以皮肤病为首发表现的恶性肿瘤
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摘要
目的：探讨皮肤病合并恶性肿瘤的临床特点、诊断、治疗和预后因素。方法：回顾性分析5例皮肤病合并恶性肿瘤的临床资料并结合文献复习。结果：2例乳腺癌合并皮肌炎患者均行乳癌改良根治术,病理为浸润性导管癌(淋巴结14/21转移)和原位癌(淋巴结0/17伴4枚癌结节),因术后不能耐受静脉化疗,予内分泌治疗。1例乳腺淋巴瘤合并皮肌炎者行乳房肿物切除术及腋窝淋巴结活检术,术后因肺间质病2个月死亡；1例获得性鱼鳞病伴发乳腺癌者行改良根治术,病理为浸润性导管癌(淋巴结10/25转移),给予T方案化疗6周期及内分泌治疗；1例红皮病伴发淋巴瘤者给予CHOP方案化疗1周期,因肺转移死亡。其余患者随访至今未见复发和转移。结论：恶性肿瘤有时会以皮肤病变为首发表现,临床容易漏诊和误诊,对于患有皮肌炎、获得性鱼鳞病、红皮病的患者有必要进行恶性肿瘤的筛查。
Objective:To explore the clinical characteristics,diagnosis、treatment and prognostic of malignant tumor and dermatomyositis.Methods:The clinical data of 5 patients with malignant tumor and dermatomyositis were analyzed retrospectively and discussed with literature. Results:Two patients received modified radical mastectomy,invasive ductal carcinoma (lymph node metastasis 14/21) and carcinoma in situ (lymph node metastasis 0/17,cancer node 4),because they could not afford systemic chemotherapy after surgery,only received endocrine therapy.One patient received breast tumor excision and axillary lymph node biopsy,however,died of interstitial lung disease at two months after operation; 1 cases of acquired ichthyosis associated with breast cancer underwent modified radical mastectomy,pathology of infiltrating ductal carcinoma (10/25 lymph node metastasis), patients receiving chemotherapy for six cycles and T program endocrine therapy; 1 cases of erythroderma associated with lymphoma,CHOP chemotherapy were given one cycle,due to death of lung metastasis.Conclusion:Sometimes,dermatosis as the initial manifestation of malignant tumor,clinical easily missed diagnosis and misdiagnosis,so malignant tumor selection is necessary to patients suffering from dermatomyositis, acquired ichthyosis, erythroderma patients.
Objective:To explore the clinical characteristics,diagnosis、treatment and prognostic of malignant tumor and dermatomyositis.Methods:The clinical data of 5 patients with malignant tumor and dermatomyositis were analyzed retrospectively and discussed with literature. Results:Two patients received modified radical mastectomy,invasive ductal carcinoma (lymph node metastasis 14/21) and carcinoma in situ (lymph node metastasis 0/17,cancer node 4),because they could not afford systemic chemotherapy after surgery,only received endocrine therapy.One patient received breast tumor excision and axillary lymph node biopsy,however,died of interstitial lung disease at two months after operation; 1 cases of acquired ichthyosis associated with breast cancer underwent modified radical mastectomy,pathology of infiltrating ductal carcinoma (10/25 lymph node metastasis), patients receiving chemotherapy for six cycles and T program endocrine therapy; 1 cases of erythroderma associated with lymphoma,CHOP chemotherapy were given one cycle,due to death of lung metastasis.Conclusion:Sometimes,dermatosis as the initial manifestation of malignant tumor,clinical easily missed diagnosis and misdiagnosis,so malignant tumor selection is necessary to patients suffering from dermatomyositis, acquired ichthyosis, erythroderma patients.
引文
1 Fardet L,Dupuy A, Gain M, et al. Factors associated with underlying malignancy in a retrospective cohort of 121 patients with dermatomyositis.Medicine (Baltimore). 2009:88(2):91-97
2 Petersen B, Bygum A. Dermatomyositis as a marker of lung cancer. Ugeskr Laeger.2009; 171(18):1514-1515.
3 Gadalla SM, Amr S, Langenberg P, et al. Breast cancer risk in elderly women with systemic autoimmune rheumatic diseases:a population-based case-control study. Br J Cancer.2009; 100(5):817-21.
4 Orphanos G, Ardavanis A, Charalambous P, et al. Systemic sclerosis associated with rectal cancer. Case report and a brief review of the literatureIn Vivo.2008;22(6):825-829
5 Kim HI, Chung SH, Hwang JE, et al. Dermatomyositis associated with cancer of unknown primary site. J Korean Med Sci.2007;22 Suppl:S174-7.
6 Osako T, Ito Y, Morimatsu A, et al. Flare-up of dermatomyositis along with recurrence of breast cancer. Breast J.2007;13(2):200-2.
