BACKGROUND: A 68-year-old Caucasian woman was found to have an incidental mediastinal lymph node. She underwent biopsy, which revealed
sarcoidosis. There was no further treatment or evidence of recurrence over the ensuing 9 years. She was then diagnosed with low-grade
papillary thyroid cancer in the right posterior lobe and treated with total
thyroidectomy followed by radioactive
iodine therapy. Six months later, she was found to have elevated serum
thyroglobulin. Post-remnant ablation scan showed increased tracer uptake in the bed of the thyroid. Though two thyroid ultrasound scans were negative, she was treated with I-131 for possible recurrence. She then developed right hip
pain, prompting further investigation. Though a skeletal survey was negative, an 18-fluorodeoxyglucose positron emission tomography (PET) scan study revealed multiple hypermetabolic skeletal lesions in both humeri and the proximal left femur. In addition, hypermetabolic hilar and mediastinal nodes were noted. As widespread
cancer metastasis was suspected, bone biopsy was performed, which showed non-caseating
granulomas, consistent with recurrence of
sarcoidosis.
CONCLUSION: