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Gaffney B, Murphy DJ. Approach to Pulmonary Nodules in Connective Tissue Disease. Semin Respir Crit Care Med 2024; 45:316-328. [PMID: 38547916 DOI: 10.1055/s-0044-1782656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
The assessment of pulmonary nodules is a common and often challenging clinical scenario. This evaluation becomes even more complex in patients with connective tissue diseases (CTDs), as a range of disease-related factors must also be taken into account. These diseases are characterized by immune-mediated chronic inflammation, leading to tissue damage, collagen deposition, and subsequent organ dysfunction. A thorough examination of nodule features in these patients is required, incorporating anatomic and functional information, along with patient demographics, clinical factors, and disease-specific knowledge. This integrated approach is vital for effective risk stratification and precise diagnosis. This review article addresses specific CTD-related factors that should be taken into account when evaluating pulmonary nodules in this patient group.
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Affiliation(s)
- Brian Gaffney
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - David J Murphy
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College, Dublin, Ireland
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2
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Li H, Xu Y, Guo Q, Zhang T, Zhou S, Wang Q, Tian Y, Cheng Y, Guo C. Causality Assessment Between Idiopathic Inflammatory Myopathies and Lung Cancer: A Bidirectional 2-Sample Mendelian Randomization. J Clin Rheumatol 2024; 30:138-144. [PMID: 38351510 DOI: 10.1097/rhu.0000000000002075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND Although observational studies have revealed associations between idiopathic inflammatory myopathies (IIMs) and lung cancer (LC), they have not established a causal relationship between these 2 conditions. METHODS We used a 2-sample Mendelian randomization approach to examine the bidirectional causal associations between IIMs and LC, using single-nucleotide polymorphisms selected from high-quality genome-wide association studies in the FinnGen database. Sensitivity analyses were conducted to assess potential heterogeneity and pleiotropy impacts on the Mendelian randomization results. RESULTS Our analysis demonstrated a positive causal effect of genetically increased IIM risk on LC (odds ratio, 1.114; 95% confidence interval, 1.057-1.173; p = 5.63 × 10 -5 ), particularly on the lung squamous cell carcinoma subtype (odds ratio, 1.168, 95% confidence interval, 1.049-1.300, p = 0.00451), but not on lung adenocarcinoma or small cell lung cancer. No causal effect of LC on IIMs was identified. Sensitivity analyses indicated that horizontal pleiotropy was unlikely to influence causality, and leave-one-out analysis confirmed that the observed associations were not driven by a single-nucleotide polymorphism. CONCLUSION Our findings offer compelling evidence of a positive causal relationship between IIMs and LC, particularly with regard to lung squamous cell carcinoma, in the European population. Conversely, there is no evidence of LC causing IIMs. We recommend that LC diagnosis consider the specific characteristics of IIMs.
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Affiliation(s)
| | | | - Qin Guo
- Department of Rheumatology and Immunology, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen
| | - Tiantian Zhang
- Department of Rheumatology and Immunology, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen
| | - Shufen Zhou
- Department of Rheumatology and Immunology, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen
| | - Qianqian Wang
- Department of Rheumatology and Immunology, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen
| | - Ye Tian
- Department of Rheumatology and Immunology, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen
| | - Yuanxiong Cheng
- Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Chengshan Guo
- Department of Rheumatology and Immunology, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen
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3
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Kim SY, Kim DK, Choi SY, Chung C. Comparative analysis of immunotherapy responses in small cell lung cancer patients with dermatomyositis. Thorac Cancer 2024; 15:672-677. [PMID: 38352989 DOI: 10.1111/1759-7714.15238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/20/2024] [Indexed: 03/13/2024] Open
Abstract
Cancer-associated dermatomyositis (CAD), a paraneoplastic syndrome characterized by dermatomyositis (DM), frequently presents in association with small cell lung cancer (SCLC). Although the advent of immune checkpoint inhibitors (ICIs) has revolutionized cancer treatment, their efficacy and safety in patients with concurrent autoimmune diseases (AD) and malignancies remains uncertain. Several studies have suggested the safe administration of ICIs in patients with AD, indicating that successful cancer therapy can alleviate CAD symptoms. Conversely, other studies have raised concerns about the potential for ICIs to exacerbate AD flares or immune-related adverse events (irAEs). A comparative analysis of two cases from our institution emphasizes the variability in ICI responses among SCLC patients with CAD. One patient, previously reported as a case study, exhibited significant clinical improvement in DM symptoms after ICI administration, whereas the other developed severe exfoliative skin changes and experienced an unfavorable prognosis. This variability emphasizes the need for careful patient selection and close monitoring during ICI treatment. We hypothesized that overweight or obese individuals and those with severe initial skin lesions and elevated lactate dehydrogenase levels are more susceptible to developing irAEs following ICI therapy. Therefore, caution is advised when considering immunotherapy in these patients.
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Affiliation(s)
- So-Yun Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Duk Ki Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Song-Yi Choi
- Department of pathology, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Chaeuk Chung
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
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4
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Guan X, Qiu S, Xu Y, Zu J, Sun C, Guo Y, Wang X, Ma K. Small cell lung cancer with dermatomyositis: a case report. Front Oncol 2024; 14:1325991. [PMID: 38414744 PMCID: PMC10898245 DOI: 10.3389/fonc.2024.1325991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/22/2024] [Indexed: 02/29/2024] Open
Abstract
Dermatomyositis represents an autoimmune disorder characterized by notable skin and muscular manifestations. The annual incidence of dermatomyositis stands at approximately (5~10)/1 million individuals. Notably, patients with malignant tumors exhibit an elevated risk of developing dermatomyositis compared to the general population. However, in cases where dermatomyositis co-occurs with malignancy, the efficacy of hormone therapy alone tends to be suboptimal. Moreover, reports addressing the correlation between tumor treatment and the management of dermatomyositis are scarce. A 60-year-old male patient presented with dermatomyositis, initially manifesting through symptoms such as rash, muscle weakness, and dysphagia. Despite undergoing standard hormone therapy, there was no discernible improvement in the dermatomyositis symptoms. Considering the patient's concomitant troublesome cough, further investigations were conducted, including CT, PET-CT, and pathological biopsy. These assessments confirmed the diagnosis of limited-stage small cell lung cancer (T1cN3M0 IIIB). Notably, in this patient, dermatomyositis was suspected to be a paraneoplastic syndrome associated with small cell lung cancer. Standard chemotherapy and radiotherapy were employed to treat the small cell lung cancer, resulting in partial remission after two treatment cycles. As the malignancy regressed, a notable improvement in dermatomyositis symptoms was observed, subsequently leading to a gradual reduction in the prescribed hormone dosage. In conclusion, we present a comprehensive case study of dermatomyositis as a paraneoplastic syndrome throughout the treatment process. The response to tumor therapy coincided with the amelioration of dermatomyositis symptoms. Therefore, diligent malignancy screening is imperative for patients diagnosed with dermatomyositis.
