Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2021; 9(13): 3140-3146
Published online May 6, 2021. doi: 10.12998/wjcc.v9.i13.3140
Sarcoidosis mimicking metastases in an echinoderm microtubule-associated protein-like 4 anaplastic lymphoma kinase positive non-small-lung cancer patient: A case report
Xi Chen, Jie Wang, Wei-Li Han, Kui Zhao, Zhen Chen, Jian-Ying Zhou, Yi-Hong Shen
Xi Chen, Jie Wang, Jian-Ying Zhou, Yi-Hong Shen, Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Wei-Li Han, Department of Lung Transplantation, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Kui Zhao, Positron Emission Tomography Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Zhen Chen, Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Chen X and Wang J wrote the original draft; Han WL, Zhao K, and Chen Z collected the data; Zhou JY, Chen X, and Wang J performed the investigation; Shen YH performed the project administration and wrote, reviewed, and edited the manuscript.
Supported by The Zhejiang Provincial Natural Science Foundation of China, No. LQ17H160005.
Informed consent statement: The patient provided his written informed consent.
Conflict-of-interest statement: No conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Hong Shen, MD, Chief Doctor, Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. drsyh@zju.edu.cn
Received: December 17, 2020
Peer-review started: December 17, 2020
First decision: January 24, 2021
Revised: February 7, 2021
Accepted: March 4, 2021
Article in press: March 4, 2021
Published online: May 6, 2021
Processing time: 125 Days and 22.8 Hours
Abstract
BACKGROUND

Rearrangements of the anaplastic lymphoma kinase (ALK) gene (ALK-positive) represent an oncogenic driver in approximately 3%-5% of non-small-lung cancer (NSCLC) patients. Sarcoidosis is a multisystem disease, and its reported incidence in Asia is 1 or less per 100000 people per year. The co-occurrence of sarcoidosis and ALK-positive NSCLC is rare, and ALK-positive lung cancer is likely to spread quickly. Therefore, the co-occurrence of sarcoidosis is more easily misdiagnosed as metastatic lung cancer by radiological examination.

CASE SUMMARY

A 50-year-old man had a nodule in the left superior lobe, many small nodules in left superior and right lungs, and enlarged bilateral hilar, mediastinal, and right supraclavicular lymph nodes. Computed tomography-guided pulmonary biopsy of the nodule in the left superior lobe revealed echinoderm microtubule-associated protein-like 4 gene-ALK positive NSCLC with concomitant noncaseating granuloma. This patient was treated with crizotinib. Thirty days later, a chest computed tomography scan revealed a dramatic decrease in the size of the left superior lobe nodule; however, the lesions in the right lung progressed. The right supraclavicular lymph nodes showed granulomas, and no tumor cells were identified in the specimens. The angiotensin-converting enzyme level was high. After 1 wk of methylprednisolone treatment, a significant response of all lesions was revealed. Following radical resection of the lung cancer, noncaseating granulomas were observed in both lung tissues and lymph nodes, which resulted in a diagnosis of echinoderm microtubule-associated protein-like 4-ALK positive NSCLC accompanied with sarcoidosis.

CONCLUSION

Our experience illustrates that pathological evidence is needed to confirm metastatic disease, especially when some suspected metastatic lesions are negative for malignancy.

Keywords: Lung cancer; Sarcoidosis; Anaplastic lymphoma kinase; Echinoderm microtubule-associated protein-like 4 anaplastic lymphoma kinase; Metastasis; Case report

Core Tip: The co-occurrence of sarcoidosis and echinoderm microtubule-associated protein-like 4 anaplastic lymphoma kinase (ALK)-positive non-small-cell lung cancer is rare. Here, we present one case of sarcoidosis mimicking metastases in an echinoderm microtubule-associated protein-like 4-ALK positive non-small-cell lung cancer patient. From this case, our experience illustrates that ALK-positive lung cancer is likely to spread quickly; therefore, the co-occurrence of sarcoidosis is more easily misdiagnosed as metastatic lung cancer by radiological examination. We suggest that pathological evidence is needed to confirm metastatic disease, especially when some suspected metastatic lesions are negative for malignancy or when the post-treatment follow-up evaluation results are unexpected.