Multiple Systemic Sarcoidosis Misdiagnosed as Lymphoma: One Case Report and Literature Review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

Department of Respiratory Diseases, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China;

Corresponding author：

Keywords：

Multiple systemic sarcoidosis; Diagnosis; Treatment; Tomography; Pathology

DOI：

10.7507/1671-6205.2014044

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Objective To improve the diagnosis and treatment of multiple systemic sarcoidosis (MSS) and avoid misdiagnosis. Methods To analyze the diagnosis and treatment of a MSS patient misdiagnosed as lymphoma. Related literatures were also reviewed. Results The patients' clinical manifestations were not specific including cough and stethocatharsis. Lung and thoracic lymph nodes were most commonly involved in MSS. MSS was characterized by symmetrical lymph nodes enlargement in the bilateral lung hilus and/or mediastinum. The enlarged lymph nodes had a clear boundary and showed homogeneous enhancement. Symmetrical fluorodeoxyglucose (FDG) uptake in the hilar and/or mediastinal node was a typical finding of sarcoidosis on FDG PET/CT. Mucosal inflammation and mucosal nodules could be seen in the bronchoscope. Sarcoidosis was characterized by the presence of noncaseating groanulomas histologically. Hormonal therapy was effective for MSS. Conclusion Sarcoidosis is a kind of disease involving multiple systems and organs with unknown etiology. The clinical manifestation of sarcoidosis is nonspecific,so it's likely to be misdiagnosed. Imaging examination and laboratory examination are helpful to the diagnosis of MSS. The definitive diagnosis depends on the pathologic biopsy.

Citation： Zhang Yue, Han Fengfeng, Guo Xuejun, Guan Wenbing, Sun Jinyuan, Song Lin, Ge Xiahui. Multiple Systemic Sarcoidosis Misdiagnosed as Lymphoma: One Case Report and Literature Review. Chinese Journal of Respiratory and Critical Care Medicine, 2013, 12(2): 185-189. doi: 10.7507/1671-6205.2014044 Copy

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13.	Judson MA.The diagnosis of sarcoidosis.Clin Chest Med,2008,29:415-427.
14.	Tremblay A,Stather DR,Maceachern P,et al.A randomized controlled trial of standard vs endobronchial ultrasonography-guided transbronchial needle aspiration in patients with suspected sarcoidosis.Chest,2009,136:340-346.
15.	Nakajima T,Yasufuku K,Kurosu K,et al.The role of EBUS-TBNA for the diagnosis of sarcoidosis--comparisons with other bronchoscopic diagnostic modalities.Respir Med,2009,103:1796-1800.
16.	Navani N,Booth HL,Kocjan G,et al.Combination of endobronchial ultrasound-guided transbronchial needle aspiration with standard bronchoscopic techniques for the diagnosis of stage I and stage II pulmonary sarcoidosis.Respirology,2011,16:467-472.

1. Polychronopoulous VS,Prakash UB.Airway involvement in sarcoidosis.Chest,2009,136:1371-1380.
2. Clement DS,Postma G,Rothova A,et al.Intraocular sarcoidosis of clinical characteristics of uveitis with positive chest high-resolution computed tomography findings.Br J Ophthalmol,2010,94:219-222.
3. Costabel U,Ohshimoa S,Guzman J.Diagnosis of sarcoidosis.Curr Ooin Pulm Med,2008,14:455-461.
4. 邓文静,杨岚.结节病19例临床分析.中国呼吸与危重监护杂志,2012,11:176-179.
5. 关志伟,姚树林,王瑞民,等.22例结节病¹⁸F-FDG PET/CT影像学特征分析.中华核医学杂志,2011,31:334-338.
6. Kruger S,Buck AK,Mottaghy FM,et al.Use of integrated FDG PET/CT in sarcoidosis.Clinical Imaging,2008,32:269-273.
7. Malasamy S,Dala B,Bimenyuy C,et al.The clinical and radiologic features of nodular pulmonary sarcoidosis.AJR, 2009,187:9-15.
8. Michael CI,Benjamin AR,Alvin ST.Sarcoidosis.N Eng J Med,2007,357:2153-2165.
9. Boros PW,Enright PL,Quanjer PH,et al.Impaired lung compliance and DL,CO but no restrictive ventilatory defect in sarcoidosis.Eur Respir J,2010,36:1315-1322.
10. Danila E,Jurgauskiene L,Malickaite R.BAL fluid cells and pulmonary function in different radiographic stages of newly diagnosed sarcoidosis.Adv Med Sci,2008,53:228-233.
11. Gerke AK,Hunninghake G.The immunology of sarcoidosis.Clin Chest Med,2008,29:379-390.
12. 金儿,任振义,王利民.临床常用的几种检查方法在胸部结节病诊断和分期中的应用价值.医学研究杂志,2007,36:111-113.
13. Judson MA.The diagnosis of sarcoidosis.Clin Chest Med,2008,29:415-427.
14. Tremblay A,Stather DR,Maceachern P,et al.A randomized controlled trial of standard vs endobronchial ultrasonography-guided transbronchial needle aspiration in patients with suspected sarcoidosis.Chest,2009,136:340-346.
15. Nakajima T,Yasufuku K,Kurosu K,et al.The role of EBUS-TBNA for the diagnosis of sarcoidosis--comparisons with other bronchoscopic diagnostic modalities.Respir Med,2009,103:1796-1800.
16. Navani N,Booth HL,Kocjan G,et al.Combination of endobronchial ultrasound-guided transbronchial needle aspiration with standard bronchoscopic techniques for the diagnosis of stage I and stage II pulmonary sarcoidosis.Respirology,2011,16:467-472.

Chinese Journal of Respiratory and Critical Care Medicine

Multiple Systemic Sarcoidosis Misdiagnosed as Lymphoma: One Case Report and Literature Review

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