C40-27 Advanced Pulmonary Sarcoidosis in Patient With Invasive Oral Squamous Cell Carcinoma

Abstract Introduction Severe pulmonary sarcoidosis is diagnosed based on clinical symptoms (cough, dyspnea), radiographic evidence of parenchymal infiltrates, and abnormal pulmonary function tests (PFT). Diagnosis requires exclusion of other causes of granulomatous lung disease and assessment of organ involvement. Scadding stages I-IV are based on chest radiography and symptoms, with stage IV representing the most severe form and highest mortality risk. There is an established association between sarcoidosis and an increased risk for malignancy. Here we discuss a patient presenting with oral squamous cell carcinoma with a complex picture leading to diagnosis of advanced pulmonary sarcoidosis. Case 50-year-old male with history of never smoking, from Latin America, presented to the hospital with ulcerating lip lesion found to be invasive squamous cell carcinoma and underwent resection and subsequent radiation. During evaluation chest imaging demonstrated dense bilateral infiltrates with surrounding nodularity (Fig 1). He denied shortness of breath and cough but endorsed night sweats and recent unintentional weight loss. He underwent bronchoscopy with transbronchial biopsy that were negative for malignancy and otherwise non-diagnostic. He was treated with course of empiric antibiotics and follow up imaging at 3 months showed no change. PET scan showed innumerable hypermetabolic bilateral nodules, mediastinal and abdominal lymphadenopathy. He had developed exertional dyspnea and PFTs showed severe obstructive pattern with FEV1 38% with new 2L supplemental oxygen requirement based on 6MWT. After multidisciplinary discussion, he underwent repeat bronchoscopy with transbronchial cryobiopsies demonstrating noncaseating granulomas, negative cultures, and he was diagnosed with pulmonary sarcoidosis. He was started on prolonged steroid taper leading to improvement in lung function, no longer needing supplemental oxygen and was eventually transitioned to methotrexate maintenance therapy under the care of rheumatology. Discussion Patients with sarcoidosis appear to be at increased risk for cancer, however the relationship is complex and possibly bidirectional, with sarcoidosis increasing cancer risk while certain cancers can trigger sarcoidosis-like reactions. Patients with sarcoidosis have a higher risk of developing both hematologic malignancies and solid tumors. For some patients, cancer can precede sarcoidosis, suggesting a possible causative relationship. In other cases, sarcoidosis may develop years after a cancer diagnosis. The autoimmune pathophysiology of sarcoid may contribute to a dysfunctional response of regulatory T-cells and an accumulation of immune-suppressing cells which could be tied to malignancy. Patients with known sarcoid should be monitored closely for malignancy; in this case the patient was being evaluated for malignancy and was found to have underlying advanced pulmonary sarcoidosis. This abstract is funded by: N/A