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Affiliation(s)
- Xiaomin Guan
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Shi Qiu
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yinghui Xu
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jianjiao Zu
- Dermatology Department, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Chao Sun
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ye Guo
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xu Wang
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Kewei Ma
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China
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5
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Dermatomyositis Associated with Lung Cancer: A Brief Review of the Current Literature and Retrospective Single Institution Experience. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010040. [PMID: 36675990 PMCID: PMC9861216 DOI: 10.3390/life13010040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
Dermatomyositis is a rare inflammatory myopathy that is often related to lung cancer. In this retrospective observational study, we analyzed data from patients diagnosed with lung cancer at Soroka University Medical Center between January 2017 and July 2021. A total of 689 patients with lung cancer were included in this study, 97 of whom had small cell lung cancer and 592 had non-small cell lung cancer. We identified a single patient (60-year-old female) who presented with signs and symptoms of dermatomyositis, which was later confirmed to be associated with lung cancer as a paraneoplastic syndrome. Both our study and a recent review of the literature illustrate the temporal link between dermatomyositis and lung cancer, as well as reinforce the need for heightened cancer screenings in DM patients.
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6
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Kim Y, Park D, Choi SY, Chung C. Immune checkpoint inhibitor therapy in a patient with small cell lung cancer and anti-transcriptional intermediary factor 1-γ antibody-positive dermatomyositis: A case report. Thorac Cancer 2022; 13:2808-2811. [PMID: 35982637 PMCID: PMC9527166 DOI: 10.1111/1759-7714.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/28/2022] [Accepted: 07/31/2022] [Indexed: 11/27/2022] Open
Abstract
Autoimmune diseases (ADs) are closely related to cancers; 30% of dermatomyositis (DM) cases are associated with malignancy. In lung cancer patients accompanied by DM, the most frequent cancer type is small cell lung cancer (SCLC). Anti‐transcriptional intermediary factor 1 γ (anti‐TIF1γ) antibody is a promising marker for the assessment of cancer risk in DM patients. The recent use of immune checkpoint inhibitors (ICIs) for extensive‐stage SCLC has improved patient outcomes. However, clinical trials of ICI excluded most patients with ADs because of the increased risk of toxicity. Nevertheless, recent evidences suggest that ICI may be appropriate for AD patients. A 76‐year‐old man diagnosed with extensive‐stage SCLC and anti–TIF1γ Ab‐positive DM developed limb weakness and typical skin manifestations of DM. Positron emission tomography‐computed tomography showed diffuse uptake in all muscles. The results of a nerve conduction study and electromyography were consistent with acute myopathy. Electron microscopy showed tubuloreticular inclusions in endothelial cells. He was treated with corticosteroids for DM and chemotherapy with atezolizumab for SCLC. Despite concerns regarding the use of ICI because of DM, atezolizumab was administered under close observation. After treatment, tumor size decreased and his symptoms improved significantly. We believe that the response of SCLC to chemotherapy including ICI, had a positive effect on the improvement of DM. Clinicians should consider ICIs for SCLC patients with DM and carefully monitor the patient's symptoms during treatment.
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Affiliation(s)
- Yoonjoo Kim
- Division of Pulmonology, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Dongil Park
- Division of Pulmonology, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Song-Yi Choi
- Department of pathology, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Chaeuk Chung
- Division of Pulmonology, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
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7
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Lei Y, Liu C, Wan X, Yang Y, Yao Y, Luo L, Huang T, Li J. Polymyositis as a paraneoplastic syndrome of a patient with primary pulmonary lymphoepithelioma-like carcinoma: a case report and literature review. J Cardiothorac Surg 2022; 17:120. [PMID: 35581657 PMCID: PMC9113618 DOI: 10.1186/s13019-022-01860-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background Pulmonary lymphoepithelioma-like carcinoma (LELC) is a rare type of non-small cell lung cancer, which mostly occurred in non-smoking Asian populations. The prognosis of this tumor is better than other lung cancers. Polymyositis, a kind of idiopathic inflammatory myopathies, may negatively affect the prognosis of patients with lung cancer as a paraneoplastic syndrome (PNPS). LELC is seldomly accompanied by PNPS, thus the treatment strategy and prognosis should be discussed. Case presentation We report a 49-year-old female patient who was hospitalized for “symmetric limb weakness and pain for more than 2 months”. Glucocorticoid-based anti-inflammatory therapy had been performed for over 3 weeks before the patient was hospitalized, however, in vain. The result of serum autoimmune antibody showed Anti-nRNP/Sm ( +). The serum level of myoglobin, lactate dehydrogenase and creatine kinase elevated significantly. An electromyogram revealed peripheral nerves injury and myogenic damages. Imaging showed a mass in the posterior basal segment of the left lung. A percutaneous transthoracic needle biopsy was performed and the pathological result was LELC. The patient was diagnosed with pulmonary LELC accompanied by polymyositis. Positron emission tomography-computed tomography (PET-CT) showed only ipsilateral hilar and mediastinal lymph nodes metastasis. Video-assisted thoracoscopic left lower lobectomy and systematic mediastinal lymphadenectomy were performed. The postoperative pathological stage was T2N2M0, IIIA (UICC 8th), and the patient received adjuvant chemotherapy and subsequent radiotherapy. The patient was followed up for 5 months with no recurrence of tumor and the limb weakness and pain were relieved apparently after the successful comprehensive treatment of her primary tumor. Conclusion Pulmonary LELC is a rare subtype of non-small cell lung cancer seldomly accompanied by PNPS. Though polymyositis is associated with lung cancer, it is easy to ignore this relationship when a patient is diagnosed with LELC in the clinic. Surgery based comprehensive treatment of primary tumor can lead to a prospective prognosis in pulmonary LELC patients with PNPS. And successful treatment of pulmonary LELC can also improve symptoms of PNPS.
