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van Erp MAJM, Slaats FMA, Emmen JMA, van Hamont D. Paraneoplastic anti-TIF1-gamma-positive dermatomyositis as expression of cervical squamous cell carcinoma recurrence. BMJ Case Rep 2024; 17:e253636. [PMID: 38262717 PMCID: PMC10826498 DOI: 10.1136/bcr-2022-253636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Idiopathic inflammatory myopathies are neuromuscular disorders characterised by muscle weakness and histologically inflammation within the muscle. Dermatomyositis and polymyositis are highly associated with a wide range of cancers, especially in antitranscriptional intermediary factor-1 (TIF1)-gamma-positive myositis. We present a case of paraneoplastic dermatomyositis in a patient with a medical history of a FIGO stage 1B1 cervical squamous cell carcinoma. Anti-TIF1-gamma autoantibodies were detected by myositis lineblot analysis and a PET-CT scan revealed an abnormality positioned at the right ovary. She underwent laparoscopic exploration and pathological analysis of the PET-positive abnormality showed a lymphogenic metastasis of a squamous cell carcinoma, competitive with cervical carcinoma recurrence. She started chemoradiation as curative oncological treatment. The dermatomyositis was successfully treated with high-dose corticosteroids. Physicians should be aware of the association between myositis and the increased risk of malignancies.
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Affiliation(s)
- Mirthe A J M van Erp
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
| | - Frank M A Slaats
- Department of Rheumatology, Amphia Hospital, Breda, The Netherlands
| | - Judith M A Emmen
- Result Laboratory of Clinical Chemistry and Haematology, Amphia Hospital, Breda, The Netherlands
| | - Dennis van Hamont
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
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2
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Costantini A, Moletta L, Pierobon ES, Serafini S, Valmasoni M, Sperti C. Paraneoplastic myopathy-related rhabdomyolysis and pancreatic cancer: A case report and review of the literature. World J Clin Cases 2023; 11:6823-6830. [PMID: 37901020 PMCID: PMC10600837 DOI: 10.12998/wjcc.v11.i28.6823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/22/2023] [Accepted: 09/07/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Rhabdomyolysis is a life-threatening condition, often leading to progressive renal failure and death. It is caused by destruction of skeletal muscle and the release of myoglobin and other intracellular contents into the circulation. The most frequent cause of this condition is "crush syndrome", although several others have been described and paraneoplastic inflammatory myopathies associated with various types of cancer are repeatedly reported. CASE SUMMARY We describe a rare case of a patient with pancreatic cancer who developed rhabdomyolysis early on, possibly due to paraneoplastic myositis leading to acute renal failure and eventually to rapid death. A 78-year-old Caucasian woman was referred to our hospital for obstructive jaundice and weight loss due to a lesion in the pancreatic head. She presented increasingly severe renal insufficiency with anuria, a dramatic increase in creatine phosphokinase (36000 U/L, n.v. 20-180 U/L) and myoglobin (> 120000 μg/L, n.v. 12-70 μg/L). On clinical examination, the patient showed increasing pain in the lower limbs associated with muscle weakness which was severe enough to immobilize her. Paraneoplastic myopathy linked to the malignant lesion of the pancreatic head was suspected. The patient was treated with hemodialysis and intravenous methylprednisolone. Despite all the efforts to prepare the patient for surgery, her general condition rapidly deteriorated and she eventually died 30 d after hospital admission. CONCLUSION The possible causes of rhabdomyolysis in this patient with pancreatic cancer are discussed, the development of paraneoplastic myopathy being the most likely. Clinicians should bear in mind that these syndromes may become clinically manifest at any stage of the cancer course and their early diagnosis and treatment could improve the patient's prognosis.
