Systemic Granulomatosis in the Context of Solid Tumors: A Study of 10 Cases

Introduction: The association between solid cancers and sarcoidosis is well-known, however,we shouldn’t quickly link a granulomatous lesion to sarcoidosis in a patient suffering from a solid tumor, hence, a granuloma in the context of a solid cancer presents a diagnostic and a therapeutic challenge.

Methods: It’s a retrospective monocentric study of 10 cases, suffering from solid tumors, with granulomatous lesions. The type of cancer, the temporal relation between the granulomatous lesion and the cancer, the associated symptoms, the final diagnosis and the disease progression are reported. The patients were separated into three sub groups based on the time of appearance of the granulomatous lesions in relation to the solid tumor.

Results: Discovery of granulomatous lesions preceded the diagnosis of cancer in 1 case, discovered concomitantly with cancer in 5 cases and finally after the cancer in 4 cases. The main solid cancer in our study was breast invasive ductal carcinoma (40%), the other cancers were: squamous cell carcinoma of the breast, colorectal adenocarcinoma, ovarian epithelial cancer, esophageal squamous cell carcinoma, thyroid papillary carcinoma and uterine sarcoma.

Conclusion: A granuloma in the course of solid cancers maybe associated with multiple etiologies. Therefore, the clinician may face many difficulties, ranging from failing to diagnose a cancer to a wrong conclusion of treatment failure or a relapse. The biopsy is still the only guiding element.