{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T20:40:19Z","timestamp":1756327219744,"version":"3.44.0"},"reference-count":41,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,4,22]]},"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:p>A 40-year-old woman was referred to the Breast Unit with a solid lump in her right breast. Investigations revealed an invasive lobular carcinoma. The patient underwent a right-sided mastectomy and sentinel lymph node (LN) biopsy, which confirmed axillary LN involvement. The postsurgery staging CT showed unusual enlargement of mediastinal and hilar LN bilaterally. This was consistent with positron emission tomography\/CT and MRI, which further established the presence of several bone lesions. Determining the pathology within the LN and bones was pivotal in providing an accurate diagnosis and deciding subsequent management. However, histopathological analysis of the initial endobronchial ultrasound-guided fine-needle aspiration biopsy of mediastinal LN failed to identify definitive metastatic breast cancer cells. The case was extensively discussed in several multidisciplinary team meetings. Collective evidence, including clinical presentation, comparative imaging analysis, and further biopsies confirmed sarcoidosis with bone involvement-mimicking metastatic disease.<\/jats:p>","DOI":"10.1136\/bcr-2020-237516","type":"journal-article","created":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T13:19:01Z","timestamp":1620652741000},"page":"e237516","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Ossified diagnosis: sarcoidosis masquerading as metastatic breast cancer"],"prefix":"10.1136","volume":"14","author":[{"given":"Meiling","family":"MacDonald-Nethercott","sequence":"first","affiliation":[{"name":"School of Clinical Medicine, University of Cambridge, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Ples","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, University of Cambridge, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramona","family":"Woitek","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Cambridge, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma","family":"Beddowes","sequence":"additional","affiliation":[{"name":"Department of Oncology, Cancer Research UK Cambridge Research Institute, Cambridge, Cambridgeshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,5,10]]},"reference":[{"key":"2025082713171161000_14.5.e237516.1","doi-asserted-by":"publisher","DOI":"10.1097\/00002281-200007000-00016"},{"key":"2025082713171161000_14.5.e237516.2","unstructured":"Public Health England . Tuberculosis in England 2019 report about public health England 2019:220."},{"key":"2025082713171161000_14.5.e237516.3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fcimb.2020.00065","article-title":"Mycobacterium tuberculosis dissemination plays a critical role in pathogenesis","volume":"10","author":"Moule","year":"2020","journal-title":"Front Cell Infect Microbiol"},{"key":"2025082713171161000_14.5.e237516.4","doi-asserted-by":"publisher","DOI":"10.1007\/s00408-012-9440-6"},{"key":"2025082713171161000_14.5.e237516.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1204699"},{"key":"2025082713171161000_14.5.e237516.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2559.1995.tb00620.x"},{"key":"2025082713171161000_14.5.e237516.7","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(07)70286-4"},{"key":"2025082713171161000_14.5.e237516.8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra050570"},{"key":"2025082713171161000_14.5.e237516.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1954.02940490011003"},{"key":"2025082713171161000_14.5.e237516.10","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/23.1.146"},{"key":"2025082713171161000_14.5.e237516.11","doi-asserted-by":"publisher","DOI":"10.1097\/md.0b013e3180679130"},{"key":"2025082713171161000_14.5.e237516.12","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2017-053273"},{"key":"2025082713171161000_14.5.e237516.13","first-page":"13635","article-title":"Clinical and pathologic diagnosis and different diagnosis of syphilis cervical lymphadenitis","volume":"8","author":"Yuan","year":"2015","journal-title":"Int J Clin Exp Pathol"},{"key":"2025082713171161000_14.5.e237516.14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4172\/2327-5073.1000184","article-title":"Granulomatous syphilis: a pattern to remember. Case report and review of literature","volume":"04","author":"Alejandro A Gru","year":"2015","journal-title":"Clin Microbiol"},{"key":"2025082713171161000_14.5.e237516.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jctube.2017.02.001"},{"key":"2025082713171161000_14.5.e237516.16","unstructured":"Hoon Tan P , Ellis I , Allison K . The 2019 WHO classification of tumours of the breast. Histopathology 2020."