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Affiliation(s)
- Andrea Costantini
- Department of Surgical, Oncological and Gastroenterological Sciences, UOC Chirurgia Generale 1, University of Padua, Padua 35128, Italy
| | - Lucia Moletta
- Department of Surgical, Oncological and Gastroenterological Sciences, UOC Chirurgia Generale 1, University of Padua, Padua 35128, Italy
| | - Elisa Sefora Pierobon
- Department of Surgical, Oncological and Gastroenterological Sciences, UOC Chirurgia Generale 1, University of Padua, Padua 35128, Italy
| | - Simone Serafini
- Department of Surgical, Oncological and Gastroenterological Sciences, UOC Chirurgia Generale 2, University of Padua, Padua 35128, Italy
| | - Michele Valmasoni
- Department of Surgical, Oncological and Gastroenterological Sciences, UOC Chirurgia Generale 1, University of Padua, Padua 35128, Italy
| | - Cosimo Sperti
- Department of Surgical, Oncological and Gastroenterological Sciences, UOC Chirurgia Generale 2, University of Padua, Padua 35128, Italy
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3
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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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4
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Melody M, Parrondo R, Alhaj Moustafa M, Wu K, Menke D, Seim L, Tun HW. Follicular lymphoma associated paraneoplastic myositis. Clin Case Rep 2020; 8:2003-2006. [PMID: 33088539 PMCID: PMC7562836 DOI: 10.1002/ccr3.3046] [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: 03/11/2020] [Revised: 04/30/2020] [Accepted: 05/28/2020] [Indexed: 12/01/2022] Open
Abstract
This case illustrates an unusual presentation of paraneoplastic myositis in stage IV follicular lymphoma managed with high‐dose steroids, a previously unreported entity in the literature.
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Affiliation(s)
- Megan Melody
- Department of Internal Medicine Mayo Clinic Jacksonville Florida USA
| | - Ricardo Parrondo
- Division of Hematology-Oncology Mayo Clinic Jacksonville Florida USA
| | | | - Kevin Wu
- Division of Laboratory Medicine and Pathology Mayo Clinic Jacksonville Florida USA
| | - David Menke
- Division of Laboratory Medicine and Pathology Mayo Clinic Jacksonville Florida USA
| | - Lynsey Seim
- Department of Internal Medicine Mayo Clinic Jacksonville Florida USA
| | - Han W Tun
- Division of Hematology-Oncology Mayo Clinic Jacksonville Florida USA
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5
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Marco JL, Collins BF. Clinical manifestations and treatment of antisynthetase syndrome. Best Pract Res Clin Rheumatol 2020; 34:101503. [PMID: 32284267 DOI: 10.1016/j.berh.2020.101503] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Antisynthetase syndrome (ASyS) is an autoimmune disease clinically manifested most often by interstitial lung disease, myositis, and arthritis. Raynaud's syndrome, fever, and rashes are also commonly seen. This syndrome is characterized by the highly specific presence of antibodies against various aminoacyl transfer RNA synthetases, including Jo-1 and others. In this chapter, we provide an overview of ASyS, including pathogenesis, common clinical manifestations, and treatment strategies. We discuss the spectrum of disease seen with specific antisynthetase antibodies and examine the differences in phenotype between patients with different antisynthetase antibodies. We outline common treatment strategies, which should generally target the most severe and life- or organ-threatening disease manifestations. Finally, we discuss short- and long-term prognosis in ASyS.
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Affiliation(s)
- Joanna L Marco
- University of Washington, Department of Medicine, Division of Rheumatology, 1959 NE Pacific Street, Box 356428, Seattle, WA, 98195-6522, USA.
| | - Bridget F Collins
- University of Washington Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, 1959 NE Pacific Street, Box 356166, Seattle, WA, 98195, USA.
