Carcinoma Breast Presenting with Concurrent Extensive Lymph Nodal Sarcoidosis

Area of Science:

• Oncology
• Immunology
• Radiology

Background:

• Sarcoidosis is a systemic inflammatory disease characterized by noncaseating granulomas.
• Concurrent breast cancer and sarcoidosis is an exceptionally rare clinical presentation.
• Distinguishing sarcoid granulomas from metastatic cancer in lymph nodes can be diagnostically challenging.

Purpose of the Study:

• To report a rare case of a 51-year-old female diagnosed with infiltrating ductal carcinoma and concurrent sarcoidosis.
• To illustrate the diagnostic process and management of this rare co-occurrence.
• To evaluate the treatment response using advanced imaging techniques.

Main Methods:

• A 51-year-old female presented with a right breast lump.
• Diagnostic workup included histopathology, estrogen receptor (ER), progesterone receptor (PR), and HER2neu status assessment, and baseline fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT).
• Biopsies of iliac and internal mammary lymph nodes were performed, followed by chemotherapy (4 EC, 12 paclitaxel) and post-treatment FDG PET/CT and modified radical mastectomy.

Main Results:

• The patient was diagnosed with infiltrating ductal carcinoma with lymph node metastases (ER+, PR+, HER2neu-).
• Baseline FDG PET/CT showed a breast mass with multiple lymph node metastases.
• Biopsies confirmed granulomatous lymphadenitis, suggesting sarcoidosis. Post-chemotherapy, FDG PET/CT revealed a complete metabolic response, with resolution of the breast mass and most lymph nodes. Mastectomy specimen was negative for malignancy, showing granulomatous lymphadenitis in lymph nodes.

Conclusions:

• This case underscores the importance of considering sarcoidosis in patients with breast cancer presenting with granulomatous lymphadenitis.
• Chemotherapy was effective in treating the breast carcinoma.
• Complete metabolic response and resolution of lymphadenopathy were observed, with the remaining lymphadenitis attributed to sarcoidosis.