Beel Andrew J, Demos David S, Chung Alfred, Liao Charles, Lui Natalie S
Stanford University School of Medicine, Stanford, USA.
Division of Thoracic Surgery, Stanford University School of Medicine, Falk Building, 300 Pasteur Drive, Stanford, 94305, USA.
J Cardiothorac Surg. 2018 Feb 7;13(1):20. doi: 10.1186/s13019-018-0705-x.
Dermatomyositis, an inflammatory myopathy with cutaneous involvement, is associated with malignancy and often manifests paraneoplastically. While co-occurrence with small cell carcinoma is well attested, primary lung adenocarcinoma, which may present as focal ground-glass opacification on computed tomography of the thorax, is less frequently coincident.
We report the case of a 72-year-old female patient with dermatomyositis - treated with a combination of prednisone, methotrexate, and intravenous immunoglobulin - and an indolent, subsolid, non-hypermetabolic pulmonary lesion, which was determined to be invasive primary lung adenocarcinoma. Supporting a paraneoplastic basis, immunosuppressive therapy was discontinued following tumor excision without relapse of signs or symptoms of dermatomyositis.
While dermatomyositis prodromal to lung adenocarcinoma is not without precedent, association with an indolent, subsolid lesion has, to the best of our knowledge, not been reported. The case described herein illustrates the importance of maintaining a high index of suspicion for malignancy in the setting of dermatomyositis.
皮肌炎是一种伴有皮肤受累的炎性肌病，与恶性肿瘤相关，且常表现为副肿瘤性。虽然与小细胞癌同时发生已有充分证实，但原发性肺腺癌在胸部计算机断层扫描上可能表现为局灶性磨玻璃影，与之同时发生的情况较少见。
我们报告了一例72岁女性皮肌炎患者，接受泼尼松、甲氨蝶呤和静脉注射免疫球蛋白联合治疗，同时存在一个惰性、实性成分少、无高代谢的肺部病变，经诊断为浸润性原发性肺腺癌。支持副肿瘤性基础的是，肿瘤切除后停用免疫抑制治疗，皮肌炎的体征或症状未复发。
虽然皮肌炎先于肺腺癌出现并非没有先例，但据我们所知，与惰性、实性成分少的病变相关的情况尚未见报道。本文所述病例说明了在皮肌炎患者中保持对恶性肿瘤高度怀疑的重要性。