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Kang EH, Go DJ, Mimori T, Lee SJ, Kwon HM, Park JW, Park MH, Song EY, Ha YJ, Lee EY, Lee YJ, Lee EB, Song YW. Novel susceptibility alleles in HLA region for myositis and myositis specific autoantibodies in Korean patients. Semin Arthritis Rheum 2019; 49:283-287. [PMID: 30952422 DOI: 10.1016/j.semarthrit.2019.03.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/20/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES HLA genes are a major genetic risk factor for myositis and myositis specific antibodies (MSAs), exhibiting unique HLA backgrounds for myositis in different ethnic groups. This is the first large scale Korean study to genotype the HLA-DRB1 and -DPB1 alleles and to examine their association with myositis and MSAs. METHODS HLA-DRB1 and HLA-DPB1 alleles and MSAs were examined in 179 patients with dermatomyositis (DM, n = 129) or polymyositis (PM, n = 50) and healthy controls (n = 800 for HLA-DRB1, n = 548 for HLA-DPB1). Associations between individual HLA alleles and myositis/MSA were examined. Bonferroni correction was applied for multiple testing comparing patients and controls. RESULTS A total of 33 HLA-DRB1 and 24 HLA-DPB1 alleles were genotyped in patients and controls. MSAs were found in 67.0% of patients. Anti-MDA5 (26.8%) and anti-aminoacyl-tRNA synthetase antibodies (15.6%) were most common, followed by anti-Mi2 (9.5%) and anti-TIF1γ antibodies (8.9%). HLA-DRB1*12:02 and HLA-DRB1*14:03 were associated with DM and PM, respectively. HLA-DRB1*12:02 was associated with anti-MDA5, HLA-DRB1*08:03 with anti-ARS, HLA-DRB1*14:03 with anti-SRP, and HLA-DRB1*07:01 with anti-Mi2 antibodies. Although HLA-DRB1*13:01 was associated with anti-TIF1γ antibodies, the frequency of HLA-DRB1*13:01 was rare. HLA-DPB1*02:01 was negatively associated with myositis and PM while HLA-DPB1*17:01 was associated with anti-Mi2 positive DM. CONCLUSIONS Unique immunogenetic background was observed for Korean patients with myositis. Novel myositis susceptibility alleles, HLA-DRB1*12:02 and HLA-DRB1*14:03, were identified, together with MSA-associated HLA alleles unique to Korean patients with myositis.
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Affiliation(s)
- Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong Jin Go
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 28 Yongun-dong, Chongno-gu, Seoul 110-744, South Korea; Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, College of Medicine, Seoul National University, Seoul, South Korea
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sang Jin Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 28 Yongun-dong, Chongno-gu, Seoul 110-744, South Korea; Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, College of Medicine, Seoul National University, Seoul, South Korea
| | - Hyun Mi Kwon
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 28 Yongun-dong, Chongno-gu, Seoul 110-744, South Korea
| | - Jun Won Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 28 Yongun-dong, Chongno-gu, Seoul 110-744, South Korea
| | - Myoung Hee Park
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Eun Young Song
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, South Korea
| | - You-Jung Ha
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 28 Yongun-dong, Chongno-gu, Seoul 110-744, South Korea
| | - Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eun Bong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 28 Yongun-dong, Chongno-gu, Seoul 110-744, South Korea
| | - Yeong Wook Song
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 28 Yongun-dong, Chongno-gu, Seoul 110-744, South Korea; Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, College of Medicine, Seoul National University, Seoul, South Korea.
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7
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Su L, Yang Y, Jia Y, Liu X, Zhang W, Yuan Y, Li Z. Anti-NXP2-antibody-positive immune-mediated necrotizing myopathy associated with acute myeloid leukemia: A case report. Medicine (Baltimore) 2018; 97:e11501. [PMID: 29995816 PMCID: PMC6076171 DOI: 10.1097/md.0000000000011501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Idiopathic inflammatory myopathies have been extensively reported associated with malignancy. Immune-mediated necrotizing myopathy (IMNM), however, has rarely been connected with malignancy including acute myeloid leukemia (AML). PATIENT CONCERNS A 65-year-old woman was diagnosed with AML and received regular chemotherapy. After the 5th cycle chemotherapy, she achieved complete remission but developed severe muscle weakness and myalgia with dramatic increasing creatine kinase (CK). DIAGNOSIS The positivity of antinuclear matrix protein 2 antibody (anti-NXP2 Ab) and muscle biopsy in together confirmed the diagnosis of IMNM. INTERVENTION Methylprednisolone and intravenous immunoglobulin was administered. OUTCOMES This treatment resulted in a dramatic clinical and laboratory improvement within 1 month. CK and lactate dehydrogenase levels dropped sharply to normal. Anti-NXP2 Ab was shown to disappear in a repeated test afterwards. LESSONS The IMNM is also closely related to malignancy. We here report a case of IMNM associated with AML for the first time. Anti-NXP2 Ab may be utilized as both diagnostic and prognostic markers of paraneoplastic IMNMs.
