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Aimaiti M, Zhang H, Aikebaier D, Ni B, Yin H, Dong Z, Zhang Y, Guan Y, Bai L, Wang S, Xia X, Zhang Z. Clinicopathological characteristics of gastric cancer patients with dermatomyositis and analysis of perioperative management: a case series study. Front Surg 2023; 10:1276575. [PMID: 38026488 PMCID: PMC10646486 DOI: 10.3389/fsurg.2023.1276575] [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: 08/21/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background This study aimed to investigate the clinical characteristics of gastric cancer (GC) patients with dermatomyositis (DM) and summarize the perioperative outcomes. Methods The clinical and pathological data of five patients diagnosed with co-occurring DM and GC (DM-GC group) were retrospectively analyzed, who were admitted to the Department of Gastrointestinal Surgery at Ren ji Hospital, Shanghai Jiao Tong University, between January 2012 and April 2023. Their data were compared with 618 GC patients (GC-1 group) from September 2016 to August 2017 and 35 GC patients who were meticulously screened from 14,580 GC cases from January 2012 and April 2023. The matching criteria included identical gender, age, tumor location, TNM stage, and surgical procedure (7 GC patients were matched for each DM-GC patient). Results Analysis indicated that the DM-GC group comprised four female and one male patient. The female proportion was significantly higher (P = 0.032) than that of GC-1 group. In DM-GC group, four DM patients were diagnosed as GC within 12 months. One DM patients was diagnosed as GC within 15 months. Among them, four patients presented with varying degrees of skin rashes, muscle weakness while one patient had elevated CK levels as the typical symptom. Similarly, the preoperative tumor markers (CA-199 and CA-125) in the DM-GC group were significantly higher than normal levels (CA-199: 100 vs. 28.6%, P = 0.002; CA-125: 40 vs. 2.9%, P = 0.003) compared to GC-2 group. Moreover, postoperative complication incidence and the length of hospital stay were significantly higher in the DM-GC than GC-2 group [complication rate: 40 vs. 8.6%, P = 0.047; hospital stay: 15 days (range: 9-28) vs. 9 days (range: 8-10), P = 0.021]. Conclusion GC Patients with dermatomyositis are more prone to experience postoperative complications and longer hospital stay.
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Affiliation(s)
- Muerzhate Aimaiti
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haoyu Zhang
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dilidaer Aikebaier
- Department of General Medicine, Kashe District Second People’s Hospital, Xinjiang, China
| | - Bo Ni
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hanlin Yin
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhongyi Dong
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yeqi Zhang
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yujing Guan
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Long Bai
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuchang Wang
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiang Xia
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zizhen Zhang
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Tang ZL, Chi CC, Tang ZW, Li XW, Man XY. Malignancy in dermatomyositis: a mono-centric retrospective study of 134 patients in China and a potential predictive model. Front Med (Lausanne) 2023; 10:1200804. [PMID: 37359002 PMCID: PMC10285222 DOI: 10.3389/fmed.2023.1200804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Objectives To describe the demographics and phenotypes of malignancies-associated dermatomyositis (MADM) in east China and pinpoint potential factors indicative of malignancies in patients with dermatomyositis and establish a predictive model. Methods We retrospectively analyzed clinical data from 134 patients with adult-onset dermatomyositis hospitalized between January 2019 and May 2022 in one comprehensive hospital. Clinical data including disease course, initial symptoms and signs, and demographic information were retrieved from the Electronic Medical Records System. Other parameters including myositis-specific autoantibodies profiles, ferritin, sedimentation, etc. were all referable. Multivariable multinomial logistic regression was employed to simulate a model to predict cancer risks. Receiver operating characteristic curve was adopted to evaluate the potency of the model. Results 134 patients with adult-onset dermatomyositis were aptly enrolled in this study based on inclusive and exclusive criteria: 12 (8.96%) with malignancies, 57 (42.53%) with aberrant tumor biomarkers but no malignancies, 65 (48.51%) with neither malignancies nor abnormal tumor biomarkers. Senior diagnostic age, higher LDH, higher ferritin, positive anti-TIF1γ and anti-Mi2 rather than anti-NXP2 autoantibodies were positive indicators of malignancies. Additionally, neither initial complaints nor signs were found to be correlated to a tendency towards malignancies. Digestive system, nasopharyngeal, and lung malignancies were mostly documented in east China. One multivariable multinomial logistic regression model was established to predict the phenotypes of dermatomyositis on the basis of potential malignancies and the overall sensitivity and specificity was satisfactory. Conclusion Positivity of anti-TIF1γ and anti-Mi2 autoantibodies are highly indicative of malignancies while the role of anti-NXP2 autoantibody in MADM in the Chinese population remains unclear. The phenotypes of malignancies can be predicted through the model and the predictive power is sufficient. More attention should be paid to malignancies screening in patients with aberrant tumor biomarkers but no malignancies, particularly digestive system, nasopharyngeal, and lung malignancies in patients with dermatomyositis but without malignancies.
