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. 2012 Dec;73(6):320-4.
doi: 10.4046/trd.2012.73.6.320. Epub 2012 Dec 28.

Sarcoidosis presenting with massive pleural effusion and elevated serum and pleural fluid carbohydrate antigen-125 levels

In Seon Lee  1 , Sae Byul Kim, Chan Soo Moon, Sung Mo Jung, Song Yee Kim, Eun Young Kim, Ji Ye Jung, Young Ae Kang, Young Sam Kim, Se Kyu Kim, Joon Chang, Moo Suk Park
Affiliations

Sarcoidosis presenting with massive pleural effusion and elevated serum and pleural fluid carbohydrate antigen-125 levels

In Seon Lee et al. Tuberc Respir Dis (Seoul). 2012 Dec.

Abstract

A 55-year-old woman was admitted for an elevated serum carbohydrate antigen-125 (CA-125) level, and a left pleural effusion, which were detected at a routine health examination. Computed tomography of the chest was performed upon admission, revealing extensive bilateral paratracheal and mediastinal lymph node enlargement with a massive left-sided pleural effusion. Subsequent analysis of the pleural fluid demonstrated consistency with an exudate, no evidence of malignant cells, and a normal adenosine deaminase. However, the pleural fluid and serum CA-125 levels were 2,846.8 U/mL and 229.5 U/mL, respectively. A positron emission tomography did not reveal any primary focus of malignancy. Finally, a surgical mediastinoscopic biopsy of several mediastinal lymph nodes was performed, revealing non-necrotizing granulomas, consistent with sarcoidosis. After a month of treatment of prednisolone, the left pleural effusion had resolved, and after 2 months the serum CA-125 level was normalized.

Keywords: CA-125 Antigen; Pleural Effusion; Sarcoidosis.

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Figures

Figure 1
Figure 1
(A) The initial chest X-ray showed a left-sided massive pleural effusion, which disappeared after 2 months of medication with oral prednisolone (B).
Figure 2
Figure 2
(A) The initial chest computed tomography showed a left-sided pleural effusion and mediastinal lymph nodes enlargement. (B) The 18F-fluorodeoxyglucose-positronemission tomography revealed intense uptake on the bilateral paratracheal, hilar, and supraclavicular lymph nodes.
Figure 3
Figure 3
(A) The fiberoptic bronchoscopic biopsy revealed non-necrotizing granulomas in the bronchial wall (H&E stain, ×100). (B) The mediastinoscopic biopsy of right paratracheal lymph node revealed that all normal structures were entirely replaced by non-caseating granulomas, each composed of aggregates of tightly clustered epithelioid cells (H&E stain, ×400).
See this image and copyright information in PMC

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