Pulmonary sarcoidosis masquerading as metastatic cervical cancer: a pitfall in CT scans and positron emission tomography (PET)

Abstract

Sarcoidosis has been associated with co-existing malignancies in several organs, including the breast and thyroid gland as well as lymphomas. However, the occurrence of sarcoidosis with cervical cancer is rare with only nine previous cases reported in the published literature. We present a case of pulmonary sarcoidosis imitating mediastinal lymph node metastases on the staging CT scan and positron emission tomography imaging. The presence of thoracic lymphadenopathy without any pelvic lymphadenopathy prompted histological confirmation of sarcoidosis on endobronchial ultrasound guided biopsy. Misdiagnosing pulmonary sarcoidosis as metastases would have precluded the patient from receiving the curative treatment and likely resulted in suboptimal outcomes.

Figure 1.

Sagittal (a), axial (e) and coronal oblique (f) T2 images showing a intermediate signal intensity (SI) mass (asterisk) in the anterior lip of the cervix which is high SI on the DWI b-800 images (b) and corresponding low SI on the ADC map (c). The mass shows hypoenhancement relative to the rest of the cervix and myometrium on the delayed phase post-contrast scans (d). ADC, apparent diffusion coefficient; DWI, diffusion-weighted imaging; SI, signal intensity.

Figure 2.

CoronalFDG-PET/CT (a) and equivalent post contrast coronalreformatted CT (b) showing right paratracheal, hilar and subcarinal lympadenopathy. The HRCT component of the CT shows asubtle focal area of thickening of the bronchovascular tree and oblique fissure (c) and tinynodules (circle) in the right lower lobe (d).

Figure 3.

Haemotoxylin and Eosin stained section of the mediastinal lymph node showing well-formed granulomas of epithelioid cells with multinucleated giant cells and lymphocytic cuffs. Image courtesy of Dr Filomena Medeiros.