A Case of Pulmonary Adenocarcinoma with Sarcoid-like Reaction in the Tumor

Abstract

Background. Noncaseating epithelioid cell granulomas are rarely observed in patients with malignant tumor without sarcoidosis. It is called sarcoid-like reaction. Case. A 82-year-old woman had been followed up by the cardiology department of our hospital because of dilated cardiomyopathy. In May 2006 a chest CT showed a 1.5 cm nodule in the right lung S⁴. The nodule was not diagnosed by brushing cytology under bronchofiberscopy. Pulmonary wedge resection for biopsy by video-assisted thoracoscopic surgery was performed. Intraoperative histopathological examination showed a pulmonary adenocarcinoma. Middle lobectomy with lymph node dissection was then performed. The histopathological findings of the resected lung specimen showed many granuloma formations in the tumor. We concluded that the granulomatous lesion was a sarcoid-like reaction related to lung cancer. No metastasis or sarcoid-like reaction was found in the dissected lymph nodes. Conclusion. When pulmonary nodules which appear malignant on diagnostic imaging show only epithelioid cell granuloma on histopathological study under bronchofiberscopy, a close follow up or pulmonary wedge resection for biopsy is recommended with sarcoid-like reaction in mind.