Research Article Sarcoid-Like Mediastinal Lymphadenopathy in Gynecologic Malignancy Bilal H. Lashari , 1 Megumi Asai, 2 Gissele Randleman, 3 Martha Sack, 3 and Rajeshkumar Patel 4 1 Department of Internal Medicine, Abington Jeferson Health, Abington, PA, USA 2 Department of Surgery, Abington Jeferson Health, Abington, PA, USA 3 Department of Pathology, Abington Jeferson Health, Abington, PA, USA 4 Pulmonary-Critical Care Medicine, Abington Jeferson Health, Abington, PA, USA Correspondence should be addressed to Bilal H. Lashari; bilal.lashari@jeferson.edu Received 23 September 2017; Revised 11 January 2018; Accepted 17 January 2018; Published 14 February 2018 Academic Editor: Charlie Strange Copyright © 2018 Bilal H. Lashari et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Noncaseating granulomas are seen surrounding tumors with varying frequency, possibly as part of an immune response to tumor cells. However, data about the association of sarcoid with gynecologic malignancy is sparse. We performed a search of our institutional database for all EBUS-TBNA biopsies conducted within the past fve years that revealed granulomatous infammation. All adult female patients with a history of gynecologic malignancy were included. Patients with a history of sarcoidosis or fungal or mycobacterial infection were excluded. All patients with evidence of malignant cells on TBNA specimen were excluded. Our results revealed 65 patients with histologic diagnosis of a noncaseating granuloma on EBUS-TBNA. Five patients (7.69%) had a history of gynecologic malignancy. Two patients had evidence of PET-positive nodes on surveillance scans, which led directly to the examination. Our fndings suggest that distant malignancies may cause granulomatous lymphadenitis, through yet undefned mechanisms. As such, patients with evidence of mediastinal lymphadenopathy could beneft from routine sampling and histologic examination to defne the pathology in the correct clinical context. 1. Introduction Granulomatous infammation in lymph nodes can be attributable to nonspecifc infammation such as sarcoidosis or secondary to fungal and mycobacterial infection or foreign body reaction to respiratory inhalants [1]. It has been asso- ciated with neoplastic disease in regional and distant lymph nodes. It was described in association with Non-Small Cell Lung Cancer [2] and as high as 14% in Hodgkin disease [3]. Te causes of this phenomenon are currently unknown. Recent studies have indicated that granulomatous lym- phadenitis may precede the development of and follow the resolution of a wide range of malignancy [4, 5]. Regional chest diseases and lymphoma understandably involve mediastinal and hilar lymph nodes. However, lit- tle data is available regarding the relationship of nonlocal malignancy and mediastinal lymphadenopathy, especially gynecologic malignancy [6]. 2. Materials and Methods Afer IRB approval (IRB Number 16-046) a retrospective review was performed of all endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) biop- sies performed between 2013 and 2016 at our institution, with histologic fndings of granuloma, histiocytes, and giant cells. All female patients with age greater than 18 were included. Patients with a history of or other clinical features consistent with sarcoidosis or evidence of mycobacterial or fungal infec- tion by tissue staining or culture were excluded. In addition, all patients with evidence of malignant cells on tissue sam- pling, in addition to granulomatous features, were excluded. 3. Procedure All bronchoscopy procedures were performed under gen- eral anesthesia. A comprehensive and systematic ultrasonic Hindawi Pulmonary Medicine Volume 2018, Article ID 5141575, 4 pages https://doi.org/10.1155/2018/5141575