open access

Vol 86, No 5 (2018)
ORIGINAL PAPERS
Published online: 2018-10-30
Submitted: 2018-07-23
Accepted: 2018-09-21
Get Citation

The concurrence of granulomatous inflammation in intrathoracic lymph nodes with regional metastasis from primary lung cancer in surgically resected specimens

Armin Krvavac, Kurt Munzer, Aaron Miller, Nishant Poddar, Zafar Jamkhana, Setu Patolia
DOI: 10.5603/ARM.2018.0034
·
Pubmed: 30378648
·
Adv Respir Med 2018;86(5):215-219.

open access

Vol 86, No 5 (2018)
ORIGINAL PAPERS
Published online: 2018-10-30
Submitted: 2018-07-23
Accepted: 2018-09-21

Abstract

Introduction: Granulomatous inflammation has been associated with malignancies such as breast, testicular, renal cell, and
lymphoma. The coexistence of granulomatous inflammation in mediastinal/hilar lymph node with primary lung malignancy has
been described in case reports.
Our goal was to examine the frequency of granulomatous reaction in mediastinal/hilar lymph node in the patients who had undergone
surgical resection of lung cancer.

Material and methods: We performed a retrospective analysis of 40 patients (1) aged ≥ 18 years and (2) who underwent lobectomy
or pneumonectomy from August 1, 2012 to October 31, 2016 at Saint Louis University Hospital and (3) had pathology
suggestive of cancer.

Results: Of those 40 patients, 3 (7.5%) had granulomatous inflammation in the lymph nodes. None of these 3 individuals had
evidence of metastasis in the particular lymph nodes with granulomatous inflammation.

Conclusion: Our small cohort revealed that the presence of granulomatous inflammation in a lymph node can be safely taken as an
evidence of the absence of metastasis to the lymph node. This finding can obviate the need for further sampling for the particular
lymph node with granulomatous inflammation and can decrease the sampling time.

Abstract

Introduction: Granulomatous inflammation has been associated with malignancies such as breast, testicular, renal cell, and
lymphoma. The coexistence of granulomatous inflammation in mediastinal/hilar lymph node with primary lung malignancy has
been described in case reports.
Our goal was to examine the frequency of granulomatous reaction in mediastinal/hilar lymph node in the patients who had undergone
surgical resection of lung cancer.

Material and methods: We performed a retrospective analysis of 40 patients (1) aged ≥ 18 years and (2) who underwent lobectomy
or pneumonectomy from August 1, 2012 to October 31, 2016 at Saint Louis University Hospital and (3) had pathology
suggestive of cancer.

Results: Of those 40 patients, 3 (7.5%) had granulomatous inflammation in the lymph nodes. None of these 3 individuals had
evidence of metastasis in the particular lymph nodes with granulomatous inflammation.

Conclusion: Our small cohort revealed that the presence of granulomatous inflammation in a lymph node can be safely taken as an
evidence of the absence of metastasis to the lymph node. This finding can obviate the need for further sampling for the particular
lymph node with granulomatous inflammation and can decrease the sampling time.

Get Citation

Keywords

biopsy, bronchoscopy, lung neoplasm, lymph nodes, sarcoidosis

About this article
Title

The concurrence of granulomatous inflammation in intrathoracic lymph nodes with regional metastasis from primary lung cancer in surgically resected specimens

Journal

Advances in Respiratory Medicine

Issue

Vol 86, No 5 (2018)

Pages

215-219

Published online

2018-10-30

DOI

10.5603/ARM.2018.0034

Pubmed

30378648

Bibliographic record

Adv Respir Med 2018;86(5):215-219.

Keywords

biopsy
bronchoscopy
lung neoplasm
lymph nodes
sarcoidosis

Authors

Armin Krvavac
Kurt Munzer
Aaron Miller
Nishant Poddar
Zafar Jamkhana
Setu Patolia

