Hendren E, Vinik O, Faragalla H, Haq R
Postgraduate Medical Education, Department of Medicine, University of Toronto.
Division of Rheumatology, Department of Medicine, St. Michael's Hospital.
Curr Oncol. 2017 Oct;24(5):e429-e433. doi: 10.3747/co.24.3696. Epub 2017 Oct 25.
A 49-year-old woman presents with an extensive violaceous rash, rapidly progressive proximal muscle weakness, and dysphagia to solids, consistent with a diagnosis of dermatomyositis. Two weeks later, she palpates a mass in her left breast and is diagnosed with her2-positive metastatic invasive ductal carcinoma of the breast. There is a well-established association between dermatomyositis and malignancy. However, the specific association between breast cancer and dermatomyositis has not been well characterized. No guideline for oncologists managing these patients has been established. Recently, 3 cases of breast cancer and dermatomyositis were diagnosed at our institution. A review of the literature was pursued to characterize the association between breast cancer and dermatomyositis. A review of 178 papers identified 22 cases of breast cancer with dermatomyositis. Most patients (71%) presented with stage iii or iv breast cancer. The median time between the diagnosis of breast cancer and the onset of dermatomyositis symptoms was 1 month. Three quarters of the patients were steroid-responsive and able to taper. Half the women with follow-up data experienced a documented cancer relapse associated with a new flare of cutaneous symptoms. The presence of dermatomyositis appears to be associated with more-advanced breast cancer stage and is most commonly associated with invasive ductal carcinoma. In our review, treatment of cancer alone is insufficient to adequately control the cutaneous and myopathic manifestations of dermatomyositis, which can significantly affect quality of life. A multidisciplinary approach, including close collaboration with rheumatologists and dermatologists, is therefore important in the diagnosis and management of oncology patients with dermatomyositis.
一名49岁女性出现广泛的紫蓝色皮疹、快速进展的近端肌无力以及吞咽固体食物困难，符合皮肌炎的诊断。两周后，她摸到左乳有一个肿块，被诊断为HER2阳性转移性乳腺浸润性导管癌。皮肌炎与恶性肿瘤之间存在明确的关联。然而，乳腺癌与皮肌炎之间的具体关联尚未得到充分描述。尚未制定针对管理这些患者的肿瘤学家的指南。最近，我们机构诊断出3例乳腺癌合并皮肌炎病例。我们对文献进行了回顾，以描述乳腺癌与皮肌炎之间的关联。对178篇论文的回顾确定了22例患有皮肌炎的乳腺癌患者。大多数患者（71%）表现为III期或IV期乳腺癌。乳腺癌诊断与皮肌炎症状出现之间的中位时间为1个月。四分之三的患者对类固醇有反应且能够逐渐减量。有随访数据的女性中有一半经历了记录在案的癌症复发，并伴有皮肤症状的新发作。皮肌炎的存在似乎与更晚期的乳腺癌分期相关，且最常与浸润性导管癌相关。在我们的回顾中，仅治疗癌症不足以充分控制皮肌炎的皮肤和肌病表现，而这些表现会显著影响生活质量。因此，多学科方法，包括与风湿病学家和皮肤科医生密切合作，对于诊断和管理患有皮肌炎的肿瘤患者很重要。
