Importance of differential diagnosis post-treatment of adenocarcinoma of the uterine cervix: a case report of sarcoidosis

Objective: To report a case of sarcoidosis post-treatment of adenocarcinoma of the uterine cervix. Case: A 38-year-old, G1P1A0 was admitted to the present hospital for palliative treatment of Stage IB1 adenocarcinoma of the uterine cervix with hepatic recurrence posthysterectomy. The patient initially received six cycles of cisplatin and taxol leading to complete remission. Six months after the palliative treatment, MRI revealed slight changes in the pelvis, suggestive of the involvement of the left iliac lymph node. Anatomo-pathological results after lymphadenectomy showed tumor recurrence. Following additional pelvic radiotherapy, the patient remained asymptomatic. However, oncologic control performed three months later exposed mediastinal lymphadenopathy and new biopsy revealed sarcoidosis. The patient remained asymptomatic in the subsequent follow-ups without evidences of tumor recurrence. This study shows the importance of differential diagnosis during the oncologic monitoring of cervical cancer patients to avoid unnecessary treatments at the expense of better therapeutic options.

Adenocarcinoma of the uterine cervix; Sarcoidosis; Differential diagnosis; Treatment.

[1] World Health Organization: GLOBOCAN 2012 “Estimated cancer. incidence, mortality, prevalence and disability-adjusted life years (DALYs)”. Available at: http://globocan.iarc.fr/

[2] Ministério da Saúde - Instituto Nacional do Câncer: “Estimativa 2014 - Incidência de câncer no Brasil”. Available at: http://www.inca.gov.br/estimativa/2014/

[3] Denny L., Hacker N.F., Gori J., Jones H.W., Ngan H.Y.S., Pecorelli S.: “Staging classifications and clinical practice guidelines for gynaecologic cancers”. In: London International Federation of Gynecology and Obstetrics, Committee on Gynecologic Oncology, 2006. Available at: http://www.figo.org/publications

[4] Quinn M.A., Benedet J.L., Odicino F., Maisonneuve P., Beller U., Creasman W., et al.: “Carcinoma of the cervix uterine: annual report on the results of treatment in gynaecological cancer”. Int. J. Gynecol. Obstet., 2006, 95, 43.

[5] Raspagliesi F., Ditto A., Quattrone P., Solima E., Fontanelli R., Dousias V., et al.: “Prognostic factors in microinvasive cervical squamous cell cancer: long-term results”. Int. J. Gynecol. Cancer, 2005; 15, 88.

[6] Silva-Filho, A.L.: “Emprego dos marcadores de prognóstico no tratamento para o carcinoma invasor de colo”. Rev. Bras. Ginecol. Obstet., 2009, 31, 468.

[7] National Comprehensive Cancer Network [Internet]. “Clinical practice guidelines in oncology: Cervical cancer”. In: Washington: NCCN. Available at: http://www.nccn.org/professionals/physician_ gls/f_guidelines.asp

[8] Vale C., Tierney J.F., Stewart L.A., Brady M., Dinshaw K., Jakobsen A., et al.: “Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration: Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials”. J. Clin. Oncol., 2008, 26, 5802.

[9] Hong J.H., Tsai C.S., Lai C.H., Chang T.C., Wang C.C., Chou H.H., et al.: “Recurrent squamous cell carcinoma of cervix after definitive radiotherapy”. Int. J. Radiat. Oncol. Biol. Phys., 2004, 60, 249.

[10] Duyn A., van Eijkeran M., Kenter G., Zwinderman K., Ansink A.: “Recurrent caervical cancer: detection and prognosis”. Acta Obstet. Gynecol. Scand., 2002, 81, 759.

[11] Chen N.J., Okuda H., Sekiba K.: “Recurrent carcinoma of the vagina following Okabayashi’s radical hysterectomy for cervical cancer”. Gynecol. Oncol., 1985, 20, 10.

[12] Chida M., Inoue T., Honma K., Murakami K.: “Sarcoid-like reaction mimics progression of disease after induction chemotherapy for lung cancer”. Ann. Thorac. Surg., 2010, 90, 2031.

[13] Kennedy M.P., Jimenez C.A., Mhatre A.D., Morice R.C., Eapen G.A.: “Clinical implications of granulomatous inflammation detectedby endobronchial ultrasound transbronchial needle as piration in patients with suspected cancer recurrence in the mediastinum”. J. Cardiothorac. Surg., 2008, 3, 8.

[14] Speiser D., Köhler C., Schneider A., Mangler M. “Radical vaginal trachelectomy: a fertility preserving procedure in early cervical cancer in young women”. Dtsch. Arztebl Int., 2013, 110, 289. [15] Cather Jr. H., Baharam S., Khachemouse A.: “Sarcoidosis”, In: Baughman R., (ed). Dermatologic diseases. New York: Taylor & Francis, 2006.

[16] Inoue k., Goto R., Shimomura H., Fukuda H.: “FDG - PET/CT of sarcoidosis and sarcoid reaction following antineoplasic treatment”. SpringerPlus, 2013, 2, 113.

[17] Cohen P.R., Kurzrock R.: “Sarcoidosis and malignancy”. Clin. Dermatol., 2007, 25, 326.

[18] Wong M., Yasufuku K., Nakajima T., Herth F.J., Sekine Y., Shibuya K., et.al.: “Endobronchial ultrasound: new insight for the diagnosisof sarcoidosis”. Eur. Respir. J., 2007, 29, 1182.

[19] Blank N., Lorenz H.M., Ho A.D., Witzens-Harig M.: “Sarcoidosis and the occurrence of malignant diseases”. Rheumatol. Int., 2014, 34, 1433.

[20] Alliot C., Barrios M., Desplechain C.: “Multisystem sarcoidosis and carcinoma of the uterine cervix: an unusual association”. Int J Gynecol Cancer 2001, 11, 323