Malignancy and autoimmunity: causally or casually related?

Chemotherapy-Induced Broadly Reactive Autoantibodies in a Colon Cancer Patient

The link between cancer and autoimmunity is well known. However, the extent to which chemotherapy induces autoimmune responses is still unclear. Here, we quantified IgM responses to various human tissues and patient tumors before and during adjuvant chemotherapy (seven cycles of the FOLFIRI plus cetuximab regimen) with metastasized colorectal cancer. IgM levels against all tissues tested increased shortly after the first cycle and further increased in the second and third cycles. Autoimmune responses then declined during cycles four through seven, but remained above baseline for most tissues. Our results suggest that chemotherapy can induce wide-reactive autoimmune responses. Monitoring self-reactive IgM responses during treatment may help alleviate the side effects associated with autoimmunity.

Chemotherapy-Induced, Broadly Reactive Autoantibodies in a Colon Cancer Patient

The link between cancer and autoimmunity is well-established. For example, increased levels of autoantibodies are frequently found in cancer patients, and autoimmune diseases are linked to an increased risk for certain neoplasms. However, the extent to which chemotherapy induces autoimmune reactions remains largely elusive. Here, we quantified immunoglobulin M (IgM) responses to various human tissues and the patient's tumor before and during adjuvanted chemotherapy (seven cycles of the FOLFIRI regimen (folinic acid/fluorouracil/irinotecan) plus cetuximab) of a patient with metastasized colon cancer. IgM levels against all investigated tissues increased shortly after the first cycle and were further boosted by cycles two and three. Autoimmune responses then decreased during cycles four to seven but remained above baseline levels for most tissues. Our findings suggest that chemotherapy can induce broadly reactive autoimmune responses. Monitoring self-reactive IgM responses during treatment may help alleviate autoimmunity-related adverse events.

A Case Report of Autoimmune Phenomena With Underlying Breast Cancer: Occam’s Razor Versus Hickam’s Dictum

The association between malignancies and autoimmunity had been well-established. The proposed pathophysiology and causality can be bidirectional. For example, a paraneoplastic syndrome can be triggered by an underlying malignancy or vice versa, where chronic inflammation of organs affected by autoimmunity can induce malignant transformation such as the case with inflammatory bowel disease and colorectal cancer or primary sclerosing cholangitis and hepatobiliary cancer. This report presents a case of autoimmune phenomena, namely, autoimmune hemolytic anemia, pernicious anemia, and Graves disease associated with newly diagnosed breast cancer. We also highlight the postulated pathophysiologic mechanisms in an attempt to answer the question of whether the occurrence of these autoimmune phenomena in our patient is a result of the law of parsimony (Occam's razor), where clinical variables are pathogenically related, or the counterargument, where random events and diseases can take place simultaneously (Hickam's dictum). 

Liver perivascular epithelioid cell tumor in a patient with systemic lupus erythematosus

INTRODUCTION

Perivascular epithelioid cell tumor (PECOMA) is a rare mesenchymal neoplasm which expresses both myogenic and melanocytic markers showing a benign course,although malignant tumors have also been reported. To date there are approximately 33 cases of published hepatic pecomas.

PRESENTATION OF CASE

We describe a 47-year-old man with a 27-year past medical history of systemic lupus erythematosus (SLE) who underwent left liver lobectomy due to a liver pecoma. His postoperative course complicated with infection, thrombosis of hepatic artery and liver ischemia as well as drug fever.

DISCUSSION

Treatment protocol especially for hepatic PECOMA has not reached a consensus although surgical resection is the preferred therapy.

CONCLUSION

This is the first case of coexistence of liver pecoma and SLE.