CASE SERIES: SARCOIDOSIS AND PAPILLARY THYROID CANCER

Introduction

Sarcoidosis (SA) is an idiopathic multisystem disease that may affect any organ including the thyroid. The association of thyroid cancer and sarcoidosis has been previously described in case reports. We are describing 3 patients with co-existence of papillary thyroid cancer (PTC) and SA.

Case presentations

Case 1: 48 year-old female with SA involving the lungs, lacrimal glands and skin who was initially referred for evaluation of incidentally found calcified thyroid nodules and cervical adenopathy on computed tomography (CT). Fine needle aspiration (FNA) of a right level III lymph node (LN) and right thyroid nodule was performed and that showed PTC. She underwent thyroidectomy and neck dissection and histology showed multiple lymph nodes with non-necrotizing granulomatous inflammation in addition to PTC.

 

Case 2: 35 year-old male with no known SA noticed a lump on the right side of her neck. On examination, he was found to have a right thyroid nodule and an ipsilateral lateral neck adenopathy. Sonographically-guided FNA of a suspicious right cervical LN and of the thyroid nodules were positive for PTC. Post thyroidectomy and ipsilateral neck dissection, pathology showed 4 LNs with extensive non-necrotizing granulomatous inflammation and sclerosis in addition to nearby thyroid malignancy. Fluorodeoxyglucose-positron emission tomography scan showed diffuse lymphadenopathies throughout the body.

 

Case 3: 54 year-old female with a history of  PTC, presented with fever, non-productive cough, weakness and fatigue and was found to have palpable left cervical LN. This LN was reported as malignant initially but repeat FNA showed granulomatous inflammation. CT of the chest showed bulky lymphadenopathy throughout the chest, including hilar, subcarinal, mediastinal, para-tracheal LNs. A sonographically-guided FNA of the left cervical LN showed granulomatous inflammation.

 

Conclusion:

 

Although 4% of thyroid cancers may induce a sarcoid reaction in the thyroid gland, SA as a disease may coexist with PTC although causality is yet uncertain. Being aware of this association is important in the differential diagnosis of a thyroid mass and/or a LN in a patient with SA. Therefore, patients with known SA who are found to have cervical adenopathies or thyroid nodules should have a thorough work up.