Conclusions:
We report a rare association between renal cancer and sarcoidosis. Because of its rarety, physiopathological link between these two diseases and prognostic value of granulomatosis remains unclear. We propose close monitoring of the incidence of renal neoplasia through a prospective study of patients with sarcoidosis to better understand and characterize this association. On the other hand, before claiming an association between renal cancer and sarcoid-like reaction, the other causes such tuberculosis or sarcoidosis must be excluded by a careful clinical history, diagnostic tests and pathologic examination.
[1]  Bottone AC, Labarbera M, Asadourian A, Barman A, Richie C. Renal sarcoidosis coexisting with hypernephroma, Urology 1993;41: 157–159.
[2]  Bonifazi M, Bravi F, Gasparini S, La Vecchia C, Gabrielli A, Wells AU,
Renzoni EA.Sarcoidosis and cancer risk: systematic review and meta-analysis of observational studies. Chest 2015:145; 778–791.
[3]  Heldmann M, Behm W, Reddy MP, Bozeman C, Welman G, Abreo F,
Minagar A. Pseudotumoral renal sarcoid: MRI, PET, and MDCT appearance with pathologic correlation, AJR Am. J. Roentgenol. 2005;185:697–699.
[4]  Majeed NK, Acosta AM, Kajdacsy-Balla A, Setty S, Aardsma NA.Granulomas within renal epithelial neoplasms in patients with sarcoidosis: A causal association? Pathol Res Pract. 2017 Nov;213(11):1431-1434. doi: 10.1016/j.prp.2017.07.021.
[5]  Moder KG, Litin SC, Gaffey TA. Renal cell carcinoma associated with sarcoid-like tissue reaction. Mayo Clin Proc 1990;65:1498–501.
[6]Arora K, Divatia MK, Truong L, Shen SS, Ayala AG, Ro JY.Sarcoid-like granulomas in renal cell carcinoma: The Houston Methodist Hospital experience. Ann Diagn Pathol. 2017 Dec;31:62-65. doi: 10.1016/j.anndiagpath.2017.07.003. Epub 2017 Jul 29.
[7]  Khatua S, Bose K, Bandyopadhyay A, Banerjee A. A rare association of sarcoid- 
like granuloma with renal cell carcinoma, J. Cancer Res. Ther. 2015;11:1033.
[8]  Piscioli I, Donato S, Morelli L, Del Nonno F, Licci S. Renal cell carcinoma with sarcomatoid features and peritumoral sarcoid-like granulomatous reaction: report 
of a case and review of the literature, Int. J. Surg. Pathol. 2008;16:345–348.
[9]  Ouellet S, Albadine R, Sabbagh R. Renal cell carcinoma associated with peritumoral sarcoid-like reaction without intratumoral granuloma. Diagn Pathol 2012;7:28.
[10] Kurata A, Terado Y, Schulz A, Fujioka Y, Franke FE. Inflammatory cells in the formation of tumor-related sarcoid reactions. Hum Pathol. 2005;36:546-554.
[11] Pavic M, Debourdeau P, Vacelet V Rousset H. Place de la pathologie granulomateuse au cours des cancers Sarcoidosis and sarcoid reactions in cancer. Rev mede interne. 2008 ;29:39-45

AUTHOR CONTRIBUTIONS :

MK and HJ : wrote the first draft of the article, participated in collecting patient data (clinical history), reviewed the literature, interpreted the clinical findings. IM, FBH, LR, LBF and MKZ : critically reviewed and edited drafts. AZ and SH : were the pathologists.

ACKNOWLEDGMENTS :

We are indebted to Drs Hela Jebali, ikram mami, lamia rais, lilia ben fatma and karim zouaghi for their active and thoughtful contribution to the management of the patient. We also thank Dr Alia zhini and dr slim haout for having interpreted the patient biopsy.

CONFLICT OF INTEREST :

We have no financial interest or conflict of interest in association with this work.

ETHICAL APPROVAL :

The two patients have given their written informed consent to publish this cases including publication of images.
This manuscript has not been published previously and is not being considered for publication by another journal.

KEY CLINICAL MESSAGE :

Granulomatosis can be observed in cancer patients. Granulomatosis reaction associated with tumor has been designated as sarcoid-like reaction. On the other side, very few cases of association of systemic sarcoidosis and neoplasia have been reported.

CORRESPONDING AUTHOR :

Meriam khadhar : khadhar-meriam@hotmail.fr