Sarcoidosis and cancer - a diagnostic dilema

<bold>Introduction:</bold>The relationship between sarcoidosis and malignancies remains a controversial subject, since there is growing evidence that malignant tumors may incite a systemic granulomatous reaction indistinguishable from sarcoidosis, with conflicting data on the prognostic value of this peculiar association. <bold>Aim:</bold> to assess the frequency of association between sarcoidosis and malignancies and to highlight clinical features and evolution. <bold>Material and methods:</bold> We have analyzed 350 cases of sarcoidosis diagnosed by morphological and/or clinical-imaging criteria, during 2017-2024 years, from the Phthisiopneumology Institute "Chiril Draganiuc", Chisinau, Republic of Moldova. <bold>Results:</bold> We found 13 cases (3,7%) of sarcoidosis with morphological confirmation associated with a malignancy. Mean age was 60,6 ±9,8 years, and women prevailed with 10 cases (76,9%). In 4 cases sarcoidosis was the primary diagnosis and malignancy occurred at 6.0±2.1 years. In 5 cases, sarcoidosis was diagnosed within a year after diagnosing the malignant disease, and in another 4 cases - concomitantly, behaving as a sarcoid reaction. Overall we found: thyroid and hematopoietic system malignancies with 3 cases each, breast cancer - 2 cases, sarcoma, prostate cancer, gastric cancer, and basalioma -1 case each. Two patients died (15,3%), and the remaining cases required re-evaluation including repeated biopsies to exclude possible recurrence/ progression of the tumor. <bold>Conclusions:</bold> the association between sarcoidosis and neoplasia is rare (3,7%); patients suspected of sarcoidosis should be screened for thyroid disease, granulomatous reaction associated with malignancy is a challenge for the assessment of malignancy relapses.