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Japanese Journal of Clinical Oncology Advance Access published online on February 1, 2007
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyl141
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© 2007 Foundation for Promotion of Cancer Research

Surgical Results of Lung Cancer with Sarcoid Reaction in Regional Lymph Nodes

Yoshito Tomimaru1, Masahiko Higashiyama1,, Jiro Okami1, Kazuyuki Oda1, Koji Takami1, Ken Kodama1 and Yoshitane Tsukamoto2

1 Department of Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
2 Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

For reprints and all correspondence: Masahiko Higashiyama, Department of Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan. E-mail: higasiyama-ma{at}mc.pref.osaka.jp

Received June 8, 2006; accepted October 7, 2006

BACKGROUND: There have been few reports of sarcoid reaction in the regional lymph nodes associated with lung cancer. The purpose of this study was to analyze the surgical results of lung cancer with sarcoid reaction.

METHODS: Of 1733 lung cancer patients undergoing surgical treatment in our institute from 1990 to 2004, we reviewed 22 patients (1.3%) with sarcoid reaction in the regional lymph nodes of lung cancer.

RESULTS: On pre-operative computed tomography (CT), mediastinal lymph node swelling was detected in 19 patients (86%) as clinical N3 disease (c-N3) in six or as c-N2 in 13, while three patients were classified as c-N0. To these 19 patients, lymph node status was histologically checked by mediastinoscopy in four patients, sternotomy approach in two and open mini-thoracotomy in 13. Because the sampling-biopsy nodes showed no tumor metastasis, radical surgery was promptly performed. However, four patients (18%) were finally judged to have pathological lymph node positive disease. Five patients were in pathological stage (p-stage) IA, nine in p-stage IB, five in p-stage IIB, two in p-stage IIIA, and one in stage IIIB. The overall 3-, and 5-year survival rates of these patients were 85.2 and 77.7%, respectively, with no significant difference compared to those of the remaining patients without sarcoid reaction.

CONCLUSIONS: Because lung cancer patients with sarcoid reaction in the regional lymph nodes frequently show mediastinal lymph node swelling on CT, radical resection should be performed after confirming the node status by appropriate sampling biopsy. It seems that surgical results of lung cancers with sarcoid reaction in the regional nodes are not prognostically different from those without sarcoid reaction.

Key Words: sarcoid reaction • lymph nodes • lung cancer • immunologic disorder


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