CASE REPORT OPEN ACCESSInternational Journal of Surgery Case Reports 16 (2015) 7172

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Sarcoidosis mimicking metastatic papillary thyro

Abdulwaa Faculty of Me is Mitb Faculty of Me c ois Mc Faculty of Me niversSulaymaniyah,

a r t i c l

Article history:Received 14 SeAccepted 20 SAvailable onlin

Keywords:SarcoidosisMetastatic papNeck mass

systeociature.ent aationo go

y was Excis

e thdevelop malignancies, less than a dozen of cases are reported in the literature to be associated withPTC with a very wide range of presentations and clincal coarses. An interesting nding of our case isthat in contrast to what is reported, both diseases were not known by the physician until the time ofpresentation.CONCLUSION: Cervical lymphadenopathy in association with goiter could be metastasis, sarcoidosis ormixed, therefore should be seperately biopsied.

2015 The Authors. Published by Elsevier Ltd. on behalf of Surgical Associates Ltd. This is an open

1. Introdu

Sarcoidopathic diseagranulomasand skin [1]has been repreceding, dcervical lymcan create aPTC metast

It is verymetastatic cer presentlimphadeno

CorresponE-mail add

(S.M. Fatih), fa

http://dx.doi.o2210-2612/ creativecommaccess article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

ction

sis (SA) (esh-like process) is a multisystemic, idio-se which is characterized by non-caseating epithelioid

mainly involving the lungs (90%), lymph nodes, eyes,. It has a highly variable clinical course [2]. Sarcoidosisported to present in association with malignancy, eitheruring, or after chemotherapy [3]. The development ofphadenopathy in a patient with both (SA) and (PTC)

diagnostic dilemma. Occasionally, lymph nodes withasis and SA may coexist in the neck [4].

important to obtain a tissue diagnosis of suspiciouslesions. We report a case of papillary thyroid can-ing with multiple sarcoid lesion (cervical and hilarpathy) mimicking metastatic lesions.

ding author.resses: awahidms@yahoo.com (A.M. Salih), Salahkalary@yahoo.comhmi.hussein@univsul.edu.iq (F.H. Kakamad).

2. Case report

A 48-year-old female presented with neck swelling for 3 monthswithout signicant associated symptoms. On examination, therewas symmetrical painless thyroid enlargement without xationto deep tissues of the neck. Multiple nodules on the both thyroidlobes, hard irregular, grade two goiter with lymphadenopathy allover anterior neck compartments. There was also clubbing of thengers. Ultrasound of the neck showed three small nodules with5 mm and less in diameter, 2 of them are solid other is cystic, nei-ther calcication no abnormal vasculature is seen. Also there wascomplex solid nodule of about 25 17 mm in size in right lobe withspots of calcication and marked internal vascularity. There wasbilateral cervical enlarged lymph nodes along the jugular chein,largist one reaching the size of 12 mm with abnormal architecture.T3 = 1.85 (nmol/L), T4 = 121 (nmol/L), TSH = 1.4 IU/mL. Chest X-rayshowed bilateral hilar masses (Fig. 1). Fine needle aspiration cytol-ogy was done under ultrasound guide from right thyroid noduleand showed papillary thyroid carcinoma. Patient underwent totalthyroidectomy with modied radical neck lymph nodes dissectionfor Level; II, III, IV and VI.

rg/10.1016/j.ijscr.2015.09.0272015 The Authors. Published by Elsevier Ltd. on behalf of Surgical Associates Ltd. This is an open access article under the CC BY-NC-ND license (http://ons.org/licenses/by-nc-nd/4.0/).hid M. Saliha, Salah M. Fatihb, F.H. Kakamadc,

dical Sciences, School of Medicine, Department Surgery, University of Sulaimani, Franc odical Sciences, School of Medicine, Department Radiology, University of Sulaimani, Frandical Sciences, School of Medicine, Department Cardiothoracic and Vascular Surgery, U