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Affiliation(s)
- Lina Su
- Department of Rheumatology and Immunology, Peking University People's Hospital
| | - Yue Yang
- Department of Rheumatology and Immunology, Peking University People's Hospital
| | - Yuan Jia
- Department of Rheumatology and Immunology, Peking University People's Hospital
| | - Xu Liu
- Department of Rheumatology and Immunology, Peking University People's Hospital
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Zhanguo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital
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8
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Baker MC, Smith GP, Miloslavsky EM. Dermatomyositis Associated With a Skull Base Chondrosarcoma. J Clin Rheumatol 2018; 25:50-53. [PMID: 29664820 DOI: 10.1097/rhu.0000000000000732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Matthew C Baker
- Division of Rheumatology Department of Internal Medicine Stanford University School of Medicine Stanford, CA Department of Dermatology Massachusetts General Hospital Harvard Medical School Boston, MA Division of Rheumatology Department of Medicine Massachusetts General Hospital Harvard Medical School Boston, MA
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9
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Dutton K, Soden M. Malignancy screening in autoimmune myositis among Australian rheumatologists. Intern Med J 2017; 47:1367-1375. [DOI: 10.1111/imj.13556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/15/2017] [Accepted: 07/18/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Katherine Dutton
- Department of Rheumatology; Royal Brisbane & Women's Hospital; Brisbane Queensland Australia
| | - Muriel Soden
- Department of Rheumatology; Townsville Hospital; Townsville Queensland Australia
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10
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Zalatnai A, Perjési E, Galambos E. Much More than Trousseau Syndrome. The Broad Spectrum of the Pancreatic Paraneoplastic Syndromes. Pathol Oncol Res 2017; 24:1-10. [PMID: 28160197 DOI: 10.1007/s12253-017-0206-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 01/24/2017] [Indexed: 11/28/2022]
Abstract
When 150 years ago Armand Trousseau proposed that some thrombotic events might be the first sign of concealed visceral malignancies, these findings seemed to be just of anecdotal interest. Since then, however, we have learned that adenocarcinomas, including pancreatic cancers could be associated with a wide spectrum of paraneoplastic syndromes. They may precede the detection of the tumor, may occur simultaneously or may develop during its progression. Due to various hematologic, endocrine, cutaneous, articular, neuromuscular, renal or even psychiatric syndromes, their correct interpretation is intriguing, and because their early signs are not necessarily recognized first by oncologists, the paraneoplastic syndromes pose a diagnostic challenge. Unfortunately, we cannot generalize about their mechanisms, because the molecular backgrounds are far-reaching. In most of the cases, the pancreatic cancer cells release various factors into the bloodstream triggering the coagulation cascade. These patients frequently present with venous thromboembolism, and sometimes they are resistant to anticoagulation. The simultaneous thrombotic and bleeding evens do reflect the abnormal hemostasis. In other instances autoantibodies are formed against cutaneous, renal, neuromuscular or nervous tissues, but the mechanism of some syndromes remains unclear. Clinicians should be aware that pancreatic carcinoma may be associated with not just the Trousseau-syndrome.