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Affiliation(s)
- Zhuang-Li Tang
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chao-cheng Chi
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhen-Wei Tang
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xia-Wei Li
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Yong Man
- Department of Dermatology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Didona D, Solimani F, Caposiena Caro RD, Sequeira Santos AM, Hinterseher J, Kussini J, Cunha T, Hertl M, Didona B. Dermatomyositis: a comprehensive review of clinical manifestations, serological features, and therapeutic approaches. Ital J Dermatol Venerol 2023; 158:84-98. [PMID: 37153943 DOI: 10.23736/s2784-8671.23.07458-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Dermatomyositis (DM) is an autoimmune disorder, which belongs to a group of rare autoimmune dermatoses characterized by different skin features and variable muscle involvement. We recognize four main variants of DM: classic DM, clinically amyopathic DM, paraneoplastic DM, and juvenile DM. Clinically, patients show several skin features, but heliotrope rash, and violaceous papules located at the interphalangeal or metacarpophalangeal joints (Gottron's papules) are the most frequently observed. Together with skin features, patients show muscle involvement, most commonly with symmetrical weakness of the proximal muscles. DM belongs to the facultative paraneoplastic dermatoses and a wide range of solid or hematologic malignancies can be detected in DM patients. Serologically, a wide range of autoantibodies can be detected in patients with DM. Indeed, distinct serotypes can be related to specific phenotypes with specific clinical features, carrying a different risk for systemic involvement and for malignancies. Systemic corticosteroids are still considered the first-line approach, but several steroid-sparing agents, such as methotrexate, azathioprine or mycophenolate mofetil, have been reported as effective in treating DM. Furthermore, new class of drugs, such as monoclonal antibodies, purified immunoglobulins or Janus kinase inhibitors are becoming more relevant in the clinical practice or are currently under investigation. In this work, we aim to offer a clinical overview of the diagnostic workout, the characteristics of DM variants, the role of autoantibodies in DM, and the management of this life-threatening systemic disorder.
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Affiliation(s)
- Dario Didona
- Department of Dermatology and Allergology, Philipps University of Marburg, Marburg, Germany -
| | - Farzan Solimani
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin BIH, Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Julia Hinterseher
- Department of Dermatology and Allergology, Philipps University of Marburg, Marburg, Germany
| | - Jacqueline Kussini
- Department of Dermatology and Allergology, Philipps University of Marburg, Marburg, Germany
| | - Tomas Cunha
- Department of Dermatology and Allergology, Philipps University of Marburg, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps University of Marburg, Marburg, Germany
| | - Biagio Didona
- Department of Dermatology, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, Rome, Italy
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Pruessmann W, Kleinheinz A, Zillikens D, Rose C. Histopathological risk factors for malignancy in dermatomyositis. Histopathology 2022; 81:529-535. [PMID: 35876260 DOI: 10.1111/his.14727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022]
Abstract
AIMS To identify possible histopathological risk factors for malignancy in skin biopsies of dermatomyositis patients. METHODS AND RESULTS We analysed clinical metadata and studied 30 skin biopsies of 11 patients with and 12 patients without associated malignancy that were treated in one secondary and one tertiary German medical center between 2009 and 2022 and fulfilling the EULAR/ACR classification criteria for dermatomyositis. Specimens were categorized by malignancy status and evaluated based on H&E, PAS, Alcian Blue and anti-CD123 immunohistochemistry stains. After correcting for multiple testing, biopsies of patients with cancer exhibited more severe basement membrane thickening (p<0.05) and pigment incontinence (p<0.05) compared to patients without tumour burden. Patients with numerous subepidermal melanophages had a more than 5-times increased odds ratio to suffer from an internal malignancy (OR 5.3, 95%CI 1.3-54.2, p<0.05). Furthermore, specimens of the malignancy group presented a distinct superficial distribution pattern of CD123+ plasmacytoid dendritic cells (PDCs, p<0.01). Extravascular eosinophils were absent in all cases. CONCLUSIONS Severity of basement membrane thickening, extent of pigment incontinence and superficial distribution pattern of CD123+ PDCs could serve as useful histopathological indicators of risk for malignancy in dermatomyositis.
