Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Cancer Res Treat. 2016 Apr;48(2):848-52. doi: 10.4143/crt.2014.310. Epub 2015 Mar 18.
Cholangiocarcinoma with paraneoplastic dermatomyositis (DM) is extremely rare, and the whole body positron emission tomography-computed tomography (PET-CT) finding of paraneoplastic DM is rarely reported. We report a 66-year-old woman with metastatic cholangiocarcinoma, initially presented with bilateral proximal muscle uptake on PET-CT without clinical muscle symptoms. The initial interpretation of the high muscle uptake was metastasis to the muscles. However, while awaiting for chemotherapy, muscle weakness evolved and rapidly progressed. The level of creatine phosphokinase was significantly elevated. Electromyography revealed moderate myopathy, and a muscle biopsy showed degenerating myofibers with variable sizes. The diagnosis of paraneoplastic dermatomyositis was made. This case highlights that, although rare, paraneoplastic dermatomyositis can be present with cholangiocarcinoma. Also, muscle inflammation can precede the clinical muscle symptoms, and paraneoplastic DM should be considered as a possible differential diagnosis in the assessment of cancer patients who present with abnormal muscle tracer uptake in PET-CT scans.
伴有副肿瘤性皮肌炎 (DM) 的胆管癌极为罕见，副肿瘤性 DM 的全身正电子发射断层扫描-计算机断层扫描 (PET-CT) 表现鲜有报道。我们报告了 1 例 66 岁女性，患有转移性胆管癌，最初在 PET-CT 上表现为双侧近端肌肉摄取，无临床肌肉症状。最初对高肌肉摄取的解释是肌肉转移。然而，在等待化疗期间，肌肉无力逐渐发展并迅速进展。肌酸磷酸激酶水平显著升高。肌电图显示中度肌病，肌肉活检显示大小不一的退行性肌纤维。诊断为副肿瘤性皮肌炎。该病例强调，尽管罕见，但副肿瘤性皮肌炎可与胆管癌同时存在。此外，肌肉炎症可能先于临床肌肉症状出现，对于在 PET-CT 扫描中出现异常肌肉示踪剂摄取的癌症患者，应考虑副肿瘤性 DM 作为可能的鉴别诊断。
