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Abstract：
Bone location is uncommon in both sarcoidosis and in neck cancer (HNC). Diagnosis of a bone lesion is therefore challenging to distinguish its nature in a patient suffering from both diseases. We report the case of a 69-years-old woman referred for P16 positive HPV-HNC. Magnetic Resonance Imaging (MRI) showed T2 hypo-signal on iliac crest and spine. 18FDG-PET demonstrated radiotracer uptake on these locations suggesting bone metastasis. However, bone biopsy showed epithelioid granuloma without malignant cells compatible with sarcoidosis location. The diagnosis of both localized advanced HPV-HNC and systemic sarcoidosis (bone, central nervous system) were retained. The patient received corticosteroid regimen at 0.5mg/kg/day and Methotrexate for sarcoidosis and radiation and chemotherapy with platins for carcinoma. As granulomatous bone marrow infiltration may have an uptake on 18FDG-PET, bone sarcoidosis can mimic metastatic disease. In addition, MRI often fails to distinguish sarcoidosis lesions from metastatic lesion in bones. As no reliable imaging test can decipher both diseases, the description of our case reinforces the necessity to perform bone biopsy in a patient suffering from both conditions to expertise the nature of bone lesions.
摘要：
在结节病和颈部癌症（HNC）中，骨位置都不常见。因此,骨病变的诊断在患有两种疾病的患者中区分其性质是具有挑战性的。我们报告了一例因P16阳性HPV-HNC转诊的69岁女性。磁共振成像（MRI）显示T2低信号在髂棘和脊柱。18FDG-PET在这些位置显示放射性示踪剂摄取，提示骨转移。然而,骨活检显示上皮样肉芽肿无恶性细胞与结节病位置相容。局部晚期HPV-HNC和系统性结节病的诊断（骨，中枢神经系统）被保留。患者接受0.5mg/kg/天的皮质类固醇方案和甲氨蝶呤治疗结节病，放疗和铂类药物治疗癌症。由于肉芽肿性骨髓浸润可能在18FDG-PET上有摄取，骨结节病可以模拟转移性疾病。此外,MRI通常无法区分结节病病变与骨骼中的转移病变。由于没有可靠的成像测试可以破译这两种疾病，我们病例的描述加强了对患有两种疾病的患者进行骨活检的必要性，以了解骨病变的性质。
