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, 8 (1), 30-3

Unilateral Pulmonary Hilar Tumor Mass: Is It Always Lung Cancer?

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Case Reports

Unilateral Pulmonary Hilar Tumor Mass: Is It Always Lung Cancer?

Claudia Lucia Toma et al. Maedica (Buchar).

Abstract

Sarcoidosis is a multisystem inflammatory disease of unknown etiology, characterized by noncaseating epithelioid cell granulomas. In sarcoidosis, the most common radiological findings are mediastinal and bilateral hilar lymph node enlargement. We present a case of sarcoidosis with a rare radiological aspect of pulmonary hilar tumor mass.A 54-year-old female patient, active smoker (40 packs/year), with a history of cutaneous lupus, was admitted in our institute for progressive dyspnea and dry cough. At admission physical examination and laboratory tests were normal. Pulmonary function tests diagnosed an obstructive syndrome. Chest X-ray showed a tumor mass of the right pulmonary hilum. Transbronchial biopsy was nondiagnostic. HRCT-scan showed a tumor mass in the right hilum, which raised the suspicion of a lung cancer. PET-CT scan revealed a high metabolic activity of the tumor mass and of a paratracheal right lymphadenopathy. Lymph node biopsy by mediastinoscopy showed noncaseating epithelioid-cell granulomas, sustaining the diagnosis of sarcoidosis. The outcome was favorable, with spontaneous remission without treatment, but with a relapse that responded after systemic corticotherapy.In conclusion, even if a tumor mass in the pulmonary hilum is highly suggestive of lung cancer, a positive diagnosis should be made only after histological examination, because other benign conditions, like sarcoidosis, could have such an aspect.

Keywords: lung cancer; sarcoidosis; tumor mass.

Figures

Figure 1
Figure 1. Tumor mass of the right pulmonary hilum on chest X-ray (postero-anterior and right lateral view).
Figure 2
Figure 2. Thoracic CT-scan with tumor mass of the right pulmonary hilum, and lymphadenopathy in Barety's space.
Figure 3
Figure 3. PET-CT scan revealed a highly glucose metabolism in the tumor mass of the right hilum and in the right paratracheal lymphadenopathy.
Figure 4
Figure 4. Noncaseating epithelioid granulomas on mediastinal lymph node biopsy.
Figure 5
Figure 5. Chest X-ray after 3 months with the spontaneous regression of the right hilar tumor mass.
Figure 6
Figure 6. CT-scan showing relapse of sarcoidosis, with right hilar tumor mass and partial right upper lobe atelectasis.
Figure 7
Figure 7. Chest radiography showing regression after corticotherapy for relapse.

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