INTERESTING IMAGE Year : 2023  |  Volume : 38  |  Issue : 1  |  Page : 79-80  

Malignancy-Associated sarcoid-like reaction in a case of triple-negative breast cancer on F-18 fluorodeoxyglucose positron emission tomography/computed tomography

Sneha Prakash1, Nishikant Avinash Damle1, Karan Madan2, Prashant Ramteke3
1 Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
2 Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
3 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

Date of Submission28-Jul-2022Date of Decision13-Sep-2022Date of Acceptance15-Sep-2022Date of Web Publication24-Feb-2023

Correspondence Address:
Dr. Nishikant Avinash Damle
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi - 110 029
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ijnm.ijnm_130_22

   Abstract 

We describe the case of a 54-year-old woman with triple-negative breast cancer whose baseline F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) showed hypermetabolic left breast primary, ipsilateral axillary lymphadenopathy, lung nodules, and mediastinal lymph nodes. Histopathological examination of tissue from mediastinal lymph nodes confirmed a diagnosis of sarcoid-like reaction. Chemotherapy may induce or cause a flare-up of malignancy-associated sarcoid-like reaction. However, in our patient's post-chemotherapy F-18 FDG PET/CT, there was reduction in size and uptake of the mediastinal lymph nodes along with partial response shown by the other lesions. We aim to describe this rare course of malignancy-associated sarcoid-like reaction and highlight the role of F-18 FDG PET-CT in such cases.

Keywords: Breast cancer, F-18 fluorodeoxyglucose positron emission tomography/computed tomography, malignancy-associated sarcoid-like reaction, sarcoidosis

How to cite this article:
Prakash S, Damle NA, Madan K, Ramteke P. Malignancy-Associated sarcoid-like reaction in a case of triple-negative breast cancer on F-18 fluorodeoxyglucose positron emission tomography/computed tomography. Indian J Nucl Med 2023;38:79-80
How to cite this URL:
Prakash S, Damle NA, Madan K, Ramteke P. Malignancy-Associated sarcoid-like reaction in a case of triple-negative breast cancer on F-18 fluorodeoxyglucose positron emission tomography/computed tomography. Indian J Nucl Med [serial online] 2023 [cited 2023 Feb 25];38:79-80. Available from: https://www.ijnm.in/text.asp?2023/38/1/79/370422

Sarcoidosis is a type of chronic granulomatous disease that is characterized by a widespread development of noncaseating granulomatous lesions in multiple organ systems. When a patient has lesions with noncaseating epitheloid cell granulomas without the systemic symptoms of sarcoidosis, it is termed as a sarcoid-like reaction.[1] Thus, differentiating the two conditions based on histopathology alone is not possible. Studies suggest that sarcoidosis may precede, occur concurrently as paraneoplastic syndrome or follow hematological and solid malignancies.[2],[3] Very few studies have described the occurrence of sarcoid-like reactions following breast cancer and have attributed it as a paraneoplastic syndrome.[4] Sarcoid-like reactions can occur in close proximity to the tumor as an immunological response to the tumor antigens.[5] Antineoplastic treatment such as chemotherapy has been found to induce or cause a flare-up of malignancy-associated sarcoid-like reaction.[2],[6] Surprisingly, in our patient, the sarcoid-like reaction mimicked the malignant lesions' response to chemotherapy, which raised questions about the previously known course of this condition [Figure 1]. In such cases, to avoid misdiagnosis or overtreatment, such as unnecessary chemotherapy for presumed residual/recurrent metastases, histopathological evidence may be necessary.[7] Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) may be used to identify the suspicious lesions and guide the site of biopsy. No specific treatment is recommended in malignancy-related sarcoid-like reactions.[1],[8] Through this case, we hope to describe one of the courses of sarcoid-like reaction, which has not been well documented in literature, and highlight the potential role of F-18 FDG PET/CT in its evaluation.

Figure 1: F-18 FDG PET/CT was performed on a 54-year-old female patient with triple-negative breast cancer for initial staging and for response assessment to chemotherapy six months later. Her baseline PET/CT showed metabolically active primary lesion in the left breast parenchyma (a: arrowhead, c: thin arrow) with metastasis to ipsilateral axillary lymph nodes (a: black arrow). Metabolically active mediastinal lymph nodes (a: solid white arrow, c: solid white arrow) and parenchymal nodules in bilateral lungs were also noted. Histopathological examination of endobronchial ultrasound-guided aspirate from mediastinal lymph nodes showed numerous nonnecrotizing epitheloid cell granuloma (e) in a background of reactive lymphoid cells. This led to a diagnosis of malignancy-associated sarcoid-like reaction. post-chemotherapy scan showed metabolically active primary lesion (b: arrowhead, d: thin arrow) in the left breast as well as the previously noted axillary lymph nodal metastases (b: black arrow). These lesions showed a significant reduction in size and metabolic activity suggestive of partial response. In addition, the previously noted mediastinal lymph nodes (b: solid white arrow, d: solid white arrow) also showed a reduction in size and metabolic activity, although to a lesser extent when compared to the other lesions. FDG PET/CT: Fluorodeoxyglucose positron emission tomography/computed tomography

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

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