Endometrial Cancer with Sarcoidosis in Regional Lymph Nodes: A Case Report

Abstract

Sarcoidosis is a chronic, multisystemic disease commonly affecting the lungs and lymphatic system and is characterized by the formation of noncaseating granulomas. Although several reports are available on cases developing both sarcoidosis and cancer metachronously, cases of simultaneous diagnosis of these diseases have rarely been reported. A 67-year-old woman diagnosed with endometrial cancer had developed systemic lymph node swelling, including bilateral hilar, paraaortic, and a few pelvic lymph nodes, as observed on preoperative imaging. During surgery, frozen sections of a paraaortic lymph node were examined, revealing noncaseating granulomas compatible with sarcoidosis. Next, modified radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy were performed. Postoperative pathological analysis revealed endometrioid adenocarcinoma of the uterus, and no metastasis but noncaseating granulomas were detected in the resected lymph nodes. Postoperatively, we identified cutaneous sarcoidosis and uveitis in the presence of a tuberculin-negative test. On the basis of these findings, we diagnosed the patients with endometrial cancer complicated by sarcoidosis. She underwent adjuvant chemotherapy, and at the 1-year follow-up, the lymph node swelling due to sarcoidosis was stable, and no recurrence of the cancer was observed. This turned out to be a case of early endometrial cancer mimicking advanced cancer by sarcoidosis. Histological confirmation and additional examination for sarcoidosis are necessary in cancer patients suspected of sarcoidosis.

Keywords: Endometrial cancer; Noncaseating granulomas; Sarcoidosis.

Fig. 1

CT findings of swollen lymph nodes. a Swelling of bilateral hilar lymph nodes (arrows). b Swelling of a right supraclavicular lymph node (arrow). c Swelling of a pancreatic head lymph node (arrow). d Swelling of a right pelvic lymph node (arrow).

Fig. 2

Microscopic findings of the resected uterus. a More than 50% myometrial invasion was detected (hematoxylin and eosin stain, ×0.5). b, c Moderately differentiated endometrioid adenocarcinoma (hematoxylin and eosin stain, b ×10, c ×40).

Fig. 3

Microscopic findings of the resected lymph nodes and the skin biopsy. a A right obturator lymph node with multiple noncaseating granulomas (hematoxylin and eosin stain, ×10). b A paraaortic lymph node with multiple noncaseating granulomas (hematoxylin and eosin stain, ×4). c Noncaseating granulomas (arrows) were observed under the epidermis (hematoxylin and eosin stain, ×10). d An asteroid body (arrow) was observed under the epidermis (hematoxylin and eosin stain, ×40).