Peripheral T-Cell Lymphoma in a Patient Previously Diagnosed With Sarcoidosis

Abstract

Sarcoidosis is a multisystem disorder characterized by granulomatous inflammation on histopathological evaluation. Diagnosis of sarcoidosis requires thorough elimination of malignancy and alternative causes of noncaseating granulomatous inflammation. Sarcoidosis and several subtypes of lymphoma have similar clinical presentations and can potentially have similar histopathological findings. Patients with a histopathology-confirmed diagnosis of sarcoidosis are at higher risk of developing malignancies. In this report, we present a case of a 64-year-old male diagnosed with sarcoidosis 2 years before presenting to the emergency department with a 4-month history of generalized weakness, cough, and very high fever. After a thorough workup involving cervical lymph node biopsy and bone marrow biopsy, he was diagnosed with peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS). Due to the patient's current lymphoma diagnosis and features noted on pathology, a retrospective review of the prior biopsy specimen was performed, finding similar hematopathological features on both initial lymph node biopsy diagnosing sarcoidosis and current biopsies diagnosing lymphoma. Given these findings, our patient likely had early manifestation of PTCL misdiagnosed as sarcoidosis. In summary, lymphoma should be considered in all patients with suspected sarcoidosis, especially those who do not respond to treatment or who present with persistent hematological abnormalities.

Keywords: Peripheral T-cell lymphoma; Sarcoidosis; Sarcoidosis-lymphoma syndrome.

Figure 1

Cervical lymph node biopsy and bone marrow biopsy histology and immunohistochemistry confirming diagnosis of peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS). (a)-(d) are cervical lymph node biopsy and (e)-(h) are bone marrow biopsy. (a) H&E of diagnostic lymph node at × 100. Clusters of epithelioid histiocytes have now been infiltrated by neoplastic lymphoid cells. (b) H&E of diagnostic lymph node at × 400. The arrows point to examples of large neoplastic T cells. (c) CD3 immunostain at × 100. (d) CD4 immunostain at × 400. The neoplastic T cells are CD4-positive/CD8-negative. (e) H&E of bone marrow at × 100. (f) H&E of bone marrow at × 400. (g) CD3 immunostain at × 100. (h) CD4 immunostain at × 400. H&E: hematoxylin and eosin.

Figure 2

Outside lymph node biopsy from patient’s original diagnosis of sarcoidosis 2 years prior to admission. (a) H&E photograph of lymph node at × 100. (b) H&E of lymph node at × 400 with black arrows pointing to representative abnormal lymphocytes. (c) CD3 immunostain at × 100. (d) CD4 immunostain at × 400. H&E: hematoxylin and eosin.