Lee Jonathan J, Girouard Sasha D, Carlberg Valerie M, Mostaghimi Arash
Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA Program in Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
BMJ Support Palliat Care. 2016 Mar;6(1):119-21. doi: 10.1136/bmjspcare-2014-000790. Epub 2014 Dec 16.
Pruritus is a debilitating symptom that can be associated with cutaneous involvement by an underlying malignancy. We report the case of a 68-year-old woman with a history of triple-negative breast cancer who presented with extensive, localised cutaneous metastasis complicated by incapacitating, treatment-refractory pruritus localised to the anatomic regions involved by her metastatic disease. Physical examination revealed an indurated, ecchymotic, ulcerated plaque circumferentially encasing her thorax. Histopathological examination revealed substantial dermal lymphatic involvement and dilation as well as dermal collagen infiltration by tumour cells and nodules. The clinical and pathological findings were consistent with a diagnosis of carcinoma en cuirasse. Mirtazapine, a noradrenergic antidepressant with antiserotonin and antihistamine activity, was started and led to rapid, sustained relief of the patient's pruritus. Mirtazapine may be a useful systemic agent for the palliative relief of pruritus associated with cutaneous infiltration by an underlying malignancy.
瘙痒是一种使人衰弱的症状，可能与潜在恶性肿瘤的皮肤受累有关。我们报告了一例68岁有三阴性乳腺癌病史的女性患者，她出现广泛的局限性皮肤转移，并伴有因转移疾病累及的解剖区域出现使人丧失能力且治疗难治的瘙痒。体格检查发现一个硬结、瘀斑、溃疡的斑块环绕着她的胸部。组织病理学检查显示大量真皮淋巴管受累和扩张，以及肿瘤细胞和结节对真皮胶原的浸润。临床和病理结果符合铠甲状癌的诊断。米氮平是一种具有抗血清素和抗组胺活性的去甲肾上腺素能抗抑郁药，开始使用后迅速、持续地缓解了患者的瘙痒。米氮平可能是一种用于缓解与潜在恶性肿瘤皮肤浸润相关瘙痒的有效全身用药。
