Sarcoid-like lymphadenopathy mimicking metastatic testicular cancer
Article Abstract:
In sarcoidosis, lesions called sarcoids form in many organs of the body; sarcoids consist of nodules of granular white blood cells. The condition is suspected to be an abnormal immune response, but its cause is unknown. Such lesions may occur in other conditions outside of classic sarcoidosis, however. Patients with cancer can sometimes develop sarcoid-like lesions in lymph nodes. A case has now been seen in which such sarcoid-like abnormalities of the lymph nodes led to a mistaken diagnosis of metastatic cancer. The patient was a 39-year-old man who developed a mass in his right testicle. The testicle was removed, and microscopic examination determined that the mass was a type of cancer called embryonal cell carcinoma. (Embryonal cell carcinoma is also called undifferentiated malignant teratoma.) X-ray examinations revealed abnormalities of the lymph nodes in the mediastinal cavity in the middle of the chest, and this was interpreted to indicate that the testicular cancer had already spread significantly. The patient was placed on chemotherapeutic treatment. After two courses of chemotherapy, no reduction in size of the suspicious lymph nodes was observed, and a biopsy was performed on one of the enlarged nodes. Tissue examination revealed that, instead of cancer cells, the lymph node contained a sarcoid-like lesion. The chemotherapeutic treatment was discontinued, and after two years the patient remains free of disease. In the present case, the lymph nodes behind the abdominal cavity were not abnormal on X-ray; in retrospect, this was a strong indication that the enlargement of the nodes in the chest were probably not due to the involvement of cancer. There have been 22 cases reported in the medical literature describing sarcoidosis in patients with testicular cancer. In three cases, a misdiagnosis of metastatic cancer was made, which led to death by chemotherapy for one patient. These cases illustrate that care must be taken to properly diagnose the extent of testicular cancer so that inappropriate and unnecessary chemotherapy may be avoided. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1991
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Sarcoid reaction mimicking intrathoracic dissemination of testicular cancer
Article Abstract:
Patients with testicular germ cell tumors in the early stage should be watched carefully for signs of metastatic spread. Often, spread beyond abdominal lymph nodes will occur in the chest cavity. However, two recent cases illustrate that isolated findings of abnormalities in the thoracic or mediastinal cavity should not be automatically assumed to indicate the spread of a germ cell tumor. True metastatic lesions in the chest will usually occur in patients with other signs of metastatic disease, such as abnormal abdominal CT scan and abnormal alpha-fetoprotein or chorionic gonadotropin concentrations. In the absence of such signs, a biopsy should be performed on any chest lesions. Two men, both 35 years old when they underwent surgery for combined seminomatous and nonseminomatous germ cell tumors in the testes, developed abnormal signs on chest X-rays. Biopsy revealed the abnormalities to be sarcoid reaction of the lymph nodes. Sarcoids are a granulomatous reaction of epithelioid cells. However, unlike the granulomas seen in diseases such as tuberculosis, there is no necrotic region in the center of the granuloma and there is no evidence of an infective organism. The cause of sarcoids is not known. In both these cases, the sarcoid reaction resolved over time without treatment. There have been previous reports of sarcoid reactions in lymph nodes that have accompanied cases of testicular cancer. However, it is not known if this is coincidental, or if there is a relationship between the two conditions. The importance of accurate diagnosis is illustrated, regardless of the cause of the sarcoids, because failure to biopsy and correctly diagnose the chest lesions in these two patients may have resulted in the unnecessary use of chemotherapy to treat metastatic lesions that did not exist. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1990
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Intestinal hemorrhages in patients with a nonseminomatous testicular tumor
Article Abstract:
Malignant tumors of the testes account for about one to two percent of cancers among men, and most often develop in 20- to 35-year-old men. The first symptom is usually a painless swelling in the scrotum. About 45 percent of tumors arising from the germ cells (the cells that give rise to the sperm in males) are seminomas, which consist of a single cell type. In the remaining types, the nonseminomatous testicular tumors or NSTT, the tumor cells form layers reminiscent of the layers of the developing embryo. Unfortunately, metastatic cancer spread is not rare among such cancers, and about one-third of patients are likely to already have metastatic disease at the time they first notice a swelling in their testis. The most common site for metastatic disease is the lungs, but NSTT may also spread to the liver, brain, kidneys, and skeleton. In about five percent of cases, there may be symptoms of spread to the gastrointestinal system. This metastatic disease in the intestines may result in diarrhea, anemia, intestinal obstruction, and other conditions. The authors present the case histories of three patients who developed intestinal hemorrhage as a complication of metastatic NSTT. The authors emphasize that hemorrhage may develop as a complication of intestinal metastases in two ways. The metastatic tumors themselves may bleed, or the destruction of the metastatic tumor tissue, which occurs after chemotherapeutic treatment, may result in bleeding. In either case, rapid diagnosis of the cause of this type of hemorrhage and proper treatment, with surgery if necessary, may be life-saving for some patients. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1991
User Contributions:
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