Sarcoid-like reaction in lymphadenopathy associated with superficial esophageal squamous cell carcinoma
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CASE REPORT
Sarcoid‑like reaction in lymphadenopathy associated with superficial esophageal squamous cell carcinoma Toshiyuki Irie1 · Takeshi Matsutani1,2 · Nobutoshi Hagiwara1 · Ryuji Ohashi3 · Tsutomu Nomura1 · Hidetsugu Hanawa2 · Keisuke Mishima2 · Nobuhiko Taniai2 · Hiroshi Yoshida1 Received: 10 March 2020 / Accepted: 23 May 2020 © Japanese Society of Gastroenterology 2020
Abstract Correctly distinguishing metastasis and sarcoid-like reaction in patients with mediastinal lymphadenopathy is clinically important in esophageal cancer. A patient was a 52-year-old Japanese woman with superficial esophageal squamous cell carcinoma and rare case of sarcoid-like reaction. The patient was admitted with pharyngeal discomfort and an upper gastrointestinal endoscopy detected a superficial tumor in the middle thoracic esophagus. Biopsy confirmed a diagnosis of squamous cell carcinoma. Chest computed tomography (CT) showed enlarged lymph nodes around the trachea and in the bilateral hilum of the lung that were found to accumulate label on positron emission tomography CT. One course of chemotherapy in 5-fluorouracil, docetaxel and cisplatin did not affect the lymphadenopathy, which suggested that it was reactive rather than metastatic. The patient had undergone thoracoscopic esophagectomy with lymph node dissection. The pathohistology of the dissected lymph nodes showed noncaseating epithelioid-cell granuloma and no malignant cells. No clinical findings indicative of systemic sarcoidosis were observed, leading to a diagnosis of sarcoid-like reaction with the esophageal cancer. The patient has survived without recurrence for 4 years after beginning the initial treatment. Monitoring the response to chemotherapy may be helpful in distinguishing between metastasis and sarcoidosis-associated lymphadenopathy in esophageal cancer. Keywords Esophageal squamous cell carcinoma · Sarcoid-like reaction · Chemotherapy
Introduction Systemic sarcoidosis is an inflammatory disorder of unknown cause, and is characterized by the presence of noncaseating epithelioid-cell granuloma [1, 2]. Sarcoid-like reaction was described as a malignant tumor-related tissue response which, unlike systemic sarcoidosis, can involve the lymph nodes, by Wolbach in 1911 [3]. Sarcoid-like reactions have been reported in lung, gastric, and breast cancer patients [4–6]. Brincker [7] reported in 1986 that sarcoidlike reactions occurred in 5% of patients with malignant * Takeshi Matsutani [email protected] 1
Department of Gastrointestinal Hepato‑Biliary‑Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
2
Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1‑396, Kosugimachi, Nakahara‑ku, Kawasaki, Kanagawa 211‑8533, Japan
3
Department of Diagnostic Pathology, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan
solid tumors, but that mediastinal sarcoid-like reactions in esophageal cancer were rare. This case of sarcoid-like reaction was diagnosed in a woman with superficial esophageal squamous
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