A Case Report of Sarcoid-Like Reaction with Early Stage Esophageal Cancer

Leo Yamada, Shinji Ohki, Wataru Sakamoto, Ujiie Daisuke, Tomohiro Kikuchi, Mai Ashizawa, Hirokazu Okayama, Hisahito Endo Hisahito Endo, Shotaro Fujita, Motonobu Saito, Tomoyuki Momma, Takeshi Tada, Azuma Nirei, Kosaku Mimura, Kenji Gonda, Hiroyuki Hanayama, Zenichiro Saze, Misato Sakuyama, Masahiko Shibata, Shigeru Maruhashi, Koji Kono, Aung Kyi Thar Min

Fukushima Medical University, Fukushima, Japan

Date, time and location: 2018.05.25 13:30, Congress Hall, 2F–C

Abstract

Sarcoid-like reaction (SLR) is a cause of non-caseating granulomas in some cancer patients with no symptoms of sarcoidosis. It has been described in various solid malignancies, including breast, lung, and gastric cancer. However, SLR associated with esophageal cancer has not been reported previously. Here, we present a case of SLR with early stage esophageal cancer and review the literature.

Case Presentation: A 65-year-old man with early stage lower thoracic esophageal cancer underwent endoscopic submucosal dissection (ESD). Pathologically, the post-ESD TNM stage was pT1a-mmN0M0 ly(+)v0 pStage1A; therefore, chemoradiotherapy (CRT; FP 1 cycle and RT 50 Gy) was conducted. After CRT, swelling of the mediastinal lymph nodes >10 mm was identified on computed tomography; hence, lymph node metastasis was suspected. However, no symptoms of sarcoidosis were observed. Recurrence could not be denied, and subtotal esophagectomy with mediastinal lymph node dissection was performed. However, pathologically, only SLR in the mediastinal lymph nodes was observed and there was no evidence of cancer recurrence.

Conclusion: SLR may occur in 4.4% of cancer patients, but this is quite rare in the early stage. The pathophysiology of SLR is not completely understood. The hypothesis is that the metabolite of humoral or T-cell-mediated factors resulting in the activation of macrophages is observed as SLR and it might be induced by malignancy, chemotherapy, radiation, and infection. In this case, CRT might have caused SLR. It is difficult to distinguish between metastasis and SLR on preoperative imaging. Additionally, it has been reported that the rate of lymph node metastasis in pT1a-mm esophageal cancer is 7%–10%. Therefore, once lymph node recurrence is suspected after ESD, surgery might be considered for treatment. Interestingly, some reports have mentioned that the prognosis of SLR patients is good, owing to an active immune reaction. We reported a rare case of SLR with early stage esophageal cancer.