Multiple pulmonary cavitating nodules in female with endometrium adenocarcinoma history – difficulties in differentiation between metastases, sarcoidosis and sarcoid-like reaction. Case report

Pulmonary cavitary lesions visible on a chest radiograph can be a diagnostic challenge. It is necessary to take into consideration a wide differential diagnosis and to conduct a wide range of examinations to confirm their exact cause. A 44-year-old woman with a history of endometrial adenocarcinoma was admitted to the pulmonology department to diagnose mediastinal lymphadenopathy with coexisting nodules in the lung parenchyma. The X-ray and positron emission tomography (PET) showed cavitating lesions in the lungs, which could correspond to metastases, but the laboratory and histopathological tests did not confirm any neoplastic features. In specimens obtained by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and video-assisted thoracoscopic surgery (VATs) non-caseating granulomas were found, which suggested sarcoidosis or a sarcoid-like reaction. At an advanced stage of pulmonary changes, the presence of neoplastic cells was revealed in the sputum. Despite chemotherapy the patient died. Multiple pulmonary metastases were confirmed in the post-mortem examination. This case is an example of a rare sarcoid-like reaction in the mediastinum and lung parenchyma due to cancer located below the diaphragm. Differentiating between sarcoidosis, a sarcoid-like reaction and lung metastases in similar cases may be difficult. For this reason, it should be advisable to repeat diagnostic procedures in patients with malignancies in the past, including EBUS-TBNA and VATs.