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Affiliation(s)
- Yu Lei
- Department of Cardiothoracic Surgery, The First People's Hospital of Neijiang, Shizhong District, No. 1866, West Section of Hanan Avenue, Neijiang, 641000, Sichuan, China
| | - Caiyang Liu
- Department of Cardiothoracic Surgery, The First People's Hospital of Neijiang, Shizhong District, No. 1866, West Section of Hanan Avenue, Neijiang, 641000, Sichuan, China
| | - Xiu Wan
- Department of Cardiothoracic Surgery, The First People's Hospital of Neijiang, Shizhong District, No. 1866, West Section of Hanan Avenue, Neijiang, 641000, Sichuan, China
| | - Yanhui Yang
- Department of Cardiothoracic Surgery, The First People's Hospital of Neijiang, Shizhong District, No. 1866, West Section of Hanan Avenue, Neijiang, 641000, Sichuan, China
| | - Yi Yao
- Department of Cardiothoracic Surgery, The First People's Hospital of Neijiang, Shizhong District, No. 1866, West Section of Hanan Avenue, Neijiang, 641000, Sichuan, China
| | - Lei Luo
- Department of Cardiothoracic Surgery, The First People's Hospital of Neijiang, Shizhong District, No. 1866, West Section of Hanan Avenue, Neijiang, 641000, Sichuan, China
| | - Tingyu Huang
- Department of Pathology, The First People's Hospital of Neijiang, Neijiang, 641000, Sichuan, China
| | - Ji Li
- Department of Cardiothoracic Surgery, The First People's Hospital of Neijiang, Shizhong District, No. 1866, West Section of Hanan Avenue, Neijiang, 641000, Sichuan, China.
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8
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Update on Malignancy in Myositis—Well-Established Association with Unmet Needs. Biomolecules 2022; 12:biom12010111. [PMID: 35053259 PMCID: PMC8773676 DOI: 10.3390/biom12010111] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 12/31/2022] Open
Abstract
Idiopathic inflammatory myopathies are a group of rare connective tissue diseases with a well-documented association with malignancy. The mechanisms underlying the increased risk of neoplasms in the course of myositis are not fully understood. The Pubmed database has been thoroughly screened for articles concerning cancer-associated myositis (CAM). The article summarizes the current state of knowledge on the epidemiology and pathogenesis of CAM. Furthermore, it analyses potential risk and protective factors for developing CAM, with particular emphasis on the association with distinct serological profiles. The review summarizes recommendations proposed so far for the management of CAM and presents a novel scheme for cancer screening proposed by the authors. Moreover, promising areas requiring further research were indicated.
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9
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Padniewski JJ, Nelson E, Mian I, Laczniak A, Ives S, Nasr R. Paraneoplastic myopathy in pancreatic cancer: a case report and literature review. J Community Hosp Intern Med Perspect 2021; 11:847-851. [PMID: 34804404 PMCID: PMC8604545 DOI: 10.1080/20009666.2021.1982487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Dermatomyositis (DM) and polymyositis (PM) are both immune-mediated inflammatory myopathies known to occur in paraneoplastic syndromes associated with a new diagnosis of malignancy, most commonly breast, ovarian, lung, pancreatic, stomach, colorectal, and Non-Hodgkin’s lymphoma1 in DM and breast, lung, bladder cancer, and Non-Hodgkin’s lymphoma in PM. 2,3,4 While inflammatory markers such as creatine kinase (CK) may be elevated with either DM or PM, marked elevation is rare. Herein, we report a case of newly diagnosed pancreatic cancer presenting with inflammatory myopathy and marked CK elevation. We review the frequency of PM as a paraneoplastic syndrome, the association with marked CK elevation, and the association with pancreatic cancer.
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Affiliation(s)
| | - Elizabeth Nelson
- Department of Medicine , Hennepin Healthcare Internal Medicine Residency, Minneapolis, MN, USA
| | - Istiaq Mian
- Department of Medicine, SSM Health, Madison, WI, USA
| | | | - Samuel Ives
- Division of General Internal Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Rawad Nasr
- Division of General Internal Medicine, Hennepin Healthcare, Minneapolis, MN, USA.,Division of Rheumatology, Hennepin Healthcare, Minneapolis, MN, USA
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10
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Miyashita K, Kajikawa H, Utsunomiya T, Hosaka M, Naito Y, Tomimoto H. [Dermatomyositis with squamous cell carcinoma of the lungs secondary to nivolumab treatment: a case report]. Rinsho Shinkeigaku 2020; 60:768-772. [PMID: 33115992 DOI: 10.5692/clinicalneurol.cn-001443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 74-year-old man was administered nivolumab to treat recurrent squamous cell carcinoma of the lungs. He developed fatigue, redness on the front of his neck, muscle weakness, and difficulty in swallowing after receiving the third course of nivolumab. Physical and neurological examinations showed proximal limb muscle weakness, periorbital erythema, and erythema of the front of his neck as well as fingers. Laboratory investigations revealed elevated serum CK and aldolase levels, and he was diagnosed with dermatomyositis. We initiated steroid pulse therapy and intravenous immunoglobulin therapy; however, he died of advanced lung cancer. Immune checkpoint inhibitor-induced neuromuscular disease is increasingly being observed in clinical practice. We report a rare case of dermatomyositis with squamous cell carcinoma of the lungs secondary to nivolumab treatment.
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Affiliation(s)
| | | | | | - Makoto Hosaka
- Department of Thoracic Surgery, Suzuka Kaisei Hospital
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11
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Lim JL, Yusof NS, Md Tarekh NA, Abdul Rahman R. Dermatomyositis Anteceding Lung Adenocarcinoma. Cureus 2020; 12:e11580. [PMID: 33364104 PMCID: PMC7749829 DOI: 10.7759/cureus.11580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Dermatomyositis is often presented as paraneoplastic syndrome. The diagnosis of dermatomyositis can prompt clinicians to further investigate the underlying cause, in particular malignancy. This case report illustrates the association of lung adenocarcinoma and dermatomyositis with antecedent presentation of cutaneous and musculoskeletal manifestations, one year prior to the diagnosis of carcinoma.
