Sarcoidosis Mimicking Cancer Metastasis Following Chemotherapy for Ovarian Cancer
A 52-year-old female was admitted to our hospital with a one-month history of abdominal pain on the left side. Her abdominal computed tomography (CT) scan showed ascites, omental caking, and peritoneal thickening. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. The final diagnosis was stage III ovarian cancer (serous papillary cystadenocarcinoma). She received combination chemotherapy comprising paclitaxel 175 mg/m2+carboplatin 400 mg/m2 for eight cycles for seven months after surgery. There were few serious complications during chemotherapy. However, four months later, she presented with a dry cough, and multiple painless subcutaneous nodules that had developed on her right arm and leg. A plain chest radiograph showed bilateral hilar enlargement compared with a previous film (). Whole-body positron emission tomography and computed tomography (PET/CT) scan for evaluation of cancer recurrence showed no uptake in the subcutaneous nodules, however, multiple areas of high uptake were observed in the enlarged paratracheal, left supraclavicular, retrocrural, and diaphragmatic lymph nodes (the maximum standardized uptake value [SUVmax] of the lymph nodes ranged from 12.3 to 21.5) () and cancer recurrence in these areas was diagnosed clinically. The same features were observed on both chest CT scan and PET/CT (). However, her serum levels of carbohydrate antigen 125 (CA125) and carbohydrate antigen 19-9 (CA19-9) were unremarkable; CA125 level was 9.42 U/mL (reference range, 0 to 35.0 U/mL) and CA19-9 level was 3.12 U/mL (referencerange, 0 to 37 U/mL).\nTo be certain of the diagnosis of cancer recurrence, biopsy of the mediastinal lymph nodes using endobronchial ultrasound-guided transbronchial needle aspiration and biopsy of the subcutaneous nodules were performed under general anesthesia. The pathological findings showed noncaseating granulomas with no evidence of malignancy (). Ziehl-Neelsen and polymerase chain reaction detection of Mycobacterium tuberculosis in tissues were negative for mycobacterial infection, and a serum interferon-gamma release assay test was also negative. The serum level of angiotensin-converting enzyme (ACE) was 101.4 U/L (reference range, 9 to 47 U/L).\nShe was diagnosed with sarcoidosis in the lymph nodes and skin. She had mild symptoms, including intermittent dry cough, and no specific treatment was required. She was observed closely at our clinic for three months, and the multiple painless subcutaneous nodules resolved spontaneously. Her follow-up chest CT scan showed an interval decrease in the size of multiple mediastinal lymph nodes (). However, newly developed perilymphatic and centrilobular nodules were detected in both lungs on the same CT scan (). Lymphangitic metastasis of ovarian cancer was suspected radiologically, therefore, she underwent video-assisted thoracoscopic wedge resection of the nodules in the right upper lobe. However, the pathological findings of the lung nodules showed noncaseating granuloma, which was similar to that of the mediastinal lymph nodes and skin (). She was finally diagnosed with sarcoidosis. She was observed closely at our clinic.