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Affiliation(s)
- Attila Zalatnai
- First Department of Pathology and Experimental Cancer Research, Faculty of Medicine, Semmelweis University, H-1085 Üllői út 26, Budapest, Hungary.
| | - Eszter Perjési
- First Department of Pathology and Experimental Cancer Research, Faculty of Medicine, Semmelweis University, H-1085 Üllői út 26, Budapest, Hungary
| | - Eszter Galambos
- First Department of Pathology and Experimental Cancer Research, Faculty of Medicine, Semmelweis University, H-1085 Üllői út 26, Budapest, Hungary
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11
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Inflammatory myopathies and lymphoma. J Neurol Sci 2016; 369:377-389. [PMID: 27653927 DOI: 10.1016/j.jns.2016.08.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/28/2016] [Accepted: 08/29/2016] [Indexed: 12/18/2022]
Abstract
The inflammatory myopathies comprise a group of immune-mediated muscle diseases. Lymphoma is a term for a variety of lymphatic system malignancies. Autoimmune diseases and lymphoproliferative malignancies share a complex bidirectional relationship. A causal relationship between inflammatory mypathies and lymphoma has not been established. The diagnosis/treatment of inflammatory myopathy usually precedes the detection/diagnosis of lymphoma. Immune system dysregulation presumably underlies the evolution of lymphoma in patients with inflammatory myopathies. Inflammatory activity with chronic B-cell activation and/or antigen stimulation is deemed the major risk factor for lymphoma in patients with autoimmunity. A "paraneoplastic" phenomenon or the effects of immunosuppressive therapy may be alternative immune-based mechanisms. In chronic lymphocytic leukemia immune system disturbance rarely results in non-hematological autoimmune disease, including inflammatory myopathies.
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12
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Kang EH, Lee SJ, Ascherman DP, Lee YJ, Lee EY, Lee EB, Song YW. Temporal relationship between cancer and myositis identifies two distinctive subgroups of cancers: impact on cancer risk and survival in patients with myositis. Rheumatology (Oxford) 2016; 55:1631-41. [PMID: 27247435 DOI: 10.1093/rheumatology/kew215] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim was to compare standardized incidence ratios (SIRs) of cancers temporally related and unrelated to active myositis in patients with myositis. METHODS Fifty-two cancer cases were identified in 281 myositis patients. SIRs of cancers having temporal overlap with the active phase of myositis [cancers concurrent with active myositis (CAM), n = 30] and cancers not having such temporal overlap [cancers non-concurrent with active myositis (CNM), n = 22] were compared in 281 patients. RESULTS Patients with CAM were older at diagnosis of myositis, had a greater tendency to be male, more frequent dysphagia and less frequent interstitial lung disease than patients with CNM. CAM SIR (95% CI) was 1.78 (1.19, 2.56) and CNM SIR 1.23 (0.75, 1.90). The peak SIR was observed in the seventh decade of life for CAM and in the third decade for CNM. When stratified by myositis-cancer intervals, CAM SIR was 9.94 (6.43, 14.67) within 1 year of myositis diagnosis, whereas no temporal relationship was found for CNM. Elevated SIRs were observed for oesophageal cancer [57.77 (11.91, 168.82)], non-Hodgkin's lymphoma [41.43 (13.45, 96.69)], adenocarcinoma of unknown primary origin [67.6 (18.42, 173.07]), lung cancer [7.27 (1.98, 18.61)] and ovarian cancer [19.15 (2.32, 69.17)] within 3 years of CAM diagnosis. The cancer stage at the time of diagnosis was more advanced in CAM than CNM (P < 0.001), with a correspondingly increased hazard ratio of mortality [4.3 (1.5, 12.7)] in patients with CAM vs CNM. CONCLUSION A significantly elevated SIR was found for CAM, whereas there was a comparable SIR for CNM relative to the general population. Multiple types of cancers showed elevated SIRs among CAM, but none among CNM. Given that cancer stages in CAM were far advanced at diagnosis, mortality risk was greater in patients with CAM.
