J Rheum Dis.  2016 Apr;23(2):130-135. 10.4078/jrd.2016.23.2.130.

Discovery of Splenic Sarcoidosis Concurrent with the Diagnosis of Ovarian Cancer: A Case Report

• Kim EH
• Lee SG
• Kim KH
• Seol YM
• Park EK
• Koo DW
• Hwang NK
• Han IS
• Lee MW
• Han SY
• Kim GT
• Tag HS

• KMID: 2222791
• DOI: http://doi.org/10.4078/jrd.2016.23.2.130

Abstract

Sarcoidosis is a multisystem inflammatory disease of unknown etiology characterized by noncaseating epithelioid granuloma formation. Although the relationship between sarcoidosis and malignancy has been noted in recent decades, there are few case reports describing the concurrent diagnosis of sarcoidosis and malignancy. Herein, we describe a case of biopsy-proven splenic sarcoidosis mimicking metastasis at the time of ovarian adenocarcinoma. Imaging studies including positron-emission tomography-computed tomography were not useful for differentiating sarcoidosis from malignancy. Thus, our case highlights the importance of histopathological examination to rule out nonmalignant conditions before the diagnosis of metastatic disease is made.

Keyword

Sarcoidosis; Ovarian neoplasms, Granuloma; Granuloma; Positron-emission tomography

MeSH Terms

Adenocarcinoma
Diagnosis*
Granuloma
Neoplasm Metastasis
Ovarian Neoplasms*
Positron-Emission Tomography
Sarcoidosis*

Figure

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  Figure 1. Abdominal computed tomography (CT; A, B) and magnetic resonance imaging (MRI; C, D) showed 100×47 mm sized multiseptated cystic mass (arrowheads in A and C) and multiple extensive lymphadenopathy including multiple 2 to 6 cm sized lymph nodes. In the spleen, a low density lesion measuring approximately 12×27 mm on CT (arrow in B) and a 62 mm sized mass lesion on MRI (arrow in D) were observed.

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  Figure 2. 18 F-fluorodeoxyglucose (FDG) labeled positron-emi-ssion tomography before (A and B) and 1 month after (C and D) prednisolone therapy. The mag-18 F-FDG uptake in nitude of multiple hypermetabolic nodules and the multiseptated mass in the right ovary (arrowhead in A) increased after 1 month (arro-whead in C). Increased 18 F-FDG uptake in spleen (arrows in A and B) nearly resolved after glucocorticoids treatment (arrows in C and D).

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  Figure 3. Microscopic findings in the spleen (hematoxylin and eosin staining). Noncaseating granulomas with aggregations of inflammatory cells (arrow in A), multinucleated giant cells (arrow in B), asteroid body (arrow in C), and eosinophils (arrow in D) were observed. (A, B) ×200, (C, E) ×400.

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  Figure 4. Microscopic findings of the omentum. (A) Hematoxylin and eosin staining showed metastatic adenocarcinoma on des-moplastic changed omentum (×200). (B) Calretinin staining was negative (×100). (C) The tumor was estrogen receptor positive, suggesting an ovarian origin (×100). (D) The tumor protein p53 was positive (×100).

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