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Weekly Chest CasesArchive of Old Cases

Case No : 746 Date 2012-02-15

  • Courtesy of Soo Hyun Lee / National Cancer Center
  • Age/Sex 49 / F
  • Chief ComplaintAbnormal finding on follow-up chest CT. Past history of colon cancer (6 month ago).
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Figure 1

Diagnosis With Brief Discussion

Diagnosis
Sarcoid-like reaction [chemotherapy (capecitabine) induced]
Radiologic Findings
Chest CT scans show conglomerated micronodules and centrilobular nodules in both lungs. We can see the enlarged mediastinal and bilateral hilar lymph nodes.
Brief Review
Sarcoidosis is a multi-system disease of unknown etiology, usually affecting the respiratory tract and other organs, and is characterized by the formation of nonnecrotizing epithelioid granulomas. The diagnosis depends on a combination of a typical clinicoradiological presentation, the finding of nonnecrotizing epithelioid granulomas in a tissue biopsy, and exclusion of other possible diseases, especially those of infectious etiology. The granulomas are present in a lymphatic pattern around bronchovascular structures and, because of this, may show angioinvasion. The bronchial involvement produces a high diagnostic yield for transbronchial and endobronchial biopsies in this disease. Finally, small amounts of fibrinoid necrosis may occur within granulomas of sarcoidosis and do not exclude the diagnosis. (1).
Sarcoidosis results from an uncontrolled cell-mediated immune reaction (2). Interactions between chemokines and receptors that activate mitogen-activated protein kinase pathways play a major role in inflammation and T-cell responses (3). Tumor necrosis factor (TNF)-[alpha] is an important player in granuloma formation, and recent clinical trials have investigated the efficacy of TNF-[alpha] inhibitors in sarcoidosis. Paradoxically, there are several case reports in the medical literature describing the development of sarcoidosis in patients treated with TNF-[alpha] inhibitors(4).
References
1. Ma Y, Gal A, Koss MN. The pathology of pulmonary sarcoidosis: update. Semin Diagn Pathol. 2007 Aug;24(3):150-61.
2. Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med. 2007;357(21):2153
3. Iannuzzi MC, Fontana JR. Sarcoidosis: clinical presentation, immunopathogenesis, and therapeutics. JAMA. 2011 Jan 26;305(4):391-9.
4. Clementine RR, Lyman J, Zakem J, Mallepalli J, Lindsey S, Quinet R. Tumor necrosis factor-alpha antagonist-induced sarcoidosis. J Clin Rheumatol. 2010 Sep;16(6):274-9.
Keywords
multiple, metabolic ans storage,

No. of Applicants : 118

▶ Correct Answer : 67/118,  56.8%
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - University of British Columbia , Canada Amr Ajlan
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Ewha Womans University Mokdong Hospital , Korea (South) So Won Lee
  • - National Jewish Health , United States Jonathan Chung
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Kurashiki Seijin-byo Center , Japan Akihiro Tada
  • - Saint Luke , Korea (South) Eui Byun
  • - Seoul National University Hospital , Korea (South) YongSub Song
  • - Az Osp Santa Maria Terni , Italy angelo carloni
  • - Kosin University , Korea (South) Woonha Lee
  • - SNUH , Korea (South) Euijin Hwang
  • - Samsung medical center , Korea (South) Hyun Su Kim
  • - Eulji Hospital Eulji University , Korea (South) Yunjung Kim
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - Chonnam national university hospital , Korea (South) Jang-hyeon Song
  • - CNUH , Korea (South) Hyedoo Jung
  • - Chonnam National University Hospital , Korea (South) Jung hyun Kim
  • - bmcri , India sanjeev choudri
  • - Chonnam university hospital , Korea (South) Jang mi Baek
  • - Chonnam National Univ. Hospital , Korea (South) Jaemyeong Jo
  • - , Korea (South) yun lee
  • - Sunchun university hospital, Bucheon , Korea (South) So Young Bae
  • - Asan medical center , Korea (South) sang young oh
  • - royal melbourne hospital , Australia kimchi kings
  • - Asan medical center , Korea (South) Cherry Kim
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Korea University Guro Hospital , Korea (South) Kyungwon Doo
  • - Okayama University Hospital , Japan Yoshihisa Masaoka
  • - Kyung Hee University Medical center , Korea (North) Myung Won You
  • - Korea university , Korea (South) SUMIN HA
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - MASAN , Korea (South) Kim Sang Hyeon
  • - Asan medical center , Korea (South) Hyun Joo Lee
  • - Chuncheon Sacred Heart Hospital , Korea (South) Kyung bum Nam
  • - Asan Medical Center , Korea (South) Sang Min Lee
  • - DongA University hospital , Korea (South) Jiyoung Kang
  • - Saga University , Japan Ryoko Egashira
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Mackay Memorial Hospital, Taipei , Taiwan Sheng-Yeh Shen
  • - Radnet Teleradiology Istanbul , Turkey Armagan Sarac
  • - Sacr , Canada Andrea Ojanguren
  • - newmasan hospital , Korea (South) park ji hoon
  • - chp st martin , France Mariotte benoit
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Hanyang University Hospital , Korea (South) Yo Won Choi
  • - University of Rochester Medical Center , United States Hongju Son
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - radiologist, aditya imaging centre , India vivek patel
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Suncheon Plus Medicine , Korea (South) Park Sang Hyun
  • - IRSA , France, Metropolitan BIGOT
  • - NDMVP Nashik , India Imran Jindani
  • - KUMC ansan , Korea (South) kihwan kim
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - A.P.Chest hospital ,hyderabad , India bhaskar kakarla
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - Private sector , Greece Vasilios Tzilas
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Seoul St Mary Hospital , Korea (South) Chae Lim
  • - Maimonides Medical Center , United States naomi twersky
▶ Correct Answer as Differential Diagnosis : 28/118,  23.7%
  • - CHU NANCY , France, Metropolitan LEGOU Francois
  • - Heart Center Pontica , Bulgaria VLADISLAV RUSINOV
  • - Song-do Hospital , Korea (South) Ji-young Yun
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae-Wook Yeh
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Louisiana State University - Shreveport , United States Carlos Previgliano
  • - CHU LYON sud , France matthieu ROUSSET
  • - CHRU lille , France manuel toledano
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - Korea university , Korea (South) Kun Woo Kang
  • - Iwate Medical University , Japan Akio Akahane
  • - Chonnam national university hospital , Korea (South) Sungmin Moon
  • - Travancore Medical College , India Chary D
  • - Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - Montreal , Canada D J
  • - All India Institute of Medical Sciences , India Jitesh Ahuja
  • - Goa Medical College , India Paresh Desai
  • - China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - kyunghee university medical center , Korea (South) An ji young
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Bupyong Serim Hospital , Korea (South) Hee Seok Choi
  • - All India Institute of medical sciences , India Justin Moses
  • - XiangYa hospital , China Xia Yu
  • - National Taiwan University Hospital , Taiwan Li-Ta Keng
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - onomitisiritushiminnbyouinn , Japan HIdeyuki Kobayashi
  • - NASA SCANS , India RAKESH BHATIA
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