Systemic sarcoidosis mimicking metastatic renal cell carcinoma with subsequent cardiac involvement

Michael Frohlich; Najwa Buhlaiga; Hangjun Wang; Francois Patenaude; Christian Sirois; Lama Sakr

doi:10.1016/j.rmcr.2020.101334

Systemic sarcoidosis mimicking metastatic renal cell carcinoma with subsequent cardiac involvement

Respir Med Case Rep. 2020 Dec 31:32:101334. doi: 10.1016/j.rmcr.2020.101334. eCollection 2021.

Authors

Michael Frohlich¹, Najwa Buhlaiga², Hangjun Wang³, Francois Patenaude², Christian Sirois⁴, Lama Sakr¹

Affiliations

¹ Department of Medicine, Division of Pulmonary Disease, Jewish General Hospital, Pavilion G Room 203, 3755 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1E2, Canada.
² Department of Medicine, Hematology Service and Department of Oncology, Jewish General Hospital, Pavilion E7, 3755 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1E2, Canada.
³ Divisions of Pathology and Molecular Genetics, Jewish General Hospital, Pavillion G Room 108, 3755 Côte-Sainte-Catherine Road, Montreal, Quebec, H3T 1E2, Canada.
⁴ Department of Surgery, Division Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, Pavilion L Room 8-505, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada.

Abstract

There exists a well-established association between sarcoidosis and many solid and hematologic malignancies however it is a less frequently described phenomenon in patients with renal cell carcinoma. Moreover the majority of described cases presented with local sarcoid-like reactions in close proximity to the tumor with comparatively few reports of more distant disease. Given the relatively low number of cases there remains a great deal of uncertainty surrounding the clinical behaviour of sarcoidosis in the setting of renal cell carcinoma. We report the case of a patient with surgically resected renal cell carcinoma who, several years later, developed bilateral pulmonary nodules, intra-thoracic lymphadenopathy as well as splenic, hepatic and osseous lesions. After extensive investigation, culminating in video-assisted thoracoscopic surgical resection, he was found to have sarcoidosis. He remained asymptomatic for many years before being diagnosed with cardiac sarcoidosis, which was found to be inactive and did not require any treatment. Both his sarcoidosis and underlying renal cell carcinoma have remained in remission to date. This case highlights the variable behaviour of sarcoidosis in these patients and underscores the importance of obtaining an accurate tissue diagnosis in the setting of suspected metastatic disease. Additionally, it underscores the importance of close monitoring and long-term follow up as these patients may develop significant organ involvement, even many years after diagnosis. Interestingly the patient's renal cell carcinoma remained in remission, raising questions about whether the development of sarcoidosis portends a better prognosis in patients with an underlying solid malignancy.

Keywords: CT, computed tomography; Cancer; EBUS-TBNA, endobronchial ultrasound-guided transbronchial needle aspiration; Endobronchial ultrasound; IFN- γ, interferon γ; IL, interleukin; MRI, magnetic resonance imaging; PET, positron emission tomography; RCC, renal cell carcinoma; Renal cell carcinoma; Sarcoidosis; TTNA, transthoracic-needle aspiration; Th1, T-helper cell type 1; Th17, T-helper cell type 17.

Publication types

Case Reports