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Affiliation(s)
- Jin Lee Lim
- Respiratory Medicine, Hospital Sultanah Aminah, Johor Bahru, MYS
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12
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Anwar A, Jafri F, Ashraf S, Jafri MAS, Fanucchi M. Paraneoplastic syndromes in lung cancer and their management. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:359. [PMID: 31516905 DOI: 10.21037/atm.2019.04.86] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Paraneoplastic syndromes are most frequently associated with lung cancer. This review considers a variety of paraneoplastic syndromes associated with lung cancer and discusses their pathophysiology, clinical features and management options.
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Affiliation(s)
- Asad Anwar
- Department of Internal Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Firas Jafri
- Department of Internal Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Sara Ashraf
- Department of Hematology/Oncology, Marshall University, Huntington, WV, USA
| | - Mohammad Ali S Jafri
- Department of Hematology/Oncology, Westchester Medical Center, Valhalla, NY, USA
| | - Michael Fanucchi
- Department of Hematology/Oncology, Westchester Medical Center, Valhalla, NY, USA
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13
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Palakkuzhiyil N, Namitha R, Rakhesh SV, Thomas R, Uvais NA. Dermatomyositis associated with adenocarcinoma of the lung: A case report. J Family Med Prim Care 2019; 8:754-756. [PMID: 30984709 PMCID: PMC6436299 DOI: 10.4103/jfmpc.jfmpc_467_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The association of dermatomyositis and underlying malignancies, especially small cell and squamous cell carcinoma of the lung, has been recognized a long time ago. We report the case of a 63-year-old male chronic smoker with adenocarcinoma lung associated with dermatomyositis. The occurrence of dermatomyositis should be considered as a potential presentation of paraneoplastic syndromes and physicians encountering similar clinical situations should perform extensive diagnostic work-up to exclude underlying neoplastic lesions.
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Affiliation(s)
- Naseem Palakkuzhiyil
- Department of Neurology, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
| | - R Namitha
- Department of Pulmonology, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
| | - S V Rakhesh
- Department of Dermatology, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
| | - Rinu Thomas
- Department of Internal Medicine, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
| | - N A Uvais
- Department of Psychiatry, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
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14
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Ground-glass opacity heralding invasive lung adenocarcinoma with prodromal dermatomyositis: a case report. J Cardiothorac Surg 2018; 13:20. [PMID: 29415746 PMCID: PMC5804049 DOI: 10.1186/s13019-018-0705-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/24/2018] [Indexed: 12/31/2022] Open
Abstract
Background Dermatomyositis, an inflammatory myopathy with cutaneous involvement, is associated with malignancy and often manifests paraneoplastically. While co-occurrence with small cell carcinoma is well attested, primary lung adenocarcinoma, which may present as focal ground-glass opacification on computed tomography of the thorax, is less frequently coincident. Case presentation We report the case of a 72-year-old female patient with dermatomyositis — treated with a combination of prednisone, methotrexate, and intravenous immunoglobulin — and an indolent, subsolid, non-hypermetabolic pulmonary lesion, which was determined to be invasive primary lung adenocarcinoma. Supporting a paraneoplastic basis, immunosuppressive therapy was discontinued following tumor excision without relapse of signs or symptoms of dermatomyositis. Conclusions While dermatomyositis prodromal to lung adenocarcinoma is not without precedent, association with an indolent, subsolid lesion has, to the best of our knowledge, not been reported. The case described herein illustrates the importance of maintaining a high index of suspicion for malignancy in the setting of dermatomyositis.
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15
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Lee WY, Kastelik J, Campbell A, Avery G, McGivern D, Lind M. A case report of dermatomyositis associated with small cell lung cancer. TUMORI JOURNAL 2018. [DOI: 10.1177/030089161209800628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dermatomyositis associated with lung cancer is uncommon. Dermatomyositis associated with small cell lung cancer is very rare and carries a poor prognosis. We present a case of a patient with dermatomyositis associated with small cell carcinoma of the lung and review the literature.
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Affiliation(s)
- Wha-Yong Lee
- Castle Hill Hospital, Cottingham, United Kingdom
| | | | | | - Ged Avery
- Castle Hill Hospital, Cottingham, United Kingdom
| | | | - Mike Lind
- Castle Hill Hospital, Cottingham, United Kingdom
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16
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Ruelle L, Bentea G, Sideris S, El Koulali M, Holbrechts S, Lafitte JJ, Grigoriu B, Sculier C, Meert AP, Durieux V, Berghmans T, Sculier JP. Autoimmune paraneoplastic syndromes associated to lung cancer: A systematic review of the literature Part 4: Neurological paraneoplastic syndromes, involving the peripheral nervous system and the neuromuscular junction and muscles. Lung Cancer 2017; 111:150-163. [PMID: 28838388 DOI: 10.1016/j.lungcan.2017.07.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The development of new immune treatment in oncology and particularly for lung cancer may induce new complications, particularly activation or reactivation of auto-immune diseases. In this context, a systematic review on the auto-immune paraneoplastic syndromes that can complicate lung cancer appears useful. This article is the fourth of a series of five and deals mainly with neurological paraneoplastic syndromes involving the peripheral nervous system and the neuromuscular junction and muscles.
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Affiliation(s)
- Lucien Ruelle
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Georgiana Bentea
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Spyridon Sideris
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Mohamed El Koulali
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | | | | | - Bogdan Grigoriu
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Claudine Sculier
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Anne-Pascale Meert
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium; Laboratoire facultaire de Médecine factuelle (ULB), Belgium
| | - Valérie Durieux
- Laboratoire facultaire de Médecine factuelle (ULB), Belgium; Bibliothèque des Sciences de la Santé, Université libre de Bruxelles (ULB), Belgium
| | - Thierry Berghmans
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium; Laboratoire facultaire de Médecine factuelle (ULB), Belgium
| | - Jean-Paul Sculier
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium; Laboratoire facultaire de Médecine factuelle (ULB), Belgium.
