A 57-year-old male with biopsy-confirmed cardiopulmonary sarcoidosis was diagnosed with a rare pulmonary spindle cell neoplasm arising within a sarcoid nodule four years later.
Case Report (n=1)
Cardiopulmonary sarcoidosis can mask the development of rare neoplasms such as spindle cell carcinoma, highlighting the potential need for radiographic surveillance of pulmonary nodules in these patients.
Abstract Introduction Annual incidence of cardiac sarcoidosis (CS) is estimated at 0.24 cases per 100,000 people per year. Spindle cell neoplasm is even less common at 0.6 cases per 1,000,000 people per year. Here, we present a case of a delayed spindle cell diagnosis due to a biopsy confirmed, steroid-responsive cardiopulmonary sarcoidosis. Case Presentation A 57-year-old male with a history of hypertension, hyperlipidemia, and stroke presented with syncope. EKG demonstrated second degree heart block with unsustained ventricular tachycardia on telemetry. Echocardiography revealed global dyskinesia with a reduced ejection fraction. Following a negative left heart catheterization, a cardiac MRI was performed showing a small intramural scar in the basal inferoseptum (2% scar burden), consistent with sarcoidosis. Biopsy of a left lung nodule revealed necrotizing granulomas, and the patient was discharged on corticosteroids with symptom relief. Four years later, he presented with syncope attributed to heart block with imaging showing progression of multiple lung nodules. Biopsy of a right lung nodule demonstrated a spindle cell neoplasm arising in a nodule noted on prior imaging. Discussion Persistent immune dysregulation and chronic inflammation have been hypothesized to contribute to the higher rate of malignancy in sarcoidosis patients. This case illustrates the importance of considering not only commonly associated cancers but neoplasia within sarcoid nodules. The histologic findings and favorable response to corticosteroid therapy supported discharge without additional evaluation of the remaining nodules. There are currently no consensus guidelines for radiographic surveillance of pulmonary nodules associated with sarcoidosis. Although the incidence of spindle cell is exceedingly rare, special attention with more frequent imaging may need to be given to nodules of patients that present with pulmonary sarcoid disease, as it may lead to later diagnosis of malignancies with potentially poor prognosis. Conclusion While the diagnosis of cardiopulmonary sarcoidosis is rare, it can also mask the development of neoplasms and prevent or delay further imaging or subsequent biopsies that may be necessary to work up malignancy. Rare diagnoses such as spindle cell carcinoma must be considered in patients with persistent sarcoid nodules. Clinicians should consider reimaging of thoracic sarcoid processes for changes in nodular burden, size, or change in morphology such as spiculation or calcification that may represent malignancy. This abstract is funded by: None
Gibson et al. (Fri,) conducted a case report in Cardiopulmonary sarcoidosis and pulmonary spindle cell neoplasm (n=1). Corticosteroids was evaluated. A 57-year-old male with biopsy-confirmed cardiopulmonary sarcoidosis was diagnosed with a rare pulmonary spindle cell neoplasm arising within a sarcoid nodule four years later.