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Dunn C, Nathoo R, Tauer A, Green L. Alopecia areata and myasthenia gravis presenting as paraneoplastic phenomena of breast cancer. JAAD Case Rep 2022; 21:35-37. [PMID: 35141386 PMCID: PMC8816651 DOI: 10.1016/j.jdcr.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
The interaction between hair and malignancy is complicated. Various hair abnormalities can manifest in oncology patients as a clinical manifestation, the result of cancer therapy, or due to a paraneoplastic condition. The mechanisms of these changes remain unclear. Alopecia is one of the common clinical presentations occurring in oncology patients that affects their quality of life. The condition can concomitantly develop during the course of malignancy or when patients undergo cancer treatment. It is important for physicians to understand alopecia in association with malignancy as it may be an important associated finding or provide the clues to aid diagnosis. The aim of this review is to summarize the clinical characteristics of alopecia that occur in cancer patients and their relationship with the type of malignancy and its treatment.
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Chen CC, Chang YT, Liu HN, Chen YJ. Cancer risk in patients with alopecia areata: a nationwide population-based matched cohort study. Cancer Med 2018; 7:2153-2159. [PMID: 29577672 PMCID: PMC5943418 DOI: 10.1002/cam4.1448] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 02/20/2018] [Accepted: 02/23/2018] [Indexed: 12/20/2022] Open
Abstract
Alopecia areata (AA) is an organ-specific autoimmune disorder. Defective immune system related disorders are prone to increase the risk of cancer formation. However, the association among AA and variety of cancer types had never been studied. A nationwide population-based matched cohort study was conducted to evaluate the cancer risk in patients with AA. Records from Taiwan National Health Insurance Research Database were analyzed. Cases of AA from 1997 to 2013 and cancers registered in the catastrophic illness profile from the same time period were collected. The standard incidence ratio (SIR) of each cancer was calculated. In total, 2099 cancers among 162,499 patients with AA and without prior cancers were identified. The overall cancer risks in AA patients were slightly decreased, especially among male subjects (SIR: 0.89). Refer to individual cancer, the cancer risk of nonmelanoma skin cancer (NMSC) (SIR: 0.59), upper GI cancer (SIR: 0.70), liver cancer (SIR: 0.82), uterine, and cervix cancer (SIR: 0.84) were significantly lower in patients with AA. In contrast, AA patients were inclined to have lymphoma, breast cancer, kidney, and urinary bladder cancer with the SIR of 1.55, 2.93, and 2.95, respectively. Age stratified analyses revealed female AA patients younger than 50 years old have even higher risk of breast cancer (SIR: 3.37). Further sensitivity analysis showed similar results after excluding major autoimmune disorders. Cancer risk in AA patients is organ specific, and it is not associated with the underlying autoimmune disorders in patients with AA.
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Affiliation(s)
- Chih-Chiang Chen
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Dermatology, National Yang-Ming University, Taipei, Taiwan.,Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, National Yang-Ming University, Taipei, Taiwan.,Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Nan Liu
- Department of Dermatology, National Yang-Ming University, Taipei, Taiwan.,Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Ju Chen
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Dermatology, National Yang-Ming University, Taipei, Taiwan.,Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
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Messina C, Christie D, Zucca E, Gospodarowicz M, Ferreri AJM. Primary and secondary bone lymphomas. Cancer Treat Rev 2015; 41:235-46. [PMID: 25698636 DOI: 10.1016/j.ctrv.2015.02.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/20/2015] [Accepted: 02/01/2015] [Indexed: 12/24/2022]
Abstract
Recent studies have contributed to the enhancement of clinical and molecular knowledge on bone lymphomas, a group of rare malignancies with particular characteristics. Nevertheless, several questions remain unanswered and the level of evidence supporting some diagnostic and therapeutic decisions remains low. Currently, three different forms of bone lymphomas can be distinguished: the primary bone lymphoma, consisting of a single bone lesion with or without regional lymphadenopathies; the polyostotic lymphoma, consisting of multifocal disease exclusively involving the skeleton; and the disseminated lymphoma with secondary infiltration of the skeleton. The first two forms exhibit a good prognosis, requiring treatments similar to those commonly used for nodal lymphomas of the same category, but several issues regarding the role of surgery and local control of the disease, the sequence of treatment, radiation volumes and doses, management of pathological fractures and prevention of late sequelae deserve particular attention. Due to its rarity, prospective trials exclusively focused on bone lymphomas appear unrealistic, thus, critical revision of our own experience and analyses of large cumulative series as well as molecular studies on archival cases remain valid alternatives to improve our knowledge on this obscure lymphoproliferative malignancy. The present review is based on the analysis of the largest available database of bone lymphomas established under the sponsorship of the International Extranodal Lymphoma Study Group (IELSG) as well as on the critical revision of related literature. We provide recommendations for diagnosis, staging, treatment, and response assessment of these patients in everyday practice as well as for the management of special conditions like pathological fractures, indolent forms and central nervous system prophylaxis.
