Abstract
Epithelioid cell granulomas identical to those of systemic sarcoidosis are occasionally observed within malignant neoplasms, particularly in the lymphatics draining a primary tumor. These histologic changes have been termed sarcoid reactions and are easily confused with systemic sarcoidosis. This report describes an extremely rare case of gastric cancer accompanied by sarcoid reactions in the regional lymph nodes and liver parenchyma near a tumor metastasis. A 63-year-old woman with advanced gastric cancer was treated by subtotal gastrectomy with dissection of the regional lymph nodes and local excision of the liver tissue involved by metastasis. Microscopic examination of the resected lymph nodes and liver disclosed the presence of sarcoid-like granulomas. The absence of any clinical manifestations and the negative results of the Kveim test, chest radiograph, and laboratory tests, including that for the serum angiotensin converting enzyme excluded the possibility of systemic sarcoidosis. The presence of a sarcoid reaction in the liver parenchyma adjacent to a metastasis has never been reported previously.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Brincker H (1986) Sarcoid reactions in malignant tumours. Cancer Treat Rev 13:147–156
Wolbach SB (1911) A new type of cell inclusion, not parasitic, associated with disseminated granulomatous lesions. J Med Res 24:243–258
Williams WJ, Williams D (1976) Residual bodies in sarcoid and sarcoid-like granulomas. J Clin Path 20:574–577
Gregorie HB, Orhersen HB, Moore MP (1962) The significance of sarcoid-like lesions in association with malignant neoplasms. Am J Surg 104:577–586
Murata Y, Tachibana T (1979) Sarcoid-like cellular reactions associated with malignant neoplasms (in Japanese). Kekkaku (Tuberculosis) 54:147–148
Yamamoto T, Tateishi H, Nishimura Y, Watanabe M, Ukyo S, Miyake T, Uchino S, Matsumoto Y, Ishii K, Takahashi K (1980) A study of gastric cancer with sarcoid reactions as observed in the regional lymph node (in Japanese with English abstract). Nippon Shokakibyou Gakkai Zasshi (Jpn J Gastroenterol) 77:1555–1561
Takeuchi H, Suchi T, Suzuki R, Sato T (1982) Histological study of immune parameters of regional lymph nodes of gastric cancer patients. Gann 73:420–428
Gotton H, Linell H (1957) Malignant tumors and sarcoid reactions in regional lymph nodes. Acta Radiol 47:381–392
Symmers WSC (1951) Localized tuberculoid granulomas associated with carcinoma. Their relationship to sarcoidosis. Am J Path 27:493–521
Syrjanen KJ (1981) Epithelioid cell granulomas in the lymph nodes draining human cancer: Ultrastructural findings of a breast cancer case. Diag Histopathol 4:291–294
James EMV, Jones WW (1974) Fine structure and histochemistry of epithelioid cells in sarcoidosis. Thorax 29:115–120
Hnna MG (1973) Reaction of lymphatic tissue in neoplastic disease: Summary. Adv Exp Med Biol 29:527–530
Spector WG (1974) The macrophage: Its origin and role in pathology. Pathobiol Annu 4:33–64
O'Connell MJ, Schimpff SC, Kirschner RH, Abt AB, Wiernik PH (1975) Epithelioid granulomas in Hodgkin's disease. JAMA 233:886–899
Sacks EL, Donaldson SS, Dorfman RF (1978) Epithelioid granulomas associated with Hodgkin's disease. Cancer 41:562–567
Okuyama K, Isono K, Iee-Kung J, Onoda S, Yamamoto Y, Koide Y, Satou H (1985) Evaluation of treatment for gastric cancer with liver metastasis. Cancer 55:2498–2505
Ota H, Takagi K (1981) Studies of liver metastasis for carcinoma of the stomach (in Japanese). Shokaki Geka (Gastroenterol Surg) 4:999–1004
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hirota, T., Kaneda, M., Iwasa, M. et al. A case report of gastric cancer associated with sarcoid reactions in the regional lymph nodes and liver. Surg Today 23, 810–815 (1993). https://doi.org/10.1007/BF00311625
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00311625