Pulmonary Sarcoidosis Associated with Leydig Cell Testicular Neoplasm: Discussion
Although Brincker and Wilbek, in a study performed on 2,544 patients, reported a significant association between neoplastic diseases and sarcoidosis, Romer—after a careful reevaluation of the same population—demonstrated a total lack of significant linkage between the two events. For this reason it has been hypothesized that the appearance of sarcoid manifestations in neoplastic patients could be interpreted as sarcoid-like granulomatous reactions, possibly due to one or more of the following mechanisms: 1) release of tumor antigens or complex products by suffering cancer cells during chemotherapy or radiation treatment, 2) increased susceptibility to the hypothetic agent of sarcoidosis in neoplastic patients due to an immune system imbalance, or 3) nonspecific enhancement of granulomatous reactions elicited by antineoplastic drugs and/or radiation treatment.
The hypothesis of a sarcoid-like reaction has been strengthened by evidence, in most reported cases, of a simple mediastinal lymph node involvement sparing lung parenchyma. In our case, on the contrary, lung tissue was deeply involved by sarcoid tissue, as is generally observed in Besniers disease. Furthermore, a short course of prednisone therapy was followed by a nearly total regression of lung opacities and by a sharp improvement in spirometric parameters; such a result would have been hard to obtain in the case of lung metastases (albeit exceptional in Leydigoma). canadianneighborpharmacy.com
In conclusion, our case enables us to rule out a simple sarcoid-like reaction confined to mediastinal lymph nodes, and points to the possibility that a neoplastic disease (particularly a testicular tumor) could be associated with the development of sarcoidosis. For this reason, lung biopsy should be included in the diagnostic workup of patients with testicular cancer and suspected lung metastases when a retroperitoneal lymph node involvement cannot be demonstrated.