Mediastinal sarcoid-like reaction after colon adenocarcinoma resection

摘要

Abstract We report a rare case of mediastinal sarcoid-like reaction presenting 5 years after colon adenocarcinoma resection. The lack of clinical and biochemical features suggestive of sarcoidosis and the high l8F-fluorodeoxyglucose uptake in mediastinal adenopathy, not seen previously, led us to suspect cancer recurrence. Pathological diagnosis obtained with a thoracoscopic biopsy confirmed sarcoidosis. Mediastinal adenopathies need to be confirmed pathologically to avoid potential interpretative pitfalls leading to toxic overtreatment. Herein, we report a rare case of mediastinal sarcoid-like reaction (SLR) that presented 5 years after colon adenocarcinoma resection. The high 18F-fluorodeoxy-glucose (18FDG) uptake on positron-emission tomography-computed tomography (PET/CT) led us to suspect cancer recurrence. Pathological diagnosis confirmed SLR. A 67-year-old woman was admitted to our unit because of high 18FDG uptake in mediastinal and hilar lymph nodes on a PET/CT scan. Five years earlier, she had undergone a typical ileocecal resection for adenocarcinoma, followed by 6 cycles of adjuvant chemotherapy. Because of thoracic pain that started one month before admission, she underwent chest computed tomography that showed multiple adenopathies not seen in previous examinations, which were 18FDG-avid on the subsequent PET/CT scan (Figure 1). Physical examination, laboratory tests, and serum tumor markers including carcinoembryonic antigen and cancer antigen 19-9, were unremarkable.