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Sarcoidosis

Cancer or Sarcoidosis

08/30/2010

Question:

I was diagnosised with breast cancer three years ago, no lymph node involvement. Had a lumpectomy, chemotherapy and radiation. After completing treatment I was started on Arimidex (aromitase inhibitor). Final biopsy results of the breast cancer was invasive ductal cell/esterogen reseptor positive. I am now into the third year of Arimidex. For the past two years I have had severe multi joint pain. About one year ago I begin to have short of breath with ambulation, now sometimes I get short of breath with talking and I noticed puffiness on the left side of my neck that didnt go away. I had a PET scan in June of this year. IMPRESSION RESULT OF PET SCAN READS: 1. Intense FDG uptake corresponding to the bilateral bulky supraclavicular lymph nodes, nediastinal lymph nodes, bilateral hilar and upper abdominal lymph nodes, left external lilac, and retrocruarl lymph nodes are consistent with malignancy. This is an unusual pattern for breast cancer metastases. Other differential considerations would include sarcoidosis or lymphomataous involvement. 2. Moderate FDG uptake in the right parotid gland likely representing a benign Warthin`s tumor. 3. Moderate FDG uptake in the right parapharyngeal region is nonspecific. 4. Intense FDG uptake throughout the colon. There is decompression of the colon with absence of gas and stool. This give the apperance of bowel wall thickening, which may be artifactual. Clinical correlation of colonscopy is suggested. END OF IMPRESSION. After two fine needle biopsy (that was undiagnosable) I had a incisional biopsy. Results were no cancer cell present but consistant with sarcoidosis. My ACE blood test were normal. What do you recommend for me. Thank You.

Answer:

Dear Madam-

I respond to this query with a cautionary note. Let me start by saying that it would be impossible to exclude active breast cancer based on the information provided. Furthermore, other possible causes of granulomatous inflammation (e.g., fungal or mycobacterial infections) should be excluded before calling this sarcoidosis. Finally, sarcoidosis (granulomas) can develop as a response to malignancy (e.g., in surrounding tissues or lymph nodes). Thus, it will be very important to coordinate your care with specialists familiar with both sarcoidosis and breast cancer. 

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Response by:

Elliott D Crouser, MD Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University