Track

Case Reports

Abstract

A 40-year-old female with a history of metastatic cervical squamous cell carcinoma (SCC) with suspected radiographic evidence of metastasis to the lung presented with firm, tender skin lesions on the face that had been present for several months. She previously received 10 rounds of cisplatin and radiation and seven months after the treatment, the lesions appeared. Seven months after the initial appearance of the skin lesions, cancer treatment was switched to pembrolizumab (PD1-inhibitor) alone. Physical examination at presentation, revealed numerous very firm subcutaneous, minimally mobile, tender nodules on the face. Right forehead lesion was biopsied with a concern for metastatic disease and morphological as well as immunohistochemical findings revealed sarcoidal granulomas. Additionally, sampling of hilar adenopathy revealed noncaseating granulomas. The findings of sarcoidosis allowed discontinuation of chemo/immunotherapy as no confirmation of true metastatic disease was found. The skin findings in sarcoidosis can be present before or at the time of systemic involvement in 80% of cases. Although the incidence of malignancies in patients with sarcoidosis is higher than the general population, there has not been clear association of sarcoidosis with cervical SCC.  Pembrolizumab is the most common cause of immune checkpoint inhibitor-induced sarcoidosis -although the timeline of this patient’s sarcoidal granulomas preceded treatment with pembrolizumab. Our case illustrates that sarcoidosis can easily mimic metastatic cervical cancer radiographically, and our case highlights that tissue sampling is essential when metastatic disease is suspected to prevent unnecessary treatment.