References (23)
  1. Brincker H. Sarcoid reactions in malignant tumours. Cancer Treat Rev. 1986; 13(3): 147–156.
  2. Dick J, Begent RH, Meyer T. Sarcoidosis and testicular cancer: A case series and literature review. Urol Oncol. 2010; 28(4): 350–354.
  3. Ouellet S, Albadine R, Sabbagh R. Renal cell carcinoma associated with peritumoral sarcoid-like reaction without intratumoral granuloma. Diagn Pathol. 2012; 7: 28.
  4. Brincker H. Sarcoid reactions and sarcoidosis in Hodgkin's disease and other malignant lymphomata. Br J Cancer. 1972; 26(2): 120–123.
  5. Shigemitsu H. Is sarcoidosis frequent in patients with cancer? Curr Opin Pulm Med. 2008; 14(5): 478–480.
  6. Haralambieva E, Rosati S, van Noesel C, et al. Florid granulomatous reaction in Epstein-Barr virus-positive nonendemic Burkitt lymphomas: report of four cases. Am J Surg Pathol. 2004; 28(3): 379–383.
  7. Kobayashi K, Kaneda K, Kasama T. Immunopathogenesis of delayed-type hypersensitivity. Microsc Res Tech. 2001; 53(4): 241–245.
  8. Sehgal S, Goyal P, Ghosh S, et al. Malignancy and granulomatosis: causality of conincidence? Narrative systemic review. Iran J Pathol. 2014(9): 237–244.
  9. Khurana KK, Stanley MW, Powers CN, et al. Aspiration cytology of malignant neoplasms associated with granulomas and granuloma-like features: diagnostic dilemmas. Cancer. 1998; 84(2): 84–91.
  10. Kennedy MP, Jimenez CA, Mhatre AD, et al. Clinical implications of granulomatous inflammation detected by endobronchial ultrasound transbronchial needle aspiration in patients with suspected cancer recurrence in the mediastinum. J Cardiothorac Surg. 2008; 3: 8.
  11. DePew ZS, Gonsalves WI, Roden AC, et al. Granulomatous inflammation detected by endobronchial ultrasound-guided transbronchial needle aspiration in patients with a concurrent diagnosis of cancer: a clinical conundrum. J Bronchology Interv Pulmonol. 2012; 19(3): 176–181.
  12. Steinfort DP, Irving LB. Sarcoidal reactions in regional lymph nodes of patients with non-small cell lung cancer: incidence and implications for minimally invasive staging with endobronchial ultrasound. Lung Cancer. 2009; 66(3): 305–308.
  13. Trisolini R, Cancellieri A, Patelli M. May sarcoidal reaction and malignant features coexist in regional lymph nodes of non-small cell lung cancer patients? Lung Cancer. 2009; 66(2): 272–273.
  14. Gilbert CR, Abendroth C, Yarmus LB. The Intranodal Presence of Coexisting Granulomatous Inflammation and Carcinoma During Transbronchial Needle Aspiration of Intrathoracic Lymphadenopathy. J Bronchology Interv Pulmonol. 2017; 24(1): 80–83.
  15. Kamiyoshihara M, Hirai T, Kawashima O, et al. Sarcoid reactions in primary pulmonary carcinoma: report of seven cases. Oncol Rep. 1998; 5(1): 177–180.
  16. Tomimaru Y, Higashiyama M, Okami J, et al. Surgical results of lung cancer with sarcoid reaction in regional lymph nodes. Jpn J Clin Oncol. 2007; 37(2): 90–95.
  17. Jepsen O, Laurberg P, Laurberg P. Sarcoid reactions in pulmonary neoplasms. Scand J Respir Dis. 1975; 56(1): 20–27.
  18. Bellinger CR, Sharma D, Ruiz J, et al. Negative Predictive Value of Granulomas on EBUS-TBNA in Suspected Extrathoracic Malignancy. Lung. 2016; 194(3): 387–391.
  19. Steinfort DP, Tsui A, Grieve J, et al. Sarcoidal reactions in regional lymph nodes of patients with early stage non-small cell lung cancer predict improved disease-free survival: a pilot case-control study. Hum Pathol. 2012; 43(3): 333–338.
  20. Grosu HB, Ost DE, Morice RC, et al. Mediastinal Granulomatous Inflammation and Overall Survival in Patients with a History of Malignancy. Ann Am Thorac Soc. 2015; 12(10): 1534–1541.
  21. Yasufuku K, Fleury Feith J. Cytological specimens obtained by endobronchial ultrasound-guided transbronchial needle aspiration: sample handling and role of rapid on-site evaluation. Ann Pathol. 2012; 32(6): e35–46, 421.
  22. Chrissian AA, Bedi H. Bronchoscopist-directed Continuous Propofol Infusion for Targeting Moderate Sedation During Endobronchial Ultrasound Bronchoscopy: A Practical and Effective Protocol. J Bronchology Interv Pulmonol. 2015; 22(3): 226–236.
  23. Lee HS, Lee GK, Lee HS, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal staging of non-small cell lung cancer: how many aspirations per target lymph node station? Chest. 2008; 134(2): 368–374.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Czasopismo Pneumonologia i Alergologia Polska dostęne jest również w Ikamed - księgarnia medyczna

Wydawcą serwisu jest "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl