Blog
About

0
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      A sarcoidosis–lymphoma syndrome revealed by hypopituitarism

      1 , 2 , 3 , 4 , 5 , 6 , 1 , 1 , 1

      Endocrinology, Diabetes & Metabolism Case Reports

      Bioscientifica Ltd

      Adolescent/young adult, Female, White, Belgium, Pituitary, Pituitary, PTH, FSH, ACTH, Cortisol, IGF1, LH, Thyroxine (T4), TSH, Hypopituitarism, Hypercalcaemia, Lymphadenopathy, Headache, Fatigue, Hypercalcaemia, Hypopituitarism, Lymphadenitis, Sarcoidosis, CT scan, MRI, PET scan, PTH, C-reactive protein, 25-hydroxyvitamin-D3, X-ray, Cortisol (9am), ACTH, FT4, FSH, LH, IGF1, TSH, Histopathology, Haematoxylin and eosin staining, Immunohistochemistry, Chemotherapy, Hydrocortisone, Glucocorticoids, Levothyroxine, Dacarbazine, Methylprednisolone, General practice, New disease or syndrome: presentations/diagnosis/management, September, 2019

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Summary

          A 26-year-old woman presented with persistent headache and tiredness. Biological investigations disclosed a moderate inflammatory syndrome, low PTH-hypercalcemia and complete anterior hypopituitarism. A magnetic resonance imaging (MRI) of the pituitary gland was performed and revealed a symmetric enlargement with a heterogeneous signal. Ophthalmological examination showed an asymptomatic bilateral anterior and posterior uveitis, and a diagnosis of pituitary sarcoidosis was suspected. As the localization of lymphadenopathies on the fused whole-body FDG-PET/computerized tomography (CT) was not evoking a sarcoidosis in first instance, an excisional biopsy of a left supraclavicular adenopathy was performed showing classic nodular sclerosis Hodgkin’s lymphoma (HL). A diagnostic transsphenoidal biopsy of the pituitary gland was proposed for accurate staging of the HL and surprisingly revealed typical granulomatous inflammation secondary to sarcoidosis, leading to the diagnosis of a sarcoidosis–lymphoma syndrome. The co-existence of these diseases constitutes a diagnostic challenge and we emphasize the necessity of exact staging of disease in order to prescribe adequate treatment.

          Learning points:
          • The possibility of a sarcoidosis–lymphoma syndrome, although rare, should be kept in mind during evaluation for lymphadenopathies.

          • In the case of such association, lymphoma usually occurs after sarcoidosis. However, sarcoidosis and lymphoma can be detected simultaneously and development of sarcoidosis in a patient with previous lymphoma has also been reported.

          • An accurate diagnosis of the disease and the respective organ involvements, including biopsy, is necessary in order to prescribe adequate treatment.

          Related collections

          Most cited references 16

          • Record: found
          • Abstract: found
          • Article: not found

          Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification.

           ,  ,   (2014)
          The purpose of this work was to modernize recommendations for evaluation, staging, and response assessment of patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). A workshop was held at the 11th International Conference on Malignant Lymphoma in Lugano, Switzerland, in June 2011, that included leading hematologists, oncologists, radiation oncologists, pathologists, radiologists, and nuclear medicine physicians, representing major international lymphoma clinical trials groups and cancer centers. Clinical and imaging subcommittees presented their conclusions at a subsequent workshop at the 12th International Conference on Malignant Lymphoma, leading to revised criteria for staging and of the International Working Group Guidelines of 2007 for response. As a result, fluorodeoxyglucose (FDG) positron emission tomography (PET)–computed tomography (CT) was formally incorporated into standard staging for FDG-avid lymphomas. A modification of the Ann Arbor descriptive terminology will be used for anatomic distribution of disease extent, but the suffixes A or B for symptoms will only be included for HL. A bone marrow biopsy is no longer indicated for the routine staging of HL and most diffuse large B-cell lymphomas. However, regardless of stage, general practice is to treat patients based on limited (stages I and II, nonbulky) or advanced (stage III or IV) disease, with stage II bulky disease considered as limited or advanced disease based on histology and a number of prognostic factors. PET-CT will be used to assess response in FDG-avid histologies using the 5-point scale. The product of the perpendicular diameters of a single node can be used to identify progressive disease. Routine surveillance scans are discouraged. These recommendations should improve evaluation of patients with lymphoma and enhance the ability to compare outcomes of clinical trials.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Extranodal Hodgkin disease: spectrum of disease.

