PO6 - Sarcoidosis and Malignancy: A Single-Center Cohort Study of Temporal Relationships
Yub Raj Sedhai (United States)1; Kathryn Hobbs (United States)1; Christopher A Thomas (United States)1; Christopher.King@inova.org (United States)1; Oksana A Shlobin (United States)1; Jared D Wilkinson (United States)1; Junad M Chowdhury (United States)1; Alan S Nyquist (United States)1; Anju L Singhal (United States)1; Zein Kattih (United States)1; Steven D Nathan (United States)1; Shambhu Aryal (United States)1;
1 - Inova Health System, Falls Church, VA;
Keywords: Sarcoidosis; Malignancy; Cancer;
Select the theme: Genetics and Immunopathology: Advances in Contemporary Understanding and Prospects for Future Research
Type: Original Papers
Presentation: Poster Presentation

Introduction:  A complex, bidirectional relationship exists between sarcoidosis and malignancy. Cancer can induce granulomatous inflammation that mimics sarcoidosis, while chronic sarcoidosis may increase malignancy risk, particularly lymphoma. 

Objectives: To evaluate the temporal relationship between malignancy and sarcoidosis in a single-center cohort.

Materials and Methods:  We queried the Epic electronic health record (Epic Systems Corporation, Verona, WI, USA) using the SlicerDicer tool with keywords including cancer, malignancy, metastasis, sarcoidosis, and granulomatous disease in a sarcoid clinic cohort of 373 patients. Seventeen patients were initially identified, of whom 5 were excluded due to lack of clinical consistency with sarcoidosis, yielding a final cohort of 12 patients with histologically proven sarcoidosis. Data collected included demographics, timing of sarcoidosis and malignancy diagnoses, and primary cancer origin. Statistical analyses were performed as appropriate.

Results: A total of 12 patients with histologically confirmed sarcoidosis were included (mean age 61.2 ± 6.3 years; 58.3% male). Half of the cohort (n=6, 50.0%) received sarcoidosis-directed therapy, most commonly corticosteroids (n=6, 50.0%), administered as monotherapy (n=3, 25.0%) or in combination with methotrexate (n=3, 25.0%); no patients received tumor necrosis factor–alpha inhibitors. The most common malignancies were breast cancer (n=4, 33.3%) and tonsillar squamous cell carcinoma (n=3, 25.0%), with thoracic metastases present in 5 patients (41.7%). The majority (n=11, 91.7%) received chemotherapy. Sarcoidosis preceded malignancy in 5 patients (41.7%), underscoring a variable temporal relationship; in this subset, malignancies included tonsillar squamous cell carcinoma (n=2), small bowel neuroendocrine tumor (n=1), melanoma (n=1), and breast cancer (n=1).

Conclusions: Sarcoidosis and malignancy demonstrate a heterogeneous and bidirectional temporal relationship, with sarcoidosis preceding cancer in a substantial subset of patients. Further studies are needed to elucidate better the biological interplay between sarcoidosis predisposing to malignancy and malignancy inciting granulomatous inflammation, which may help clarify underlying molecular mechanisms and inform future therapeutic strategies.