Sarcoid reaction mimicking intrathoracic dissemination of testicular cancer

Patients with testicular germ cell tumors in the early stage should be watched carefully for signs of metastatic spread. Often, spread beyond abdominal lymph nodes will occur in the chest cavity. However, two recent cases illustrate that isolated findings of abnormalities in the thoracic or mediastinal cavity should not be automatically assumed to indicate the spread of a germ cell tumor. True metastatic lesions in the chest will usually occur in patients with other signs of metastatic disease, such as abnormal abdominal CT scan and abnormal alpha-fetoprotein or chorionic gonadotropin concentrations. In the absence of such signs, a biopsy should be performed on any chest lesions. Two men, both 35 years old when they underwent surgery for combined seminomatous and nonseminomatous germ cell tumors in the testes, developed abnormal signs on chest X-rays. Biopsy revealed the abnormalities to be sarcoid reaction of the lymph nodes. Sarcoids are a granulomatous reaction of epithelioid cells. However, unlike the granulomas seen in diseases such as tuberculosis, there is no necrotic region in the center of the granuloma and there is no evidence of an infective organism. The cause of sarcoids is not known. In both these cases, the sarcoid reaction resolved over time without treatment. There have been previous reports of sarcoid reactions in lymph nodes that have accompanied cases of testicular cancer. However, it is not known if this is coincidental, or if there is a relationship between the two conditions. The importance of accurate diagnosis is illustrated, regardless of the cause of the sarcoids, because failure to biopsy and correctly diagnose the chest lesions in these two patients may have resulted in the unnecessary use of chemotherapy to treat metastatic lesions that did not exist. (Consumer Summary produced by Reliance Medical Information, Inc.)