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Case Reports
. 2020 Nov 30:7:541629.
doi: 10.3389/fmed.2020.541629. eCollection 2020.

Case Report: All That Glisters Is Not* Cancer

Claudio Tirelli  1 , Chandra Bortolotto  2 , Patrizia Morbini  3 , Giulia Maria Stella  1
Affiliations
Case Reports

Case Report: All That Glisters Is Not* Cancer

Claudio Tirelli et al. Front Med (Lausanne). .

Abstract

Properly performed staging in non-small-cell lung cancer (NSCLC) is necessary to avoid wrong therapeutic decisions. Here we present a case which manifested as advanced NSCLC but ultimately was composed of two different and rare pathologies. The first is a TTF-1 positive axillary lymph node that could be defined either as an unusual isolated differentiated cancer of unknown primary or as an even rarer case of ectopic lung epithelium which underwent malignant transformation. The second is sarcoidosis, a sarcoid-like alteration, in remission after oral steroids. The main implication of a correct diagnosis regards patient outcome and the avoidance of toxic inappropriate systemic chemotherapy.

Keywords: lung cancer; metastases; origin; sarcoidosis; staging.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Chest X-rays at presentation. Left subclavian pulmonary thickening associated with patchy bilateral peripheral opacity particularly represented in the left lung where there are also band-like consolidations and pleural effusion.
Figure 2
Figure 2
CT scan at presentation: bilateral parenchymal infiltrates (A) and mediastinal hilar lymph node enlargement (B), suggestive of sarcoidosis but also compatible with malignant origin. Enlarged vascularized pathologic (3 cm) axillar node detected in the right axillary region (red arrow).
Figure 3
Figure 3
Histologic samples. Surgical sample of lymph node localization of adenocarcinoma, ×20 (A), ×5 (B, → ), featuring positive staining for cytokeratin 7 (C), and concomitant epithelioid sarcoid-like granuloma, ×5 (D). Transbroronchial biopsy ×10 (E) and ×20 (F) displaying sarcoid non-necrotizing epithelioid granulomas (→ ).
Figure 4
Figure 4
Whole-body positron emission tomography (PET): supra- and subdiaphragmatic pathologic lymphadenopathies in the absence of putative primary mass detection. The red circle shows the pathologic standardized uptake value (SUV) at left hilar lymph node (L10 station).
Figure 5
Figure 5
CT scan after treatment: remaining parenchymal fibrosis in upper lobes compatible with sarcoidosis grade IV (A), without mediastinal or extra-thoracic lymph node enlargement (B).
Figure 6
Figure 6
Timeline with the most relevant data of the clinical case.
See this image and copyright information in PMC

References

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