7 ATSUSHI YOSHINAGA, TETSUO HAYASHI, NOBUYUKI ISHII, etal. Successful cure of dermato myositis after treatment of nonseminomatous testicular cancer. Int J Urol.2005;12 (6) :593-5
8 Nagashima T, Onishi S, Kamata Y, et al. Dermatomyositis associated with thyroid cancer:a paraneoplastic syndrome?Rheumatol Int.2009;29(10):1261-2.
9顾有守。皮肌炎诊断和治疗进展。临床皮肤科杂志,2006,35(6)：407-409.
10徐文俊,方木平,李惠。皮肌炎、多发性肌炎合并恶性肿瘤21例高危因素分析。中国皮肤性病学杂志,2008：22(3)：151-152.
11 Ponyi A, Constantin T, Garami M, et al. Cancer-associated myositis:clinical features and prognostic signs. Ann N Y Acad Sci,2005;1051:64-71.
12 Andras C, Ponyi A, Constantin T, Dermatomyositis and polymyositis associated with malignancy:a 21-year retrospective study. J Rheumatol.2008;35(3):438-44.
13 Bronner IM, van der Meulen MF, de Visser M, et al. Long-term outcome in polymyositis and dermatomyositis. Ann Rheum Dis,2006:65(11):1456-1461.
14吕香花,张优拉。皮肌炎伴发恶性肿2例。现代中西医结合杂志,2006；15(16)：2691-2692
15 Chen YJ, Wu CY, Shen JL. Predicting factors of malignancy in dermatomyositis and polymyositis:a case-control study. Br J Dermatol,2001;144(4):825-831.
16 Pectasides D, Koumpou M, Gaglia A, et al. Dermatomyositis associated with breast cancer. Anticancer Res.2006;26(3B):2329-31.
17 Hodak E,Amitay I, Feinmesser M, et al. Ichthyosiform mycosis fungoides:an atypical variant of cutaneous T-cell lymphoma. J Am Acad Dermatol,2004,50(3):368-374.
18赵辩。临床皮肤病学。2版。南京：江苏科学技术出版社,1990：701.
19隋潇微,周慧,李颖等。皮下脂肪膜炎样T细胞淋巴瘤一例报道并文献复习。中华肿瘤防治杂志,2009：16(8)：633-635.
20刘小丽,邓飞,张锚链等。皮肤淋巴瘤样丘疹病39例临床病理学研究。肿瘤防治杂志,2005：12(16)：1212-1214.
1 Adamietz B, Melzer K, Schulz-Wendtland R. Intraductal papilloma of the male breast. Rofo,2008;180(12):1124-1125.
2练士贤,张勇,秦贤举等。乳腺导管内乳头状瘤癌变18例临床分析。中国临床医学,2005；12(4)：602
3 Li G, Wang X, Cao G, et al. Value of selective mammary ductography in the diagnosis of ductal carcinoma in situ.2008;40(2):143-145
4 Gupta RK, Gaskell D, Dowle CS, et al. The role of nipple discharge cytology in the diagnosis of breast disease:a study of 1948 nipple discharge smears from 1530 patients. Cytopathology,2004;15(6):326-330
5 Sauter ER, Ehya H, Klein-Szanto AL, et al. Fiberoptic ductoscopy findings in women with and withoutspontaneous nipple discharge. Cancer,2005;103(5):914-921
6 He JH, Liang XM, Hou JH, et al. Study of CD44v6 protein expression in intraductal papilloma and its malignant transformation of breast. Chin J Cancer,2002;21(6):615-618
7 Tavassoli F A, Devilee P. World Health Organization classification of tumors. Pathology and genetics, tumors of the breast and female genital organs. Lyon:IARC Press,2003:76-80.
8 Ali-Fehmi R, Carolin K, Wallis T, et al. Clinicopathologic analysis of breast lesions associated with multiple papillomas. Hum Pathol,2003;34(3):234-239.
9 Page D L, Salhany K E, Jensen R A, et al. Subsequent breast carcinoma risk after biop sy with atyp ia in a breast pap illoma. Cancer,1996;78(2):258-266.
10 Raju U, Vertes D. Breast pap illomas with atyp ical ductal hyperp lasia:a clinicopathologic study.Hum Pathol,1996:27(11):1231-1238.
11 Ruqqiero R, Procaccini E, Sanquinetti A, et al. Ductal carcinoma in situ of the breast: our experience. G Chir,2009; 30 (3):121-124
12李洪涛,赵颖,宁连胜.从外科角度探讨乳腺导管内乳头状瘤癌变的治疗方法.中国肿瘤临床,2006：33(2)：99-101
2 Petersen B, Bygum A. Dermatomyositis as a marker of lung cancer. Ugeskr Laeger.2009; 171(18):1514-1515.
3 Gadalla SM, Amr S, Langenberg P, et al. Breast cancer risk in elderly women with systemic autoimmune rheumatic diseases:a population-based case-control study. Br J Cancer.2009; 100(5):817-21.