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Zhang X, Wang Y, Ma G, Zhang L, Jing H, DU J. Dermatomyositis as a symptom of primary lung cancer: A case report and review of the literature. Oncol Lett 2016; 11:3413-3416. [PMID: 27123126 DOI: 10.3892/ol.2016.4418] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 03/08/2016] [Indexed: 11/05/2022] Open
Abstract
Dermatomyositis (DM) is a rare autoimmune disease associated with manifestations of proximal muscle weakness and typical cutaneous skin rash. Patients with DM have a higher incidence rate of cancer, compared with the general population, since DM usually presents as a paraneoplastic syndrome. The present study reports a case of a 69-year-old male patient presenting with typical cutaneous rash and aggravating proximal muscle weakness for 3 months. When first admitted to the Department of Dermatology of Shandong Provincial Hospital Affiliated to Shandong University (Jinan, China), the patient was diagnosed with DM. Subsequently, chest computed tomography scan revealed a neoplasm located in the right upper lobe. Video-assisted thoracoscopic surgery right upper lobectomy and lymph node dissection were then performed. The patient experienced a fast recovery from the surgery. The removal of the neoplasm clearly improved the symptoms of DM. Considering that DM is usually associated with the existence of a tumor, cases of DM require a thorough diagnostic investigation in order to exclude an underlying malignancy.
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Affiliation(s)
- Xiangwei Zhang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, Shandong 250021, P.R. China
| | - Yang Wang
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, Shandong 250021, P.R. China
| | - Guoyuan Ma
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, Shandong 250021, P.R. China
| | - Lin Zhang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, Shandong 250021, P.R. China
| | - Haiyan Jing
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, Shandong 250021, P.R. China
| | - Jiajun DU
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, Shandong 250021, P.R. China
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18
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Papakonstantinou E, Kapp A, Raap U. A mild form of dermatomyositis as a prodromal sign of lung adenocarcinoma: a case report. J Med Case Rep 2016; 10:34. [PMID: 26851947 PMCID: PMC4744381 DOI: 10.1186/s13256-016-0816-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/21/2016] [Indexed: 01/05/2023] Open
Abstract
Background Dermatomyositis is an idiopathic connective tissue disease characterized by specific cutaneous findings and inflammatory lesions in the muscle biopsy. An association between dermatomyositis and malignancy, including breast, ovarian, lung and colon cancer was recognized many years ago, with an incidence of malignancy in approximately 20 % of cases. Dermatomyositis is hypothesized to be an autoimmune reaction against factors or hormones secreted by the tumor; however, the exact autoimmune mechanism of the disease pathogenesis remains unknown. Case presentation Here we report a case of a woman with dermatomyositis who was diagnosed with lung adenocarcinoma in the setting of weight loss, progressive fatigue and muscle weakness. A 43-year-old Caucasian woman was referred to our hospital by her physician for suspected contact dermatitis since she described mild itching sensations in her arms and legs as her major symptom. A physical examination revealed erythematous papular lesions over her metacarpophalangeal and proximal interphalangeal joints together with a periungual involvement with redness, hyperkeratosis and capillary telangiectasia along the distal nailfolds on her hands. She was unaware of these features and they did not seem to bother her. A thorough examination of her medical history, however, revealed more symptoms. Pain and weakness in the muscles of her proximal extremities and neck flexor muscles led to difficulty in raising her arms and climbing stairs. At the same time she experienced swallowing difficulties and reported an uncharacteristic weight loss of 10 kg in the last 3 months. The results of laboratory tests showed increased values of serum creatine kinase and myoglobin. An electromyogram, a skin biopsy and a muscle biopsy confirmed the diagnosis of dermatomyositis. A computed tomography of her thorax showed a nodular mass in the upper lobe of her right lung. A histological examination of the lung biopsy showed an adenocarcinoma of moderate differentiation. She was diagnosed with paraneoplastic dermatomyositis as the first sign of a lung adenocarcinoma. Conclusions Our case report highlights the importance of a thorough search for underlying malignancy in patients with dermatomyositis even if dermatomyositis has a mild appearance or a discrete skin manifestation.
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Affiliation(s)
- Eleni Papakonstantinou
- Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Alexander Kapp
- Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Ulrike Raap
- Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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19
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Kanaji N, Okuda M, Dobashi H, Kameda T, Tadokoro A, Wakiya R, Kadowaki N, Bandoh S. Squamous Cell Lung Cancer Associated With Systemic Sclerosis. J Clin Med Res 2015; 7:896-900. [PMID: 26491504 PMCID: PMC4596273 DOI: 10.14740/jocmr2313w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2015] [Indexed: 11/11/2022] Open
Abstract
We here describe a 50-year-old woman diagnosed with squamous cell lung cancer (SqLC) with underlying interstitial lung disease (ILD) 14 years after a diagnosis of systemic sclerosis (SSc). We reviewed the literature and collected 21 well-documented cases with SqLC associated with SSc including the present case. Several characteristics of SqLC associated with SSc have been found. First, the average age at diagnosis of SqLC is 57 years, which is much younger than that reported for patients without SSc. Second, SqLC could occur even in never or light smokers, although SqLC usually has a strong association with smoking history. Third, two-thirds of the available cases have ILD. In addition, SqLC developed in the area of ILD in most cases with ILD. Fourth, SqLC generally occurs after a long period from the diagnosis of SSc; the average of this interval reaches 12 years. It would be helpful to know these features so that physicians follow up and treat SSc patients adequately.
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Affiliation(s)
- Nobuhiro Kanaji
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Masaya Okuda
- Department of General Thoracic, Breast and Endocrinogical Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hiroaki Dobashi
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Tomohiro Kameda
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Akira Tadokoro
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Risa Wakiya
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Norimitsu Kadowaki
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Shuji Bandoh
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
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20
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Albert TJ, Bastawrous S, Raugi GJ, Hirschmann JV. A 62-year-old man with skin rash and an abnormal chest radiograph. Chest 2015; 147:e90-e94. [PMID: 25732478 DOI: 10.1378/chest.14-1100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
A 62-year-old man developed a scalp rash 2 months ago, followed by bilateral eyelid swelling. The nonpruritic rash then spread to involve most of his skin. He also had fatigue, muscle weakness, mild muscle soreness with activity, and dysphagia for solid foods for the last 3 weeks. He had no other symptoms. He had a 50 pack-year history of smoking and drank two to three shots of alcohol daily.
