Koinzidenz von sekundärem nodulärem malignem Melanom und Sarkoidose

Zusammenfassung

Wir diagnostizierten bei einer 46-jährigen Patientin mit sekundär nodulärem malignem Melanom (Tumoreindringtiefe nach Breslow 2,38 mm, pT3a) im Rahmen der Sentinel-Lymphnode-Biopsie eine Sarkoidose. In einem der entfernten Wächterlymphknoten fanden wir sogenannte „sarcoid-like lesions“, jedoch keine Mikrometastasen des Melanoms.

Daher und wegen auffälliger mediastinaler Lymphknoten in der CT und in der [¹⁸F]FDG PET-CT erfolgte zur weiteren Diagnosesicherung eine Mediastinoskopie mittels weiterer Lymphknotenbiopsie, um unsere Verdachtsdiagnose zu sichern. Auch in diesen Lymphknoten konnten erneut Granulome im Rahmen einer Sarkoidose, jedoch keine Mikrometastasen des Melanoms, histologisch gesichert werden.

Eine Koinzidenz von malignem Melanom und Sarkoidose war somit bewiesen.

Abstract

We diagnosed sarcoidosis in a 46-year-old woman with secondary nodular malignant melanoma (Breslow’s tumor thickness 2,38 mm, pT3a) accounting the sentinel lymphnode biopsy.

One of the removed lymphnodes histologically revealed sarcoid-like lesions, but no micrometastases of the melanoma.

Therefore and because of the demonstration of conspicuous mediastinal lymphnodes in the CT and PET-CT a mediastinoscopy combined with lymphnode biopsy followed, to ensure our suspected diagnosis. Histologically these lymphnodes again showed the sarcoid-like lesions of sarcoidosis, but no micrometastatic melanoma cells. Therefore the coexistence of a malignant melanoma and sarcoidosis was ensured. We discuss the possible treatment modalities in this situation.

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