., Ay-doğdu Z., Yalnız E. A case of endometrium adenocarcinoma with multiple cavitary pulmonary metastasis. [Article in Turkish]. Tuberk. Toraks 2018; 66(4): 349–352, doi: 10.5578/tt.67686.
 
24.
Berger M., Thompson J.R. Cavitary carcinomatosis of the lungs: Report of a case. Dis. Chest 1967; 52(1): 106–111, doi: 10.1378/chest.52.1.106.
 
25.
D’Orsi C.J., Bruckman J., Mauch P., Smith E.H. Lung metastases in cervical and endometrial carcinoma. AJR Am. J. Roentgenol. 1979; 133(4): 719–722, doi: 10.2214/ajr.133.4.719.
 
26.
Seo J.B., Im J.G., Goo J.M., Chung M.J., Kim M.Y. Atypical pulmonary metastases: spectrum of radiologic findings. Radiographics 2001; 21(2): 403–417, doi: 10.1148/radiographics.21.2.g01mr17403.
 
27.
Rai M.P., Randhawa M.S., Nemakayala D.R., Marinas E.B. Endometrial adenocarcinoma with pulmonary recurrence. BMJ Case Rep. 2018; 2018: bcr2017223015, doi: 10.1136/bcr-2017-223015.
 
28.
Kennedy M.P., Jimenez C.A., Mhatre A.D., Morice R.C., Eapen G.A. Clinical implications of granulomatous inflammation detected by endobronchial ultrasound transbronchial needle aspiration in patients with suspected cancer recurrence in the mediastinum. J. Cardiothorac. Surg. 2008; 3: 8, doi: 10.1186/1749-8090-3-8.
 
29.
Lashari B.H., Asai M., Randleman G., Sack M., Patel R. Sarcoid-like mediastinal lymphadenopathy in gynecologic malignancy. Pulm. Med. 2018; 2018: 5141575, doi: 10.1155/2018/5141575.
 
eISSN:1734-025X
Journals System - logo
Scroll to top