Journal Article

The diagnostic challenge of coexistent sarcoidosis and thyroid cancer – a retrospective study

Freba Ahmaddy, Marcus Unterrainer, Christine Spitzweg, Nathalie L. Albert, Peter Bartenstein, Julia Hornung, Andrei Todica, Vera Wenter, Harun Ilhan, Nikolaus Kneidinger

2021

Overview

Background Sarcoid lesions may mimic metastatic disease or recurrence in thyroid cancer (TC) patients as both diseases may affect the lungs and lymph nodes. We present the first study to systematically evaluate the clinical course of patients with (TC) after adjuvant radioactive iodine therapy (RIT) and concomitant sarcoidosis of the lung or the lymph nodes. Methods We screened 3285 patients and retrospectively identified 16 patients with TC (11 papillary thyroid cancer (PTC), 3 follicular thyroid cancer (FTC), 1 oncocytic PTC, 1 oncocytic FTC) and coexisting sarcoidosis of the lung and/or the lymph nodes treated at our institute. All patients had undergone thyroidectomy and initial adjuvant RIT. Challenges in diagnosing and the management of these patients were evaluated during long term follow-up (median 4.9 years (0.8–15.0 years)). Results Median age at first diagnosis of TC was 50.1 years (33.0–71.5 years) and of sarcoidosis 39.4 years (18.0–63.9 years). During follow-up, physicians were able to differentiate between SA and persistent or recurrent TC in 10 of 16 patients (63%). Diagnosis was complicated by initial negative thyroglobulin (Tg), positive Tg antibodies and non-specific imaging findings. Histopathology can reliably distinguish between SA and TC in patients with one suspicious lesion. Conclusion Physicians should be aware of the rare coexistence of sarcoidosis and TC. Lymphadenopathy and pulmonary lesions could be metastases, sarcoidosis or even a mix of both. Therefore, this rare patient group should receive a thorough work up including histopathological clarification and, if necessary, separately for each lesion.

• Publisher: Springer Science and Business Media LLC,BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adenocarcinoma, Follicular / Adenocarcinoma, Follicular - diagnosis / Adenocarcinoma, Follicular - diagnostic imaging / Adenocarcinoma, Follicular - metabolism / Adenocarcinoma, Follicular - surgery / Adolescent / Adult / Aged / Aged [MeSH] ; Diagnosis, Differential [MeSH] ; Sarcoidosis/surgery [MeSH] ; Thyroid Neoplasms/metabolism [MeSH] ; Male [MeSH] ; Thyroid Neoplasms/surgery [MeSH] ; Research Article ; Thyroid Cancer, Papillary/surgery [MeSH] ; Thyroid Neoplasms/diagnosis [MeSH] ; Adolescent [MeSH] ; Female [MeSH] ; Follow-Up Studies [MeSH] ; Adenocarcinoma, Follicular/diagnosis [MeSH] ; Sarcoidosis/diagnostic imaging [MeSH] ; Thyroid Cancer, Papillary/metabolism [MeSH] ; Adult [MeSH] ; Humans [MeSH] ; Radioiodine therapy ; Adenocarcinoma, Follicular/metabolism [MeSH] ; Adenocarcinoma, Follicular/diagnostic imaging [MeSH] ; Retrospective Studies [MeSH] ; Thyroid Cancer, Papillary/diagnostic imaging [MeSH] ; Thyroid cancer ; Middle Aged [MeSH] ; Sarcoidosis/diagnosis [MeSH] ; Thyroid Neoplasms/diagnostic imaging [MeSH] ; Medical and radiation oncology ; Biomarkers, Tumor/metabolism [MeSH] ; Sarcoidosis ; Prognosis [MeSH] ; Young Adult [MeSH] ; Thyroid Cancer, Papillary/diagnosis [MeSH] ; Thyroid gland ; Sarcoidosis/metabolism [MeSH] ; Adenocarcinoma, Follicular/surgery [MeSH] / Antibodies / Biomarkers, Tumor / Biomarkers, Tumor - metabolism / Biomedical and Life Sciences / Biomedicine / Cancer Research / Coexistence / Diagnosis / Diagnosis, Differential / Female / Follow-Up Studies / Health Promotion and Disease Prevention / Histopathology / Humans / Hypothyroidism / Iodine / Laboratories / Lung diseases / Lungs / Lymph nodes / Lymphadenopathy / Lymphatic system / Male / Medical and radiation oncology / Medicine/Public Health / Metastases / Metastasis / Middle Aged / Neoplasms. Tumors. Oncology. Including cancer and carcinogens / Oncology / Papillary thyroid cancer / Patients / Prognosis / Pulmonary lesions / Radioiodine therapy / Radioiodine Therapy ; Sarcoidosis ; Thyroid Cancer ; Thyroid Gland / RC254-282 / Research Article / Retrospective Studies / Sarcoidosis / Sarcoidosis - diagnosis / Sarcoidosis - diagnostic imaging / Sarcoidosis - metabolism / Sarcoidosis - surgery / Surgical Oncology / Thyroglobulin / Thyroid cancer / Thyroid Cancer, Papillary / Thyroid Cancer, Papillary - diagnosis / Thyroid Cancer, Papillary - diagnostic imaging / Thyroid Cancer, Papillary - metabolism / Thyroid Cancer, Papillary - surgery / Thyroid gland / Thyroid Neoplasms / Thyroid Neoplasms - diagnosis / Thyroid Neoplasms - diagnostic imaging / Thyroid Neoplasms - metabolism / Thyroid Neoplasms - surgery / Thyroidectomy / Young Adult