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Affiliation(s)
- Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Sang Jin Lee
- Division of Rheumatology, Department of Internal Medicine Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| | - Dana P Ascherman
- Division of Rheumatology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine
| | - Eun Bong Lee
- Division of Rheumatology, Department of Internal Medicine
| | - Yeong Wook Song
- Division of Rheumatology, Department of Internal Medicine Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Center, Seoul National University, Seoul, Korea
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13
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Noda T, Iijima M, Noda S, Maeshima S, Nakanishi H, Kimura S, Koike H, Ishigaki S, Iguchi Y, Katsuno M, Sobue G. Gene Expression Profile of Inflammatory Myopathy with Malignancy is Similar to that of Dermatomyositis rather than Polymyositis. Intern Med 2016; 55:2571-80. [PMID: 27629949 DOI: 10.2169/internalmedicine.55.6706] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective An association has been reported between inflammatory myopathies (IMs), which include polymyositis (PM) and dermatomyositis (DM), and malignancy, and the concept of cancer-associated myositis (CAM) was recently proposed. We herein attempted to determine the features and etiologies of these myopathies. Methods We analyzed the gene expression levels via microarray and real-time quantitative reverse transcription polymerase chain reaction analyses to identify genes that were specifically upregulated or downregulated with suspected inflammatory involvement and verified the microarray data via an immunohistochemical (IHC) analysis in additional cases. Patients We selected 14 patients with the following conditions: PM without malignancy (n=3), DM without malignancy (n=3), CAM (n=3), and Controls (no pathological changes or malignancy; n=5). Results PM was distinct from DM and CAM in a clustering analysis and exhibited the highest numbers of overexpressed genes and specific pathologies in a gene ontology analysis. The IHC analysis confirmed the gene expression results. Conclusion PM is associated with severe inflammatory pathological findings, primarily in the cell-mediated immune system. DM and CAM exhibit similarities in the gene expression and IHC results, which suggest that humoral immunity is the main etiology for both myopathies, indicating the importance of cancer screening in patients with IMs, particularly DM.
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Affiliation(s)
- Tomoko Noda
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
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14
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Jones J, Wortmann R. Idiopathic inflammatory myopathies—a review. Clin Rheumatol 2015; 34:839-44. [DOI: 10.1007/s10067-015-2891-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 01/31/2015] [Indexed: 11/30/2022]
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15
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Naert E, De Bleecker JL, Lumen N, Rottey S. Necrotizing myopathy as a paraneoplastic syndrome associated with renal cell carcinoma. Acta Clin Belg 2015; 70:61-4. [PMID: 25268468 DOI: 10.1179/2295333714y.0000000080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report a 49-year-old patient with necrotizing myopathy and a right renal mass. After laparoscopic radical nephrectomy, a remission of myopathy was seen. Pathologic evaluation of the nephrectomy specimen revealed a clear cell renal cell carcinoma. Relapse of myopathy 6 months postoperatively coincided with the diagnosis of the appearance of liver metastatic disease. After initiation of treatment with an mTOR-inhibitor, myopathy became less active requiring smaller amounts of corticosteroids with a complete remission of myopathy after 3 months of systemic treatment for metastatic renal cell cancer.
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Affiliation(s)
| | | | - N. Lumen
- Department of UrologyGhent University Hospital, Ghent, Belgium
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Ding L, Xiao X, Huang L. Peripheral T-cell lymphoma with hypercalcemic crisis as a primary symptom accompanied by polymyositis: A case report and review of the literature. Oncol Lett 2014; 9:231-234. [PMID: 25435965 PMCID: PMC4246622 DOI: 10.3892/ol.2014.2661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 10/15/2014] [Indexed: 11/24/2022] Open
Abstract
The present study reports the case of a 61-year-old male with polymyositis who presented with exacerbated weakness in the lower limbs and a recurrent fever that had persisted for one month. Positron emission tomography/computed tomography scans revealed multiple regions of elevated fluorodeoxyglucose metabolism in the lymph nodes, lungs, liver, spleen and bones. While symptoms of nonchalance and confusion were identified on admission, the patient’s serum calcium level was high at 3.87 mmol/l, so a hypercalcemic crisis was confirmed. A biopsy of the right lingual lymph node revealed peripheral T-cell lymphoma, not otherwise specified. The serum calcium level was restored to within the normal range following emergency measures, such as saline rehydration, diuretics, calcitonin and glucocorticoids, and partial remission was achieved following two courses of chemotherapy. The study may improve our present understanding of the diagnosis and treatment of cancer-associated myositis (CAM) and malignancy-associated hypercalcemia.
