A recent report in the journal Internal Medicine, published by the Japanese Society of Internal Medicine, described the unusual case of a 78-year-old woman who had a rare combination of pancreatic mass and nodules in the airways and lungs — all consistent with a diagnosis of sarcoidosis.
Sarcoidosis is characterized by the accumulation of immune cells in structures called granulomas, which cause inflammation and impaired activity in the affected tissues. In most cases, sarcoidosis affects the lungs, lymph nodes, and skin. In fewer cases, the eyes, liver, heart, and brain can be affected.
An article titled, “Sarcoidosis with Pancreatic Mass, Endobronchial Nodules, and Miliary Opacties in the Lung,” described the rare combination of sarcoidosis symptoms.
The patient arrived at the hospital with a persistent cough for about two months and slightly elevated blood levels of the pancreatic enzyme amylase.
With no additional symptoms, the researchers performed a chest radiography that revealed small, dispersed nodules in the lungs (miliary nodules) and accumulation of fluids in the chest cavity (pleural effusion).
A chest computed tomography (CT) scan and a bronchoscopy — an endoscopic technique to visualize the inside of the airways — showed the presence of small nodules in the airways. A tissue biopsy analysis confirmed the presence of non-caseating granulomas, the hallmark of sarcoidosis.
Because sarcoidosis can affect multiple organs, the team conducted a systemic search for any further signs of the disease. No heart or eye involvement was found. Instead, a mass was discovered in the patient’s pancreas. Tissue analysis showed that the mass had no signs of malignant cells, but had granulomas.
“The ultimate diagnosis was pancreatic, pulmonary, and bronchial sarcoidosis,” the researchers wrote. “Her cough spontaneously improved. She received no treatment for sarcoidosis and was followed up at an outpatient clinic for one year, during which no pulmonary disease progression was observed and the pancreatic masses partially regressed.”
Miliary patterns are only detected in less than 1% of patients, whereas pancreatic sarcoidosis is only very rarely detected before death. Also, previous studies have reported that pleural effusions caused by sarcoidosis can only be found in 1.1% of patients.
Overall, this case report presented a rare combination of already rare manifestations of sarcoidosis.