},{"key":"2025082713171161000_14.5.e237516.17","doi-asserted-by":"crossref","first-page":"482","DOI":"10.21037\/atm.2020.03.55","article-title":"Incidence of patients with bone metastases at diagnosis of solid tumors in adults: a large population-based study","volume":"8","author":"Huang","year":"2020","journal-title":"Ann Transl Med"},{"key":"2025082713171161000_14.5.e237516.18","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-06-0931"},{"key":"2025082713171161000_14.5.e237516.19","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60680-7"},{"key":"2025082713171161000_14.5.e237516.20","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.160.2.ats4-99"},{"key":"2025082713171161000_14.5.e237516.21","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/j.mpmed.2020.03.011","article-title":"Pulmonary sarcoidosis","volume":"48","author":"Butler","year":"2020","journal-title":"Medicine"},{"key":"2025082713171161000_14.5.e237516.22","doi-asserted-by":"publisher","DOI":"10.1186\/2193-1801-2-1"},{"key":"2025082713171161000_14.5.e237516.23","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.semarthrit.2017.02.004","article-title":"Clinical characteristics of patients with bone sarcoidosis","volume":"47","author":"Zhou","year":"2017","journal-title":"Semin Arthritis Rheum"},{"key":"2025082713171161000_14.5.e237516.24","first-page":"7643","article-title":"Coexistence of sarcoidosis and metastatic lesions: a diagnostic and therapeutic dilemma","volume":"14","author":"Spiekermann","year":"2017","journal-title":"Oncol Lett"},{"key":"2025082713171161000_14.5.e237516.25","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.24261"},{"key":"2025082713171161000_14.5.e237516.26","unstructured":"NICE . Early and locally advanced breast cancer. Diagnosis and treatment. NICE Guidel [NG101], 2018. Available: https:\/\/www.nice.org.uk\/guidance\/ng101"},{"key":"2025082713171161000_14.5.e237516.27","doi-asserted-by":"publisher","DOI":"10.1002\/jmri.24548"},{"key":"2025082713171161000_14.5.e237516.28","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1053\/j.seminoncol.2013.05.015","article-title":"Sarcoidosis mimicking metastatic bone disease in head and neck cancer","volume":"40","author":"Arana Yi","year":"2013","journal-title":"Semin Oncol"},{"key":"2025082713171161000_14.5.e237516.29","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/RLU.0b013e31823eaaf0","article-title":"False-Positive bone metastases on PET\/CT secondary to sarcoidosis in a patient with rectal cancer","volume":"37","author":"Montini","year":"2012","journal-title":"Clin Nucl Med"},{"key":"2025082713171161000_14.5.e237516.30","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1111\/j.1524-4741.2011.01136.x","article-title":"Sarcoidosis mimicking metastatic breast cancer","volume":"17","author":"Bush","year":"2011","journal-title":"Breast J"},{"key":"2025082713171161000_14.5.e237516.31","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1016\/S0140-6736(78)91972-4","article-title":"Serum angiotensin-converting enzyme (SACE) in sarcoidosis and other granulomatous disorders","volume":"2","author":"Studdy","year":"1978","journal-title":"Lancet"},{"key":"2025082713171161000_14.5.e237516.32","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00050106"},{"key":"2025082713171161000_14.5.e237516.33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3332\/ecancer.2015.537","article-title":"Sarcoidosis with bone involvement mimicking metastatic disease at (18)F-FDG PET\/CT: problem solving by diffusion whole-body MRI","volume":"9","author":"Conte","year":"2015","journal-title":"Ecancermedicalscience"},{"key":"2025082713171161000_14.5.e237516.34","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.11.8185"},{"key":"2025082713171161000_14.5.e237516.35","doi-asserted-by":"crossref","DOI":"10.1007\/s11882-020-00953-1","article-title":"Localized granulomatous with polyangiitis (GPA): varied clinical presentations and update on treatment","volume":"20","author":"Sattui","year":"2020","journal-title":"Curr Allergy Asthma Rep"},{"key":"2025082713171161000_14.5.e237516.36","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.jaut.2014.01.028","article-title":"Diagnosis and classification of granulomatosis with polyangiitis (aka Wegener\u2019s granulomatosis)","volume":"48\u201349","author":"Lutalo","year":"2014","journal-title":"J Autoimmun"},{"key":"2025082713171161000_14.5.e237516.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2009.02.004"},{"key":"2025082713171161000_14.5.e237516.38","doi-asserted-by":"publisher","DOI":"10.1002\/art.27240"},{"key":"2025082713171161000_14.5.e237516.39","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1038\/nrrheum.2017.142","article-title":"Giant cell arteritis and polymyalgia rheumatica: current challenges and opportunities","volume":"13","author":"Dejaco","year":"2017","journal-title":"Nat Rev Rheumatol"},{"key":"2025082713171161000_14.5.e237516.40","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1100359"},{"key":"2025082713171161000_14.5.e237516.41","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(16)30173-8. PubMed PMID: 27156434."}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-237516","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T20:17:25Z","timestamp":1756325845000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-237516"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5]]},"references-count":41,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,10]]},"published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1136\/bcr-2020-237516"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-237516","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,5]]}}}