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Affiliation(s)
- Luyin Ding
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University Medical College, Hangzhou, Zhejiang 310009, P.R. China
| | - Xibin Xiao
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University Medical College, Hangzhou, Zhejiang 310009, P.R. China
| | - Liansheng Huang
- Department of Hematology, The Second Affiliated Hospital of Zhejiang University Medical College, Hangzhou, Zhejiang 310009, P.R. China
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Lu X, Yang H, Shu X, Chen F, Zhang Y, Zhang S, Peng Q, Tian X, Wang G. Factors predicting malignancy in patients with polymyositis and dermatomyostis: a systematic review and meta-analysis. PLoS One 2014; 9:e94128. [PMID: 24713868 PMCID: PMC3979740 DOI: 10.1371/journal.pone.0094128] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/12/2014] [Indexed: 12/17/2022] Open
Abstract
Objective To define potential factors that could predict concomitant neoplastic diseases in patients diagnosed with PM/DM, which could inform screening decisions. Methods Two researchers independently reviewed articles from Pubmed (MEDLINE), EMBASE, Cochrane Plus Library and ISI Web of Knowledge with no restrictions on study design or language. Given that some of the studies combined PM and DM patients as research subjects while others included only DM patients, data were subjected to meta-analyses for all combined PM/DM studies and studies that included only DM patients to obtain informative results. Results For PM/DM patients, the following factors are all associated with an increased risk of malignancy: older age, age greater than 45, male sex, dysphagia, cutaneous necrosis, cutaneous vasculitis, rapid onset of myostis (<4 weeks), elevated CK, higher ESR, higher CRP levels. Several factors were associated with lower-than-average risk, including the presence of ILD, arthritis/arthralgia, Raynaud's syndrome, or anti-Jo-1 antibody. For DM patients, results indicated an increased risk of malignancy with older age, male sex, the presence of cutaneous necrosis, elevated ESR (>35 mm/hr), higher CRP levels, or anti-p155 antibody. In addition, the presence of anti-ENA antibodies seem to be related to reduced risk of malignancy. Conclusion Awareness and implementation of early-stage cancer screening in PM/DM patients who have these identified factors – such as being older than 45, male sex, cutaneous necrosis, cutaneous vasculitis – are of crucial importance from public health and clinical perspectives and provide insight into the etiopathogenesis of CAM.
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Affiliation(s)
- Xin Lu
- China-Japan Friendship Hospital, Beijing, China
| | - Hanbo Yang
- China-Japan Friendship Hospital, Beijing, China
| | | | - Fang Chen
- China-Japan Friendship Hospital, Beijing, China
| | - Yinli Zhang
- China-Japan Friendship Hospital, Beijing, China
| | | | | | | | - Guochun Wang
- China-Japan Friendship Hospital, Beijing, China
- * E-mail:
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A benign tumor as the apparent trigger for myopathy. J Clin Rheumatol 2014; 20:115-7. [PMID: 24561420 DOI: 10.1097/rhu.0000000000000083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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What is the Background Incidence of Malignancy in Children with Rheumatic Disease? Curr Rheumatol Rep 2013; 15:310. [DOI: 10.1007/s11926-012-0310-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Current world literature. Curr Opin Rheumatol 2012; 24:694-702. [PMID: 23018859 DOI: 10.1097/bor.0b013e328359ee5b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chakraborti C, Antoon JW. Incomplete reporting in a case report of corticosteroids in the treatment of alcohol-induced rhabdomyolysis. Mayo Clin Proc 2012; 87:803. [PMID: 22862868 PMCID: PMC3497881 DOI: 10.1016/j.mayocp.2012.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 06/11/2012] [Accepted: 06/11/2012] [Indexed: 11/23/2022]
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