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Affiliation(s)
- Wiebke Pruessmann
- Department of Dermatology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Andreas Kleinheinz
- Department of Dermatology, Clinical Centre Buxtehude, Am Krankenhaus 1, 21614, Buxtehude, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Christian Rose
- Department of Dermatology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.,Dermatopathology Lübeck, Maria-Goeppert-Str. 5, 23562, Lübeck, Germany
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Tumorassoziierte Dermatomyositiden präsentieren sich anders. AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1766-4907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Harada Y, Tominaga M, Iitoh E, Kaieda S, Koga T, Fujimoto K, Chikasue T, Obara H, Kakuma T, Ida H, Kawayama T, Hoshino T. Clinical Characteristics of Anti-TIF-1γ Antibody-Positive Dermatomyositis Associated with Malignancy. J Clin Med 2022; 11:jcm11071925. [PMID: 35407533 PMCID: PMC8999723 DOI: 10.3390/jcm11071925] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 12/04/2022] Open
Abstract
We retrospectively analyzed the clinical and laboratory data of patients diagnosed with anti-transcriptional intermediary factor 1 (TIF-1γ) antibody-positive polymyositis (PM)/dermatomyositis (DM) to clarify the characteristics of this disease. We identified 14 patients with TIF-1γ antibody-positive DM (TIF-1γ DM), 47 with anti-aminoacyl-tRNA synthetase antibody (ARS)-positive PM/DM, and 24 with anti-melanoma differentiation-associated gene 5 antibody (MDA-5)-positive PM/DM treated at the Kurume University Hospital between 2002 and 2020. Patients with TIF-1γ DM were significantly older than the other two groups. Nine patients with TIF-1γ DM were female, thirteen patients had DM, and one had clinically amyopathic DM. Primary malignant lesions were lung (3), uterus (2), colon (2), breast (2), ovary (1), lymphoma (1), and unknown (2). Cutaneous manifestation and dysphagia were the most common symptoms in TIF-1γ DM. Erythema (9/14), the V-neck sign (8/14), heliotrope (9/14), and nailfold telangiectasia (14/14) were significantly more common in TIF-1γ DM. Furthermore, no patients with TIF-1γ DM had interstitial lung abnormality on high-resolution CT. In patients with TIF-1γ DM, the frequency of dysphagia and unusual erythema, particularly that which spreads from the trunk, and nailfold telangiectasia, were characteristic findings. In most patients with TIF-1γ DM, it is necessary to administer other immunosuppressive drugs along with glucocorticoids.
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Affiliation(s)
- Yumi Harada
- Division of Respirology, Department of Medicine, Neurology and Rheumatology, Kurume University School of Medicine, Kurume 830-0011, Japan; (Y.H.); (E.I.); (S.K.); (T.K.); (H.I.); (T.K.); (T.H.)
| | - Masaki Tominaga
- Division of Respirology, Department of Medicine, Neurology and Rheumatology, Kurume University School of Medicine, Kurume 830-0011, Japan; (Y.H.); (E.I.); (S.K.); (T.K.); (H.I.); (T.K.); (T.H.)
- Correspondence: ; Tel.: +81-942-31-7560; Fax: +81-942-31-7703
| | - Eriko Iitoh
- Division of Respirology, Department of Medicine, Neurology and Rheumatology, Kurume University School of Medicine, Kurume 830-0011, Japan; (Y.H.); (E.I.); (S.K.); (T.K.); (H.I.); (T.K.); (T.H.)
| | - Shinjiro Kaieda
- Division of Respirology, Department of Medicine, Neurology and Rheumatology, Kurume University School of Medicine, Kurume 830-0011, Japan; (Y.H.); (E.I.); (S.K.); (T.K.); (H.I.); (T.K.); (T.H.)
| | - Takuma Koga
- Division of Respirology, Department of Medicine, Neurology and Rheumatology, Kurume University School of Medicine, Kurume 830-0011, Japan; (Y.H.); (E.I.); (S.K.); (T.K.); (H.I.); (T.K.); (T.H.)
| | - Kiminori Fujimoto
- Department of Radiology, Center for Diagnostic Imaging, Kurume University School of Medicine, Kurume 830-0011, Japan; (K.F.); (T.C.)
| | - Tomonori Chikasue
- Department of Radiology, Center for Diagnostic Imaging, Kurume University School of Medicine, Kurume 830-0011, Japan; (K.F.); (T.C.)
| | - Hitoshi Obara
- Biostatistics Center, Kurume University, Kurume 830-0011, Japan; (H.O.); (T.K.)
| | - Tatsuyuki Kakuma
- Biostatistics Center, Kurume University, Kurume 830-0011, Japan; (H.O.); (T.K.)
| | - Hiroaki Ida
- Division of Respirology, Department of Medicine, Neurology and Rheumatology, Kurume University School of Medicine, Kurume 830-0011, Japan; (Y.H.); (E.I.); (S.K.); (T.K.); (H.I.); (T.K.); (T.H.)
| | - Tomotaka Kawayama
- Division of Respirology, Department of Medicine, Neurology and Rheumatology, Kurume University School of Medicine, Kurume 830-0011, Japan; (Y.H.); (E.I.); (S.K.); (T.K.); (H.I.); (T.K.); (T.H.)
| | - Tomoaki Hoshino
- Division of Respirology, Department of Medicine, Neurology and Rheumatology, Kurume University School of Medicine, Kurume 830-0011, Japan; (Y.H.); (E.I.); (S.K.); (T.K.); (H.I.); (T.K.); (T.H.)
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