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Affiliation(s)
- Tyler J Albert
- Department of Medicine, VA Puget Sound Medical Center, Department of Medicine, Seattle WA
| | - Sarah Bastawrous
- Department of Radiology, VA Puget Sound Medical Center, University of Washington School of Medicine, Seattle WA.
| | - Gregory J Raugi
- Department of Medicine, VA Puget Sound Medical Center, Division of Dermatology, University of Washington School of Medicine, Seattle WA
| | - Jan V Hirschmann
- Department of Medicine, VA Puget Sound Medical Center, Department of Medicine, Seattle WA
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21
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Mori H, Habe K, Hakamada A, Isoda KI, Mizutani H. Relapse of Dermatomyositis after 10 Years in Remission Following Curative Surgical Treatment of Lung Cancer. J Dermatol 2014; 32:290-4. [PMID: 15863853 DOI: 10.1111/j.1346-8138.2005.tb00765.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Accepted: 11/30/2004] [Indexed: 11/29/2022]
Abstract
A 55-year-old woman with dermatomyositis and small cell lung cancer was successfully treated with surgery followed by combination chemotherapy in 1987. She had been in remission without further immunosuppressive therapy for 10 years. However, myositis with cutaneous manifestations specific for dermatomyositis relapsed when the patient was 69 years old. Intensive examinations revealed no neoplasm, and she responded to a moderate dose of systemic corticosteroids. This case suggests a long-lasting autoimmune abnormality in dermatomyositis and that a neoplasm is an important factor in eliciting an occult dermatomyositis.
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Affiliation(s)
- Hitoshi Mori
- Department of Dermatology, Mie University, Faculty of Medicine, Tsu 514-8507, Japan
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22
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Salimbene I, Leli I, Valente S. Respiratory failure in a patient with dermatomyositis. Multidiscip Respir Med 2013; 8:27. [PMID: 23531196 PMCID: PMC3620045 DOI: 10.1186/2049-6958-8-27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 02/18/2013] [Indexed: 12/03/2022] Open
Abstract
Since its original description in 1956 the association between interstitial lung disease and polymyositis (PM) and dermatomyositis (DM) has become well established. Interstitial lung disease (ILD) can be a significant complication in rheumatic diseases (RDs). Although most patients with RD do not develop clinically evident ILD, these systemic autoimmune disorders are estimated to be responsible for approximately 25% of all ILD deaths and 2% of deaths due to all respiratory causes. Radiologic abnormalities in DM are characterized by a high incidence of airspace consolidation. Non-Specific Interstitial Pneumonia (NSIP) is the most common form of lung disease, with a frequency in biopsies 4-fold greater than that of Usual Interstitial Pneumonia (UIP) in PM and a slightly smaller predominance in DM. We report a case of a female patient, 57 years old, no former smoker, whose clinical history was onset in November 2008 with asthenia with muscle and osteoarticular pain especially located in the upper limbs and then also expanded to the lower limbs. The EMG was compatible with dermatomyositis in the acute phase. The patient received therapy with steroids and tacrolimus, also making several rounds of treatment with immunoglobulin. Given the recurrence of myositis in association with signs of poorly controlled interstitial lung disease, immunosuppressive therapy with Rituximab was administered. The Computed Tomography (CT) scans showed "bronchiectasis and traction bronchiolectasis, hypodense areas consistent with the phenomena of air trapping. The pattern of interstitial lung disease with fibrotic evolution seems consistent with NSIP. The arterial blood gas analysis showed a pattern of hypoxic-hypercapnic respiratory failure (pH: 7,34, PaO2: 67 mmHg; PaCO2: 55 mmHg). As a result of an episode of marked desaturation unresponsive to supplemental oxygen at high flows we proceeded to noninvasive mechanical ventilation with Helmet for 24 hours/24. This ventilatory support was maintained for a week, with resolution of the respiratory failure. In this brief case report we want to highlight various pulmonary complications as a result of dermatomyositis. The progression of respiratory complications may also lead to a situation of respiratory failure, as in our patient, and require a noninvasive ventilatory treatment.
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Affiliation(s)
- Ivano Salimbene
- Department of Pulmonary Medicine, A, Gemelli University Polyclinic, Sacro Cuore Catholic University, Largo A, Gemelli 8, Rome, 00168, Italy.
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23
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Abstract
Dermatomyositis is an inflammatory myopathy that has an association with malignancy in adults. We present a patient who initially presented with adenopathy and progressive muscular weakness and was diagnosed with dermatomyositis and lung carcinoma on further investigation. Whole-body PET/CT scan revealed diffuse proximal muscle hypermetabolism representing the inflammatory nature of dermatomyositis, and an intensely FDG-avid primary right lower lung small cell lung carcinoma and metastatic thoracic lymphadenopathy. PET/CT imaging may offer an "all-in-one" procedure as an alternative to other diagnostic procedures, reducing the number of unnecessary investigations in patients presenting with paraneoplastic syndromes searching for underlying malignancy.
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24
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Schneider F, Gruden J, Tazelaar HD, Leslie KO. Pleuropulmonary pathology in patients with rheumatic disease. Arch Pathol Lab Med 2012; 136:1242-52. [PMID: 23020730 DOI: 10.5858/arpa.2012-0248-sa] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Thoracic manifestations of rheumatic disease (RD) are increasingly recognized as a significant cause of morbidity and mortality worldwide. Rheumatologic underpinnings have been identified in a significant proportion of patients with interstitial lung disease. The 5 RDs most frequently associated with pleuropulmonary disease are (1) rheumatoid arthritis, (2) systemic lupus erythematosus, (3) progressive systemic sclerosis, (4) polymyositis/dermatomyositis, and (5) Sjögren syndrome. The onset of thoracic involvement in these diseases is variable. In some patients, it precedes the systemic disease or is its only manifestation. Moreover, there is a wide spectrum of clinical presentation ranging from subclinical abnormalities to acute respiratory failure. Histopathologically, the hallmark features of thoracic involvement by RD are inflammatory, targeting one or more lung compartments. The reactions range from acute to chronic, with remodeling by fibrosis being a common result. Although the inflammatory findings are often nonspecific, certain reactions or anatomic distributions may favor one RD over another, and occasionally, a distinctive histopathology may be present (eg, rheumatoid nodules). Three diagnostic dilemmas are encountered in patients with RD who develop diffuse lung disease: 1) opportunistic infection in the immunocompromised host, 2) drug toxicity related to the medications used to treat the systemic disease, and 3) manifestations of the patient's known systemic disease in lung and pleura. To confidently address the latter, the 5 major RDs are presented here, with their most common pleuropulmonary pathologic manifestations, accompanied by brief clinical and radiologic correlations.
