Tuberc Respir Dis.  2012 Dec;73(6):320-324. 10.4046/trd.2012.73.6.320.

Sarcoidosis Presenting with Massive Pleural Effusion and Elevated Serum and Pleural Fluid Carbohydrate Antigen-125 Levels

• Lee IS
• Kim SB
• Moon CS
• Jung SM
• Kim SY
• Kim EY
• Jung JY
• Kang YA
• Kim YS
• Kim SK
• Chang J
• Park MS

• KMID: 1842925
• DOI: http://doi.org/10.4046/trd.2012.73.6.320

Abstract

A 55-year-old woman was admitted for an elevated serum carbohydrate antigen-125 (CA-125) level, and a left pleural effusion, which were detected at a routine health examination. Computed tomography of the chest was performed upon admission, revealing extensive bilateral paratracheal and mediastinal lymph node enlargement with a massive left-sided pleural effusion. Subsequent analysis of the pleural fluid demonstrated consistency with an exudate, no evidence of malignant cells, and a normal adenosine deaminase. However, the pleural fluid and serum CA-125 levels were 2,846.8 U/mL and 229.5 U/mL, respectively. A positron emission tomography did not reveal any primary focus of malignancy. Finally, a surgical mediastinoscopic biopsy of several mediastinal lymph nodes was performed, revealing non-necrotizing granulomas, consistent with sarcoidosis. After a month of treatment of prednisolone, the left pleural effusion had resolved, and after 2 months the serum CA-125 level was normalized.

Keyword

Sarcoidosis; Pleural Effusion; CA-125 Antigen

MeSH Terms

Adenosine Deaminase
Biopsy
CA-125 Antigen
Exudates and Transudates
Female
Granuloma
Humans
Lymph Nodes
Pleural Effusion
Positron-Emission Tomography
Prednisolone
Sarcoidosis
Thorax
Adenosine Deaminase
CA-125 Antigen
Prednisolone

Figure

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  Figure 1 (A) The initial chest X-ray showed a left-sided massive pleural effusion, which disappeared after 2 months of medication with oral prednisolone (B).

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  Figure 2 (A) The initial chest computed tomography showed a left-sided pleural effusion and mediastinal lymph nodes enlargement. (B) The 18F-fluorodeoxyglucose-positronemission tomography revealed intense uptake on the bilateral paratracheal, hilar, and supraclavicular lymph nodes.

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  Figure 3 (A) The fiberoptic bronchoscopic biopsy revealed non-necrotizing granulomas in the bronchial wall (H&E stain, ×100). (B) The mediastinoscopic biopsy of right paratracheal lymph node revealed that all normal structures were entirely replaced by non-caseating granulomas, each composed of aggregates of tightly clustered epithelioid cells (H&E stain, ×400).

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