Iraq

e i n f o

ptember 2015eptember 2015e 26 September 2015

illary thyroid cancer

a b s t r a c t

INTRODUCTION: Sarcoidosis is a multiIt has been reported to present in asscancer is rarely reported in the literatPRESENTATIOIN OF THE CASE: We presless thyroid enlargement without xthyroid lobes, hard irregular, grade twments. Fine needle aspiration cytologshowed papillary thyroid carcinoma.for sarcoidosis.DISCUSSION: Most researchers believid cancer

terrand Street, Sulaymaniyah, Iraqitterrand Street, Sulaymaniyah, Iraq

ity of Sulaimani, Franc ois Mitterrand Street,

mic, idiopathic disease. It has a highly variable clinical course.ion with malignancy. Coexistence of sarcoidosis and thyroid

case with neck swelling for 3 months, and symmetrical pain- to deep tissues of the neck. Multiple nodules on the bothiter with lymphadenopathy all over anterior neck compart-

done under ultrasound guide from right thyroid nodule andional biopsy of the neck lymphnode showed picture typical

at patients with pulmonary sarcoidosis are predisposed to

CASE REPORT OPEN ACCESS72 A.M. Salih et al. / International Journal of Surgery Case Reports 16 (2015) 7172

(23 lymrmed PCTand other lpicture of soperativelyand steroidfor the hilain our counof symptomshadow.

3. Discussi

Althougsarcoidosis Most researare predispmalignancicase series, histopatholreaction hanancies, lesto be associand clincal nancy, accoof co-existieases can af[4]. An intenot knownin other casease beforediagnostic w

4. Conclus

Physicialymphaden

or sarcoidosis or mixed, therefore should be seperately biopsied.Proper examination and and investigation of respiratory systemare mandatory when a patient presented with neck mass to excludeco-existence diseases.

Consent

Written informed consent was obtained from the patient forpublication of this case report and accompanying images. A copyof the written consent is available for review by the Editor-in-Chief

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Open AccesThis articlepermits uncredited.Fig. 1. Showing bilateral hilar shadow.

phnodes from each side) results of tissue biopsy con- and metastasis to a right upper cervical lymphnodeymphnodes showed non-caseating granuloma, typicalarcoidosis conrmed by multiple examinations. Post

patient was put on daily 125 g of l-thyroxine, I-131. Patient refused to do more invasive diagnostic workupr mass as facility for transbronchial biopsy are absenttry. Three months after medication patient was frees and her chest X-ray showed decrease size of hilar

on

h there have been many theories on the link betweenand malignancy, the association remains unproven [5].chers believe that patients with pulmonary sarcoidosisosed to develop malignancies, but others presume thates lead to sarcoidosis [6]. according to two retrospective414% of all patients with malignancy can exhibit someogical evidence of sarcoidosis [7,8]. Although sarcoids been reported to be associated with various malig-s than a dozen of cases are reported in the literatureated with PTC with a very wide range of presentationscoarses [4]. PTC are the most common thyroid malig-

of this

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[2] A. ShRadi

[3] Zin W(201

[4] Ahmunts for 80% of the all thyroid cancers. Managementng PTC and SA can be challenging because both of dis-fect the same organs and the incidences are very similarresting nding of our case is that both diseases were

by the physician until the time of presentation whilees patients are known to have at least one of the dis-

cosultation [1,2,5]. and this make more cofusion fororkup and need special attension.

ion

n should think widely when facing neck mass, cervicalopathy in association with goiter could be metastasis

Sarcoidosi[5] C. Mingins

carcinoma[6] B.P. Krawc

neoplasms9496.

[7] H. Brincke147156.

[8] L. Llombarsarcoid-likmorpholog

s is published Open Access at sciencedirect.com. It is distributed underestricted non commercial use, distribution, and reproduction in any interest

no conict of interest.

no sources of funding.

roval

l has been givenby ethics committee of bioscience cen-

tribution

ahid M. Salih; performed operation. Data collection.mad; writing the manuscript. Salah M. Fatih; Data col-ination and follow up.

n of research studies

registry559.

. Kakamad.

s

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and pulmonary sarcoidosisa case report, New Med. 7 (2004)

r, Sarcoid reactions in malignanttumors, Cancer Treat. Rev. 13 (1986)

t Jr, J.M. Escudero, The incidence andsignicance of epithelioid ande cellular reaction in the stromata of malignant tumours: aical and experimental study, Eur. J. Cancer 6 (1970) 545551.

r the IJSCR Supplemental terms and conditions, whichmedium, provided the original authors and source are

Sarcoidosis mimicking metastatic papillary thyroid cancer1 Introduction2 Case report3 Discussion4 ConclusionConsentConflict of interestFundingEthical approvalAuthor contributionRegistration of research studiesGuarantorReferrences