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Affiliation(s)
- Frank Schneider
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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25
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Lung cancer and interstitial lung diseases: a systematic review. Pulm Med 2012; 2012:315918. [PMID: 22900168 PMCID: PMC3414065 DOI: 10.1155/2012/315918] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 05/29/2012] [Accepted: 06/01/2012] [Indexed: 12/21/2022] Open
Abstract
Interstitial lung diseases (ILDs) represent a heterogeneous group of more than two hundred diseases of either known or unknown etiology with different pathogenesis and prognosis. Lung cancer, which is the major cause of cancer death in the developed countries, is mainly attributed to cigarette smoking and exposure to inhaled carcinogens. Different studies suggest a link between ILDs and lung cancer, through different pathogenetic mechanisms, such as inflammation, coagulation, dysregulated apoptosis, focal hypoxia, activation, and accumulation of myofibroblasts as well as extracellular matrix accumulation. This paper reviews current evidence on the association between lung cancer and interstitial lung diseases such as idiopathic pulmonary fibrosis, sarcoidosis, systemic sclerosis, dermatomyositis/polymyositis, rheumatoid arthritis, systemic lupus erythematosus, and pneumoconiosis.
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26
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27
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Abstract
Dermatomyositis is associated with an underlying malignancy in about 24% of cases. This association is also true for polymyositis but is less prominent. The malignancy is usually an adenocarcinoma of the ovary, lung, or gastrointestinal tract in Western countries and nasopharyngeal carcinoma in Southeast Asia, Southern China, and Northern Africa. Factors predictive of malignancy in myositis patients include more severe skin and muscle disease and the absence of overlap connective tissue disease features, such as interstitial lung disease. Anti-p155/140 antibodies have a strong predictive value for malignancy in adult patients. Patients with dermatomyositis or polymyositis require an evaluation for occult malignancy at the time of diagnosis and, in some cases, in the event of a subsequent recurrence. This paraneoplastic phenomenon may stem from an immune reaction to antigens expressed in both cancer cells and regenerating fibers in affected muscle.
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Affiliation(s)
- Zaki Abou Zahr
- Department of Internal Medicine, Good Samaritan Hospital, 5601 Loch Raven Boulevard, Baltimore, MD 21239, USA.
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28
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Abstract
In paraneoplastic muscle disease, the malignancy may remotely affect neuromuscular transmission or incite muscle inflammation or necrosis. In several of these diseases, an autoimmune basis for the muscle disease has been established and has become a defining feature. These paraneoplastic muscle diseases may be the first manifestation of a malignancy, and their diagnosis thus demands a vigilant search for an underlying tumor. This article is focused on inflammatory and necrotizing myopathies and disorders of neuromuscular transmission that may arise in the setting of malignancy and are considered paraneoplastic phenomena.
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Affiliation(s)
- Alan N Baer
- Division of Rheumatology, Johns Hopkins University School of Medicine, Good Samaritan Hospital, 5200 Eastern Avenue, Mason F. Lord Building Center Tower, Suite 4100, Room 413, Baltimore MD 21224, USA.
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29
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Small cell lung cancer presenting as dermatomyositis: mistaken for single connective tissue disease. Rheumatol Int 2011; 32:1737-40. [DOI: 10.1007/s00296-011-1857-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 02/18/2011] [Indexed: 11/26/2022]
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30
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Vincze M, Molnár PA, Zilahi E, Kapitány A, Dezső B, Takács I, Dankó K. Primary lung adenocarcinoma associated with anti-Jo-1 positive polymyositis. Joint Bone Spine 2011; 78:209-11. [DOI: 10.1016/j.jbspin.2010.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 08/09/2010] [Indexed: 10/18/2022]
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31
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Milanez FM, Pereira CADC, Trindade PHDM, Milinavicius R, Coletta ENAM. Lung adenocarcinoma, dermatomyositis, and Lambert-Eaton myasthenic syndrome: a rare combination. J Bras Pneumol 2008; 34:333-6. [PMID: 18545831 DOI: 10.1590/s1806-37132008000500014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 07/31/2007] [Indexed: 11/22/2022] Open
Abstract
The incidence of lung neoplasms is increasing in Brazil and in the world, probably as a result of the increase in smoking. Due to the greater number of cases, atypical presentations appear. We report the case of a 66-year-old hypertensive male smoker who presented progressive proximal muscular weakness and, in two months, evolved to dysphagia, dysphonia, and V-shaped skin lesions on the chest. A chest X-ray showed a spiculated pulmonary nodule in the right upper lobe. The biochemical analysis revealed elevated creatine kinase levels. After complementary tests and biopsies, the patient underwent right upper lobectomy. Histopathology showed a moderately differentiated adenocarcinoma. The overall analysis of the case and a review of the literature allow us to suggest that the clinical profile of the patient was a result of an overlap of two paraneoplastic syndromes (dermatomyositis and Lambert-Eaton myasthenic syndrome) secondary to lung adenocarcinoma.
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32
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Zang YS, Xiu QY, Fang Z, Li B, Xia TB. Case report: dramatic recovery of lung adenocarcinoma-associated dermatomyositis with targeted lung cancer therapy alone. Oncologist 2008; 13:79-81. [PMID: 18245014 DOI: 10.1634/theoncologist.2007-0172] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This case report details the sudden onset of severe dermatomyositis (DM) symptoms followed by rapid progression of adenocarcinoma of the lung and an obvious diminution of the primary tumor with the administration of lung cancer targeted drug therapy alone, followed by nearly complete disappearance of the DM symptoms, with no conspicuous improvement in the DM symptoms when using corticosteroids.
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Affiliation(s)
- Yuan-Sheng Zang
- Department of Respiratory Medicine, Changzheng Hospital, Second Military Medical University, Shanghai, China
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33
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Liau N, Ooi C, Reid C, Kirkwood ID, Bartholomeusz D. F-18 FDG PET/CT Detection of Mediastinal Malignancy in a Patient With Dermatomyositis. Clin Nucl Med 2007; 32:304-5. [PMID: 17413581 DOI: 10.1097/01.rlu.0000257282.76269.85] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Nicholas Liau
- Department of Nuclear Medicine and Bone Densitometry, Royal Adelaide Hospital, Adelaide, South Australia.
