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Silika Maruziyetli Hastada PET/BT 'de Akcier Kanserinin Nodal Yaylmn Taklit Eden Sarkoid Benzeri Reaksiyon: Olgu Sunumu [Respir Case Rep]
Respir Case Rep. 2018; 7(1): 13-16 | DOI: 10.5505/respircase.2018.33600

Silika Maruziyetli Hastada PET/BT 'de Akcier Kanserinin Nodal Yaylmn Taklit Eden Sarkoid Benzeri Reaksiyon: Olgu Sunumu

Feyza en1, Ahmet Sami Bayram2, Mehmet Karada3, Elif lker Akyldz4
1Uluda niversitesi Tp Fakltesi, Nkleer Tp AD, Bursa
2Uluda niversitesi Tp Fakltesi, Gs Cerrahi AD, Bursa
3Uluda niversitesi Tp Fakltesi, Gs Hastalklar AD, Bursa
4Uluda niversitesi Tp Fakltesi, Patoloji AD, Bursa

Malign pulmoner lezyonlarda mediastinal lenf nodu durumunun deerlendirilmesinde noninvaziv bir grntleme yntemi olan PET/BT nemli bir ilk adm saylmaktadr. Bununla birlikte yanl pozitifliklere bal hatal evre ykseltilmesi sz konusu olabilir. N evresinin belirlenmesi, tedavi planlama stratejisini etkileyebilecek son derece nemli bir durumdur. Silika maruziyeti olan bu olguyu akcierindeki kitle karakterizasyonu iin yaplan PET/BTsinde karlalan evreleme gl nedeniyle sunuyoruz. Youn FDG uptakei gsteren kitlenin lobektomi sonras histopatolojik olarak skuamz hcreli kanser olduu kantlanmasna ramen beraberindeki kalsifiye olmayan hipermetabolik lenf nodlarnn sarkoid benzeri reaksiyonu temsil eder ekilde nonkazez granlom ile uyumlu olduu deerlendirildi. Bu tarz reaksiyonlarn nemi, ilk evreleme PET/BTde ileri evreye ykseltilme ya da tedavi sonras hastalk progresyonu olduuna dair yanl bir izlenim oluturmasnda yatmaktadr. Mediastinal lenf nodlarnn benign nedenlerinden birisi olarak elikiye yol aan altta yatan meslek yks ayrca tartlmtr. PET/BTnin yanl pozitif olarak deerlendirilmemesi iin tmr ile ilikili sarkoid benzeri reaksiyonun farkndal gerekmektedir. Byle bir durumda doru evrelendirme iin lenf nodlarnn histolojik olarak konfirme edilmesi gereklilii vurgulanmtr.

Anahtar Kelimeler: PET/BT, silica maruziyeti, meslek hastal, granlamatz hastalk

Sarcoid-Like Reaction Mimicking Nodal Spread of Lung Cancer in a Silica-Exposed Patient on Positron Emission Tomography/Computed Tomography: A Case Report

Feyza en1, Ahmet Sami Bayram2, Mehmet Karada3, Elif lker Akyldz4
1Department of Nuclear Medicine, Uluda University Facul-ty of Medicine, Bursa, Turkey
2Department of Thoracic Surgery, Uluda University Faculty of Medicine, Bursa, Turkey
3Department of Pulmonary Medicine, Uluda University Faculty of Medicine, Bursa, Turkey
4Department of Pathology, Uluda University Faculty of Medicine, Bursa, Turkey

As a noninvasive modality, Fluorine-18 Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is an important first step to assess mediastinal lymph node (LN) status in malignant pulmonary lesions. However, incorrect upstaging may occur due to false-positive results. Determining N stage is of utmost importance, and will affect the treatment planning strategy. Presently described is a staging challenge with PET/CT in a silica-exposed patient who was evaluated for characterization of a lung mass. The mass had an intense FDG uptake and proved to be squamous cell lung cancer (squamous cell carcinoma [SCC]) after a lobectomy. Histopathology revealed non-caseating granulomas representing sarcoidlike reaction (SLR) in non-calcified hypermetabolic mediastinal-hilar LNs. The significance of such reactions lies in how they can give a false impression of upstaging on the initial PET/CT or mimic disease progression after treatment. As an underlying clinical manifestation, occupational history is also discussed as a confounding factor for a benign cause of mediastinal lymphadenopathy. Awareness of tumor-related SLR is needed to avoid false positive PET/CT interpretation. To obtain histological confirmation of LNs for accurate staging in such a circumstance is also emphasized.

Keywords: PET/CT, silica exposure, occupational disease, granulamatous disease

Feyza en, Ahmet Sami Bayram, Mehmet Karada, Elif lker Akyldz. Sarcoid-Like Reaction Mimicking Nodal Spread of Lung Cancer in a Silica-Exposed Patient on Positron Emission Tomography/Computed Tomography: A Case Report. Respir Case Rep. 2018; 7(1): 13-16

Sorumlu Yazar: Feyza en, Trkiye
Makale Dili: ngilizce
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