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DOI: 10.1055/s-0032-1326087
Koinzidenz von sekundärem nodulärem malignem Melanom und Sarkoidose
Coexistence of Secondary Nodular Malignant Melanoma and SarcoidosisPublikationsverlauf
Publikationsdatum:
25. Februar 2013 (online)
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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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Literatur
- 1 Rubinstein I, Baum GL, Yellin A et al. Sarcoidosis: a cause of bilateral hilar lymphadenopathy after excision of malignant melanoma of the arm. South Med J 1985; 78: 1139-1140
- 2 Mackenzie H, Retsas S. Malignant melanoma co-existing with sarcoidosis: implications for prognosis and management. Melanoma Res 1996; 6: 71-72
- 3 Robert C, Schoenlaub P, Avril MF et al. Malignant melanoma and granulomatosis. Br J Dermatol 1997; 137: 787-792
- 4 Echigo T, Saito A, Takehara K et al. Coexistence of micrometastatic melanoma cells and sarcoid granulomas in all regional lymph nodes in a patient with acral melanoma Sarcoidosis and melanoma: a referral center study of 1,199 cases. Clin Exp Dermatol 2003; 28: 375-376
- 5 Seve P, Schott AM, Pavic M et al. Sarcoidosis and melanoma: a referral center study of 1,199 cases. Dermatology 2009; 219: 25-31
- 6 Malli F, Gourgoulianis KI, Daniil Z. Concurrent sarcoidosis and melanoma: coexistence more than by chance?. Dermatology 2010; 221: 320
- 7 Brincker H. Sarcoid reactions in malignant tumours. Cancer Treat Rev 1986; 13: 147-156
- 8 Fireman EM, Topilsky MR. Sarcoidosis: an organized pattern of reaction from immunology to therapy. Immunol Today 1994; 15: 199-201
- 9 Müller-Quernheim J. Interstitielle Lungenerkrankungen, Standards in Klinik, Diagnostik und Therapie. Stuttgart, New York: Georg Thieme; 2003
- 10 Hunninghake GW, Costabel U, Ando M et al. American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and other Granulomatous Disorders. Sarcoidosis Vasc Diffuse Lung Dis 1999; 16: 149-173
- 11 Baughman RP, Lower EE. Alternatives to corticosteroids in the treatment of sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 1997; 14: 121-130
- 12 Muller-Quernheim J, Kienast K, Held M et al. Treatment of chronic sarcoidosis with an azathioprine/prednisolone regimen. Eur Respir J 1999; 14: 1117-1122
- 13 Baughman RP, Lower EE. Infliximab for refractory sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2001; 18: 70-74
- 14 Hunninghake GW. Goal of the treatment for sarcoidosis. Minimize harm for the patient. Am J Respir Crit Care Med 1997; 156: 1369-1370
- 15 Wyser CP, van Schalkwyk EM, Alheit B et al. A randomized controlled trial. Am J Respir Crit Care Med 1997; 156: 1371-1376
- 16 Gutzmer R, Kapp A, Werfel T. [Successful treatment of skin and lung sarcoidosis with fumaric acid ester]. Hautarzt 2004; 55: 553-557
- 17 Wolter A, Muller M, Volker B et al. [Cutaneous and pulmonary sarcoidosis: Successful therapy with fumaric acid esters]. Hautarzt Oktober 2012; 63: 808-812
- 18 Barth D, Simon JC, Wetzig T. Malignant melanoma during treatment with fumaric acid esters – coincidence or treatment-related?. J Dtsch Dermatol Ges 2011; 9: 223-225
- 19 Liang X, De Vera ME, Buchser WJ et al. Inhibiting systemic autophagy during interleukin 2 immunotherapy promotes long-term tumor regression. Cancer Res 2012; 72: 2791-2801
- 20 Harhaji-Trajkovic L, Arsikin K, Kravic-Stevovic T et al. Chloroquine-mediated lysosomal dysfunction enhances the anticancer effect of nutrient deprivation. Pharm Res 2012; 29: 2249-2263
- 21 Heinzerling LM, Anliker MD, Muller J et al. Sarcoidosis induced by interferon-alpha in melanoma patients: incidence, clinical manifestations, and management strategies. J Immunother 2010; 33: 834-839
- 22 North J, Mully T. Alpha-interferon induced sarcoidosis mimicking metastatic melanoma. J Cutan Pathol 2011; 38: 585-589
- 23 Breitenseher M. Bildgebende Diagnostik und Therapie der Weichteiltumoren. Georg Thieme Verlag; 2008
- 24 Mohnike K. PET/CT-Atlas. 2. Aufl. Berlin, Heidelberg: Springer Verlag; 2011