4 Orphanos G, Ardavanis A, Charalambous P, et al. Systemic sclerosis associated with rectal cancer. Case report and a brief review of the literatureIn Vivo.2008;22(6):825-829
5 Kim HI, Chung SH, Hwang JE, et al. Dermatomyositis associated with cancer of unknown primary site. J Korean Med Sci.2007;22 Suppl:S174-7.
6 Osako T, Ito Y, Morimatsu A, et al. Flare-up of dermatomyositis along with recurrence of breast cancer. Breast J.2007;13(2):200-2.
7 ATSUSHI YOSHINAGA, TETSUO HAYASHI, NOBUYUKI ISHII, etal. Successful cure of dermato myositis after treatment of nonseminomatous testicular cancer. Int J Urol.2005;12 (6) :593-5
8 Nagashima T, Onishi S, Kamata Y, et al. Dermatomyositis associated with thyroid cancer:a paraneoplastic syndrome?Rheumatol Int.2009;29(10):1261-2.
9顾有守。皮肌炎诊断和治疗进展。临床皮肤科杂志,2006,35(6)：407-409.
10徐文俊,方木平,李惠。皮肌炎、多发性肌炎合并恶性肿瘤21例高危因素分析。中国皮肤性病学杂志,2008：22(3)：151-152.
11 Ponyi A, Constantin T, Garami M, et al. Cancer-associated myositis:clinical features and prognostic signs. Ann N Y Acad Sci,2005;1051:64-71.
12 Andras C, Ponyi A, Constantin T, Dermatomyositis and polymyositis associated with malignancy:a 21-year retrospective study. J Rheumatol.2008;35(3):438-44.
13 Bronner IM, van der Meulen MF, de Visser M, et al. Long-term outcome in polymyositis and dermatomyositis. Ann Rheum Dis,2006:65(11):1456-1461.
14吕香花,张优拉。皮肌炎伴发恶性肿2例。现代中西医结合杂志,2006；15(16)：2691-2692
15 Chen YJ, Wu CY, Shen JL. Predicting factors of malignancy in dermatomyositis and polymyositis:a case-control study. Br J Dermatol,2001;144(4):825-831.
16 Pectasides D, Koumpou M, Gaglia A, et al. Dermatomyositis associated with breast cancer. Anticancer Res.2006;26(3B):2329-31.
17 Hodak E,Amitay I, Feinmesser M, et al. Ichthyosiform mycosis fungoides:an atypical variant of cutaneous T-cell lymphoma. J Am Acad Dermatol,2004,50(3):368-374.
18赵辩。临床皮肤病学。2版。南京：江苏科学技术出版社,1990：701.
19隋潇微,周慧,李颖等。皮下脂肪膜炎样T细胞淋巴瘤一例报道并文献复习。中华肿瘤防治杂志,2009：16(8)：633-635.
20刘小丽,邓飞,张锚链等。皮肤淋巴瘤样丘疹病39例临床病理学研究。肿瘤防治杂志,2005：12(16)：1212-1214.
1 Adamietz B, Melzer K, Schulz-Wendtland R. Intraductal papilloma of the male breast. Rofo,2008;180(12):1124-1125.
2练士贤,张勇,秦贤举等。乳腺导管内乳头状瘤癌变18例临床分析。中国临床医学,2005；12(4)：602
3 Li G, Wang X, Cao G, et al. Value of selective mammary ductography in the diagnosis of ductal carcinoma in situ.2008;40(2):143-145
4 Gupta RK, Gaskell D, Dowle CS, et al. The role of nipple discharge cytology in the diagnosis of breast disease:a study of 1948 nipple discharge smears from 1530 patients. Cytopathology,2004;15(6):326-330
5 Sauter ER, Ehya H, Klein-Szanto AL, et al. Fiberoptic ductoscopy findings in women with and withoutspontaneous nipple discharge. Cancer,2005;103(5):914-921
6 He JH, Liang XM, Hou JH, et al. Study of CD44v6 protein expression in intraductal papilloma and its malignant transformation of breast. Chin J Cancer,2002;21(6):615-618
7 Tavassoli F A, Devilee P. World Health Organization classification of tumors. Pathology and genetics, tumors of the breast and female genital organs. Lyon:IARC Press,2003:76-80.
8 Ali-Fehmi R, Carolin K, Wallis T, et al. Clinicopathologic analysis of breast lesions associated with multiple papillomas. Hum Pathol,2003;34(3):234-239.
9 Page D L, Salhany K E, Jensen R A, et al. Subsequent breast carcinoma risk after biop sy with atyp ia in a breast pap illoma. Cancer,1996;78(2):258-266.
10 Raju U, Vertes D. Breast pap illomas with atyp ical ductal hyperp lasia:a clinicopathologic study.Hum Pathol,1996:27(11):1231-1238.
11 Ruqqiero R, Procaccini E, Sanquinetti A, et al. Ductal carcinoma in situ of the breast: our experience. G Chir,2009; 30 (3):121-124
12李洪涛,赵颖,宁连胜.从外科角度探讨乳腺导管内乳头状瘤癌变的治疗方法.中国肿瘤临床,2006：33(2)：99-101