International Journal of Clinical Case Reports 2015, Vol.5, No. 44, 1-3
1
A Letter Open Access
Co-existing Sarcoidosis and Clear Cell Renal Carcinoma: A Case Report
Nabil Bel Fek
Imed Ben Ghorbel, Karim Mbarek, Thouraya Ben Salem, Mohamed Habib Houman
Department of Internal Medicine. University Hospital of La Rabta, Tunis, Tunisia
Corresponding author email
International Journal of Clinical Case Reports, 2015, Vol.5, No.44 doi: 10.5376/ijccr.2015.05.0044
Received: 16 May, 2015
Accepted: 17 Jun., 2015
Published: 28 Sep., 2015
Copyright
©
2015 Ghorbel et al., This is an open access article published under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is properly cited.
Preferred citation for this article:
Ghorbel I.B., Feki N.B., Salem T.B., Mbarek K., Lamloum M., Houman M.H., 2015, Co-existing Sarcoidosis and Clear Cell Renal Carcinoma: A Case Report,
International Journal of Clinical Case Reports, 5(44) 1
-
3 (doi
Abstract
Systemic sarcoidosis has been described in association with many primary tumors. Although it is more seen in carcinomas
than in hematologic malignancies, it is very rarely reported in renal carcinoma. Here, we describe a rare association of systemic
sarcoidosis and clear cell renal carcinoma in a 62-year-old-female. At 36 months follow-up, she had no recurrence.
Keywords
Systemic sarcoidosis; Clear cell renal carcinoma
1 Introduction
Sarcoidosis is a multisystem disease due to non-caseating
epithelioid granulomatous inflammation in affected
organs. Diagnosis requires a consistent clinical picture
and a biopsy with typical non-caseating granulomas,
excluding diseases that can cause similar granulomatous
reactions (Statement on sarcoidosis, 1999). Few
reported cases of systemic sarcoidosis were associated
to the occurrence of cancers such as lung cancer
(Yamasawa et al., 2000), cutaneous cancer (Alexandrescu
et al., 2011) or testicular cancer (Rayson et al., 1998).
We report hereby the case of a 62-year-old patient
with a diagnosis of a concomitant sarcoidosis and
renal clear cell carcinoma.
2 Observation
A 62-year-old-female patient without medical history
was referred to our department for chronic dry cough
and shortness of breath. She denied any family history
of malignancy. Physical examination revealed bilateral
crackles on lung auscultation, lymph nodes enlargement
on the cervical area, and spleen enlargement on
abdominal palpation. Laboratory tests revealed
lymphopenia of 1 000 cells/mm
3
at blood count.
Serum electrophoresis, calcium and phosphate levels
in blood and urine, proteinuria of 24 hours were
within normal range. Immunologic findings including
antinuclear antibodies were negative. HCV and HBV
serology and tuberculin skin test were negative. Chest
X-ray showed bilateral interstitial syndrome.
Thoracoabdominal computed tomography revealed
mediastinal lymphadenopathy, bilateral ground glasses
at bases (Figure 1), spleen enlargement and a
3-centimeter hypervascularized lower pole renal mass
(Figure 2). Bronchial endoscopy was performed and
biopsies revealed non caseating epithelioid granulomas.
Salivary gland biopsy showed granulomatous
sialadenitis. Bronchoalveolar lavage concluded to a
lymphocytic alveolitis with a CD4/CD8 ratio of 2.8.
An open left heminephrectomy was performed through
a flank incision. Pathological examination concluded
to a stage T1a, clear cell renal cell carcinoma (Figure
3,4). The diagnosis of systemic sarcoidosis associated
to renal carcinoma was retained and the patient
underwent a course of corticosteroids treatment (1
mg/kg/day for 4 weeks with progressive tapering of
the doses). The evolution was marked by an improvement
of the dry cough and normalization of the biological
hepatic parameters. The CT scan control showed an
improvement of the interstitial lesions and a size
normalization of spleen and lymph nodes. There was
no tumor recurrence. The decline is 36 months.
3 Discussion
Sarcoidosis is a multisystem granulomatous disease of
unknown origin with pulmonary and extrapulmonary
manifestations. Cancer can eventually occur in patients
who have an established diagnosis of sarcoidosis and
sarcoidosis can also develop subsequently in an
oncologic patient. The sarcoidosis-related cancer
includes not only lymphomas but also other hematologic
malignancies and solid tumors (Reich, 2006). In our