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Affiliation(s)
- Carlo Messina
- Unit of Lymphoid Malignancies, Department of Onco-Haematology, San Raffaele Scientific Institute, Milan, Italy
| | - David Christie
- Genesiscare and Bond University, Inland Dr., Tugun, QLD, Australia
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Mary Gospodarowicz
- Department of Radiation Oncology, Princess Margaret Hospital, Ontario Cancer Institute, Toronto, ON, Canada
| | - Andrés J M Ferreri
- Unit of Lymphoid Malignancies, Department of Onco-Haematology, San Raffaele Scientific Institute, Milan, Italy.
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Gong J, Lim SW. Alopecia areata as a paraneoplastic syndrome of Hodgkin's lymphoma: A case report. Mol Clin Oncol 2014; 2:596-598. [PMID: 24940502 DOI: 10.3892/mco.2014.274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 04/03/2014] [Indexed: 11/05/2022] Open
Abstract
Alopecia areata (AA) has been classically associated with several autoimmune disorders. However, AA as a paraneoplastic syndrome of Hodgkin's lymphoma (HL) remains a rare entity and our understanding of this phenomenon is limited to a few case reports. This is the case report of a 46-year-old male patient who was diagnosed with AA several months prior to the onset of B symptoms and the diagnosis of stage IVB classical HL. The patient was subsequently treated with 6 cycles of adriamycin, bleomycin, vinblastine and dacarbazine and experienced a complete response and resolution of his AA. In our case, the onset of AA preceded the onset of systemic manifestations and diagnosis of HL, whereas in other cases AA was shown to occur concurrently with the clinical manifestations of HL. In all the cases, however, treatment of the HL subsequently led to resolution of the AA. The present case report highlights the significance of AA as a herald of underlying malignancy, although AA in classical HL remains poorly characterized in the literature.
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Affiliation(s)
- Jun Gong
- Department of Internal Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Stephen W Lim
- Blood and Marrow Transplant Program, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Abstract
Many reports have described the presence of alopecia areata (AA) associated with other autoimmune diseases, which support the autoimmune nature of AA. Additionally, AA has been reported in association with malignancy as a paraneoplastic symptom. In this report, we describe three patients with diffuse large B-cell lymphoma, alveolar soft part sarcoma, and cavernous sinus arteriovenous fistula with embolization treatment, respectively, who characteristically presented with rectangular-patterned occipital AA.
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Affiliation(s)
- Jaeyong Shin
- Department of Dermatology and Cutaneous, Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Antoniou E, Paraskeva P, Smyrnis A, Konstantopoulos K. Alopecia: a common paraneoplastic manifestation of cholangiocarcinoma in humans and animals. BMJ Case Rep 2012; 2012:bcr-2012-006217. [PMID: 22717934 DOI: 10.1136/bcr-2012-006217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The coincidence of alopecia and a tumour may indicate the paraneoplastic nature of alopecia. Paraneoplastic alopecia is not uncommon in animals, feline paraneoplastic alopecia being the best example known. We present a case of alopecia coinciding with the presentation of a cholangiocarcinoma in a woman. Following surgical resection of the tumour, alopecia resolved spontaneously and it reappeared on local recurrence, 2 years later. As far as pathogenesis is concerned, the coincidence of alopecia and cholangiocarcinoma may indicate the paraneoplastic nature of alopecia as a rare complication of this rare tumour in humans. This also implies that common interspecies mechanism(s) must exist as far as this paraneoplastic complication is concerned.
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Affiliation(s)
- Efstathios Antoniou
- Second Teaching Department of Surgery, Athens University Medical School, Athens, Greece
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Molina Infante J, Hernández Alonso M, Martín Noguerol E, Pérez Gallardo B, Dueñas Sadornil C. Alopecia areata como presentación inicial paraneoplásica de un adenocarcinoma gástrico. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:128-30. [DOI: 10.1016/j.gastrohep.2008.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 09/01/2008] [Indexed: 10/20/2022]
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Yağci B, Varan A, Uner A, Akyüz C, Büyükpamukçu M. Thymic Langerhans cell histiocytosis mimicking lymphoma. Pediatr Blood Cancer 2008; 51:833-5. [PMID: 18680163 DOI: 10.1002/pbc.21690] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare disorder characterized by clonal expansion of antigen presenting Langerhans cells. Different clinical features can be seen according to the involved organs and systems. Multisystem disease with organ dysfunction is more common in infants, whereas single system disease is usually observed in older children. The disease can affect any system or organ throughout the body. Thymus is a rarely involvement site reported in LCH and usually is accompanied by skin, bone or lung disease. Here we report a 12-year-old male with thymic involvement by LCH clinically mimicking lymphoma.
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Affiliation(s)
- Begül Yağci
- Department of Pediatric Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey.
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Hinds G, Thomas VD. Malignancy and Cancer Treatment-Related Hair and Nail Changes. Dermatol Clin 2008; 26:59-68, viii. [DOI: 10.1016/j.det.2007.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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