Abdalla Hossam, Bagchi Arindam, Bandagi Sabiha
Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA.
Department of Rheumatology, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Queens, NY, USA.
Am J Case Rep. 2015 Jun 24;16:390-2. doi: 10.12659/AJCR.892906.
Lynch syndrome (LS) is an inherited colorectal cancer (CRC) syndrome accounting for about 3-5% of all cases and involves significantly higher risk of subsequent malignancies, colonic as well as extra-colonic. Increased risk of malignancies, especially lymphoid malignancies, have been described in patients with autoimmune diseases like rheumatoid arthritis (RA), systemic lupus erythematosus, and Sjögren's syndrome. Epidemiological studies demonstrated that hematopoietic, lung, skin, and prostate cancers are increased in RA, while breast and colon cancers are decreased, with an overall slight increase in all cancers.
Our case demonstrates the development of CRC, endometrial cancer, and breast cancer as a presentation of LS in a patient with RA and presents a therapeutic challenge for RA treatment.
We describe a patient with LS and RA presenting a therapeutic challenge because biologic agents commonly used to treat severe RA need to be used cautiously in patients with history of malignancy.
林奇综合征（LS）是一种遗传性结直肠癌（CRC）综合征，约占所有病例的3%至5%，会显著增加后续发生恶性肿瘤的风险，包括结肠和结肠外的恶性肿瘤。类风湿关节炎（RA）、系统性红斑狼疮和干燥综合征等自身免疫性疾病患者发生恶性肿瘤的风险增加，尤其是淋巴系统恶性肿瘤。流行病学研究表明，RA患者患血液系统、肺癌、皮肤癌和前列腺癌的风险增加，而乳腺癌和结肠癌的风险降低，所有癌症的总体风险略有增加。
我们的病例展示了一名患有RA的患者发生CRC、子宫内膜癌和乳腺癌，这是LS的一种表现，对RA的治疗提出了挑战。
我们描述了一名患有LS和RA的患者面临治疗挑战，因为常用于治疗重度RA的生物制剂在有恶性肿瘤病史的患者中需要谨慎使用。
