Author of

• 12824

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  P3.21 - Poster Session 3 - Diagnosis and Staging (ID 171)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Prevention & Epidemiology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12833

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    P3.21-009 - Differential diagnosis of intrathoracic lymphadenopathy and/or infiltrates in patients with malignant tumours (ID 2171)

    09:30 - 09:30  |  Author(s): R. Bittenglova
    • Abstract

    Background
    Patients which are treated due to various malignant tumours, should be investigated by pneumologists because of having intrathoracic lympadenopathy and/or pulmonary infiltrates. We should consider either progression of first malignant tumour, secondary and tertiary malignancies, adverse reactions on therapy, infectious diseases, or, last but not least, systemic diseases, e.g. sarcoidosis. However in sarcoidosis patients, increased risk of hematologic and lung malignancies were reported. The occurrence of intrathoracic lymphadenopathy with or without pulmonary infiltrates is subject to frequent diagnostic difficulties in patients with cancer history. Accumulation of pulmonary infiltrates and lymphadenopathy may be mistakenly interpreted as metastases. We present 41 patients with malignancies, who contracted sarcoidosis simultaneously, subsequently or before the diagnosis of malignancy. The coincidence of both diseases hasn't been published in the Czech Republic yet. In these patients, according to a number of studies, increased prevalence of malignant diseases was found. Sarcoidosis is a non-tumor, chronic, systemic granulomatous disease of unknown etiology and characterized by T-cell dysfunction. It affects mainly the lungs and lymphatic system, but also other parenchymal organs, the skin, the eyes, the heart. The generally accepted hypothesis is some environmental factors may promote the development of sarcoidosis in genetically susceptible individuals. Characteristic lesions are noncaseating granulomas, which consist of epithelioid cells and T-lymphocytes.

    Methods
    During the course of 28 years we have examined around 500 patients with sarcoidosis. We selected patients with sarcoidosis and also malignant diseases from these.Using the method of retrospective study, we evaluated the frequency of the coincidence of the period since 1996.

    Results
    Of all the investigated we follow a group of 41 patients with malignancy and sarcoidosis. In 33 patients there was the primary tumor, in 7 patients primary sarcoidosis, 1 patient had two diagnoses simultaneously. These are 18 men and 22 women with the mean age of 62,3 years. The spectrum of malignancies covers hematological malignancy (6), lung (3), breast (13), head and neck (4), intestine (3), melanoma (4), seminoma (3) and other (5). All patients had sarcoidosis diagnosed by biopsy (23) by CT or PET / CT and the bronchioalveolar lavages (18). Mediastinal lymphadenopathy was presented by 37 patients, pulmonary infiltrates and nodules were detected in 31 patients, infiltrates only 3 patients, extrapulmonary disease in 9 patients. The interval between sarcoidosis and the primary cancer was 0-552 months with a median of 36.Treatment with corticosteroids (or in combination with immunosuppressive agents) had to be initiated in 28 patients, 12 patients were left without treatment. 31 patients showed regression or disappearance of lesions, 8 patients were stable and disease didn't progress, the development of 2 patient is still unknown.

    Conclusion
    Differential diagnosis of pulmonary lesions is a common problem in patients with primary malignant disease in history. Not every pulmonary lesion must be just a manifestation of the disease, but as we argue in this presentation, it may be a manifestation of sarcoidosis. Therefore, we stress the need of histological verification of each newly formed pathological finding. The exclusion of generalized malignancy should have a significant influence on the treatment and survival.