            Extranodal lesions in Hodgkin disease may develop and spread to virtually any organ system, simulating other neoplastic or infectious diseases. It is important to determine whether extranodal involvement represents a primary manifestation or dissemination of systemic disease, which has a poorer prognosis. Computed tomography (CT) is the preferred modality, although ultrasonography and magnetic resonance (MR) imaging may also be helpful. CT is superior to conventional radiography in assessing chest disease, although MR imaging is more sensitive than CT in detecting chest wall involvement. CT is preferred for evaluating hepatic lymphoma and has proved particularly valuable in diagnosing gastric lymphoma and detecting renal or perirenal masses. CT and MR imaging are equally effective in detecting brain Hodgkin disease; however, the latter is superior in the detection of extracerebral tumor deposits in the subdural or epidural space. MR imaging is also preferred for evaluating meningeal and spinal cord involvement. Both MR imaging and CT allow excellent assessment of bone texture and accurate analysis of tumoral bone invasion, but MR imaging is superior in demonstrating bone marrow infiltration, and CT is superior in delineating the extent of cortical bone destruction. In the future, metabolic positron emission tomography may provide more information about extranodal lymphoma than do the current imaging modalities.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Sarcoidosis and malignancy.

              Malignancy in patients with sarcoidosis occurs in 3 settings. The first setting relates to patients with hematologic malignancies. It includes the sarcoidosis-lymphoma syndrome, which refers to the development of lymphoma at least 1 to 2 years after the diagnosis of sarcoidosis. It also includes patients with sarcoidosis who develop other hematologic malignancies. In addition, this subset of individuals includes patients with cancer and hematologic malignancies who subsequently develop sarcoidosis. The second setting consists of patients with sarcoidosis who develop solid tumors and oncologic patients in whom sarcoidosis subsequently appears; in addition to melanoma and nonmelanoma skin cancer, the neoplasms most commonly associated involve the cervix, liver, lung, testicles, and uterus. The third setting of malignancy-related sarcoidosis occurs when sarcoidosis presents as a paraneoplastic syndrome for the associated cancer, specifically when the discovery of cancer is concurrent with or within 1 year of the diagnosis of sarcoidosis or vis-a-vis. Antineoplastic treatment of either the hematologic malignancy or the solid tumor has also been observed to either induce the initial onset or flare the activity of sarcoidosis. Malignancy can also be associated with the occurrence of sarcoid reactions that typically are restricted to the regional lymph nodes or the visceral organ of tumor origin; rarely, the sarcoid reaction can also be observed in the skin or is only limited to the skin.
                Bookmark

                Author and article information

                Journal
                Endocrinol Diabetes Metab Case Rep
                Endocrinol Diabetes Metab Case Rep
                EDM
                Endocrinology, Diabetes & Metabolism Case Reports
                Bioscientifica Ltd (Bristol )
                2052-0573
                03 September 2019
                2019
                : 2019
                Affiliations
                [1 ]Departments of Endocrinology and Nutrition , Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
                [2 ]Internal Medicine , Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
                [3 ]Pathology , Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
                [4 ]Hematology , Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
                [5 ]Nuclear Medicine , Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
                [6 ]Ophthalmology , Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
                Author notes
                Correspondence should be addressed to C Delcourt; Email: charlotte.delcourt@ 123456uclouvain.be
                Article
                EDM190091
                10.1530/EDM-19-0091
                6765315
                © 2019 The authors

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License..

                Categories
                Adolescent/Young Adult
                Female
                White
                Belgium
                Pituitary
                Pituitary
                PTH
                FSH
                ACTH
                Cortisol
                IGF1
                LH
                Thyroxine (T4)
                TSH
                Hypopituitarism
                Hypercalcaemia
                Lymphadenopathy
                Headache
                Fatigue
                Hypercalcaemia
                Hypopituitarism
                Lymphadenitis
                Sarcoidosis
                CT scan
                MRI
                PET scan
                PTH
                C-reactive protein
                25-hydroxyvitamin-D3
                X-ray
                Cortisol (9am)
                ACTH
                FT4
                FSH
                LH
                IGF1
                TSH
                Histopathology
                Haematoxylin and eosin staining
                Immunohistochemistry
                Chemotherapy
                Hydrocortisone
                Glucocorticoids
                Levothyroxine
                Dacarbazine
                Methylprednisolone
                General Practice
                New Disease or Syndrome: Presentations/Diagnosis/Management
                New Disease or Syndrome: Presentations/Diagnosis/Management

                Comments

                Comment on this article