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34
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Ponyi A, Constantin T, Garami M, András C, Tállai B, Váncsa A, Gergely L, Dankó K. Cancer-associated myositis: clinical features and prognostic signs. Ann N Y Acad Sci 2006; 1051:64-71. [PMID: 16126945 DOI: 10.1196/annals.1361.047] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Idiopathic inflammatory myositis is characterized by progressive weakness of the proximal muscles. There is a higher risk of malignancy than in the normal population. The aim of this study was to evaluate the frequency of malignancy among 251 myositis patients. We also compared clinical and immunological characteristics of cancer-associated myositis with primary myositis. There were no malignancies among polymyositis, overlap, or juvenile myositis patients. Twenty-two of ninety dermatomyositis patients also had a malignant disease. Patients with cancer-associated dermatomyositis were significantly older than primary myositis patients and had more severe cutaneous and muscle symptoms. Dysphagia and diaphragmatic involvement were more frequent among cancer-associated patients, while extramuscular features were less frequent. After successful treatment of the malignancy, we were able to manage myositis symptoms. One-year survival rate was significantly better in primary dermatomyositis patients. The subset of cancer-associated myositis differs from primary myositis in many aspects of its clinical and immunological features. Prognosis and life expectancy in cancer-associated myositis patients is determined by the underlying malignant disease. Therefore, age- and sex-specific examinations for detection of an underlying malignancy are important in the management of patients with dermatomyositis.
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Affiliation(s)
- Andrea Ponyi
- Division of Clinical Immunology, Third Department of Internal Medicine, Medical and Health Science Center, University of Debrecen, Moricz Zs Krt 22, 4004 Debrecen, Hungary.
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35
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Gabrilovich M, Raza M, Dolan S, Raza T. Paraneoplastic Polymyositis Associated With Squamous Cell Carcinoma of the Lung. Chest 2006; 129:1721-3. [PMID: 16778295 DOI: 10.1378/chest.129.6.1721] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
An association between polymyositis and lung cancer has been debated. Published data usually lack either lung cancer histologic differentiation or biopsy-based delineation between polymyositis and dermatomyositis. We reported a case of a 56-year-old man with squamous cell carcinoma of the lung confined to a single hilar lymph node presenting with biopsy-proven polymyositis of 3 months in duration. Polymyositis should be considered as a potential presentation of paraneoplastic syndrome, especially in patients who are at risk for lung cancer.
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Affiliation(s)
- Mikhail Gabrilovich
- Department Of Medicine, Medical College Of Wisconsin, 9200 West Wisconsin Ave, Milwaukee, WI 53226, USA.
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36
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András C, Csiki Z, Ponyi A, Illés A, Dankó K. Paraneoplastic rheumatic syndromes. Rheumatol Int 2005; 26:376-82. [PMID: 16091919 DOI: 10.1007/s00296-005-0005-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 04/20/2005] [Indexed: 10/25/2022]
Abstract
Paraneoplastic symptoms caused by a malignancy but not directly related to tumour invasion are the result of a wide variety of tumour-derived biologic mediators, such as hormones, peptides, antibodies, cytotoxic lymphocytes, autocrine and paracrine mediators. Recognition of paraneoplastic syndromes is important, as it may lead to an early diagnosis of cancer. On the other hand, the clinical severity of the symptoms can be used as a guide to the extent of response to underlying tumour therapy. The quality of life of the patient is affected, therefore the palliative treatment of paraneoplasia is very important.
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Affiliation(s)
- Csilla András
- Department of Oncology, University of Debrecen, Medical and Health Science Center, 4012, Debrecen, Nagyerdei krt. 98, Hungary
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Murakami Y, Kanazawa K, Okuno K, Maekawa S, Matsuda Y, Miyamoto Y, Nishimura Y, Kanomata N, Ohbayashi C, Hashimoto M, Akita H. High-Grade Neuroendocrine Carcinoma of the Lung Presenting an Unusual Spread Mimicking Pleural Mesothelioma Associated with Dermatomyositis. Am J Med Sci 2004; 327:227-30. [PMID: 15084919 DOI: 10.1097/00000441-200404000-00009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neuroendocrine tumors of the lung comprise a heterogeneous group of tumors that represents a spectrum of disease from typical carcinoid tumors to the high-grade neuroendocrine carcinomas (large-cell neuroendocrine carcinomas and small-cell carcinomas). The high-grade neuroendocrine carcinomas are characterized by early metastasis and poor prognosis. The peripheral location and especially the massive pleural spread are rare for a high-grade neuroendocrine carcinoma. We report a case in which a high-grade neuroendocrine carcinoma, associated with dermatomyositis, presented an unusual pattern of progression, mimicking malignant pleural mesothelioma on diagnostic imaging.
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Affiliation(s)
- Yukiko Murakami
- Department of General Therapeutics, Kobe University Graduate School of Medicine, Kobe, Japan
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38
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Pulmonary Complications of Polymyositis and Dermatomyositis. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/s1571-5078(04)02011-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Abstract
The most recent evidence from population-based cohort studies confirms the association between malignancy and dermatomyositis and polymyositis. These studies show an even stronger association between polymyositis and malignancy than previous studies, suggesting less misclassification. This is particularly true of one study that used pathologic criteria to distinguish between myositis subtypes. Recent data also confirm that the association for dermatomyositis and polymyositis is not purely caused by diagnostic suspicion or surveillance bias. More data are still required to determine individual cancer risks, although it appears that ovarian and lung cancer are associated with dermatomyositis while lung cancer and non-Hodgkin's lymphoma are associated with polymyositis. An association between malignant disease and inclusion body myositis has also been verified for the first time. Of interest, too, is the increasing number of reports documenting cases in which the clinical course of the myositis mirrors that of the cancer, supporting the notion that in some instances, myositis is a paraneoplastic disorder.
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Affiliation(s)
- Rachelle Buchbinder
- Cabrini Medical Centre, Suite 41, 183 Wattletree Road, Malvern, Victoria 3144, Australia.
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