Table 1.

Clinical characteristics of the patients and the imaging and histologic findings of sarcoid-like granulomatosis of the lung

Baseline Patient Characteristics
	Patient 1	Patient 2	Patient 3	Patient 4
Age/Sex	61/Female	29/Male	65/Female	74/Male
Tumor type	Lung adenocarcinoma	Hodgkin lymphoma	Melanoma	Melanoma
Prior therapy	Carboplatin, pemetrexed, plus bevacizumab	ABVD; ICE; GND; autologous stem cell transplant with BEAM; brentuximab	Ipilimumab plus nivolumab	Carboplatin plus etoposide; ipilimumab; temozolomide;
Immunotherapy agent	Pembrolizumab	Nivolumab and Lirilumab	Pembrolizumab	Pembrolizumab
Treatment regimen	200 mg every 3 weeks	Nivolumab: 3mg/kg every 2 weeks; Lirilumab: 3mg/kg, every 4 weeks	2mg/kg every 3 weeks	2mg/kg every 3 weeks
Clinical Characteristics of Sarcoid-like Granulomatosis of the Lung
Onset since therapy initiation	8.0 months	20.7 months	11.3 months	14.3 months
New or worsening respiratory symptom	None	None	None	None
Treatment for sarcoid-like granulomatosis	Hold pembrolizumab	Hold nivolumab and lirilumab	Hold pembrolizumab	Hold pembrolizumab
Imaging Features of Sarcoid-like Granulomatosis of the Lung (Fig. 1)
	Patient 1	Patient 2	Patient 3	Patient 4
Lung	Focal nodular consolidation (2.1×1.5 cm) with GGO halo in the right lower lobe FDG-avid on PET	Focal nodular opacity (1.5×1.4 cm) with GGO halo in the right lower lobe Increased to a focal consolidation (3.3×2.0 cm) and new bilateral small nodular opacities after 2 months FDG-avid on PET	Focal round consolidation (2.5×1.8 cm) with GGO halo in the left upper lobe	Focal area of small centrilobular nodular opacities Gradually increased to a focal consolidation (3.9×2.8 cm) over 16 months in the right lower lobe
New or enlarging lymph nodes	None	None	None	None
Follow-up imaging	Consolidation markedly decreased on follow-up CT scans performed 2 and 4 months after holding pembrolizumab	Consolidation markedly decreased on follow-up CT performed 2 months later while on another immune-checkpoint inhibitor regimen	Consolidation resolved on follow-up CT performed 1 month after holding pembrolizumab	Consolidation markedly decreased on follow-up CT performed 4 months after holding pembrolizumab
Histologic Findings of Sarcoid-like Granulomatosis of the Lung (Fig. 2)
	Patient 1	Patient 2*	Patient 3	Patient 4
	Diffuse replacement of the lung parenchyma by large aggregates of epithelioid histiocytes forming non-necrotizing granulomas	Alveolar spaces filled by organizing fibroblasts, alveolar macrophages, numerous lymphocytes focally forming aggregates, scattered eosinophils, and rare epithelioid giant cells	N/A (Biopsy not performed)	Interstitial non-necrotizing granulomas with associated lymphocytic infiltrates and peri-airway granulomas with prominent giant cells

^*The patient also underwent biopsy of supraclavicular node that has been involved by lymphoma, which showed distorted architecture by nodules containing loose aggregates of histiocytes and giant cells with admixed lymphocytes rimmed by circumferential fibrosis, representing a pattern reminiscent of sarcoidosis.

ABVD: Doxorubicin Hydrochloride, Bleomycin, Vincristine Sulfate, Dacarbazine

ICE: Ifosfamide, Carboplatin, and Etoposide

GND: Gemcitabine, Navelbine, and Doxorubicin

BEAM: Carmustine, Etoposide, Cytarabine, and Melphalan

GGO: ground glass opacity

FDG: fluorodeoxyglucose

PET: positron emission tomography