Lymphoma presenting as chronic aortic dissection in Marfan syndrome

Thoracic aortic dissection associated with involvement by small lymphocytic lymphoma/chronic lymphocytic leukemia: a possible underappreciated risk factor?

We report a case of a 77-year-old man with small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) thought to be in remission who developed an acute type A thoracic aortic dissection despite no known risk factors for aortic dissection. Surgical pathology evaluation of the aorta specimen removed at surgery showed direct lymphocytic infiltration of the aortic adventitia and media in the region of the aortic dissection. The potential causative role and pathophysiologic mechanisms of SLL/CLL in aortic dissection are discussed.

Association between malignancies and Marfan syndrome: a population-based, nested case-control study in Taiwan

OBJECTIVE

Marfan syndrome (MFS) involves a deficiency of the structural extracellular matrix component fibrillin-1 and overactivation of the transforming growth factor-β (TGF-β) signalling pathway. The TGF-β signalling pathway also actively participates in malignant transformation. Although anecdotal case reports have suggested associations between MFS/MFS-like conditions and several haematological and solid malignancies, such associations have not been thoroughly evaluated in large-scale studies. We sought to use a nationwide healthcare insurance claim database to evaluate whether patients with MFS are at increased risk of malignancy.

PATIENTS AND METHODS

We conducted a nested case-control analysis using a database extracted from Taiwan's National Health Insurance Research Database. All medical conditions for each case and control were categorised using the International Classification of Diseases, 9th Revision classifications. ORs and 95% CIs for associations between MFS and malignancies were estimated using conditional logistic regression and adjusted for comorbidities.

RESULTS

Our analyses included 1 153 137 cancer cases and 1 153 137 propensity score-matched controls. Relative to other subjects, patients with MFS had a significantly higher risk of having a malignancy (adjusted OR 3.991) and hypertension (adjusted OR 1.964) and were significantly more likely to be men. Malignancies originating from the head and neck and the urinary tract were significantly more frequent among patients with MFS than among subjects without MFS.

CONCLUSION

Patients with MFS are at increased risk of developing various malignancies. Healthcare professionals should be aware of this risk when treating such patients, and increased cancer surveillance may be necessary for these patients.

Increased risk of malignancy in patients with an aortic aneurysm: a nationwide population-based retrospective study

Background

Cardiovascular disease and malignancy have numerous similarities and possible interactions, as these diseases share several risk factors, epidemiological features and biological signaling pathways. Data regarding the risk of malignancy in patients with aortic aneurysm (AA) are scarce. We aimed to determine whether patients with AA have an increased risk of malignancy.

Materials and Methods

The data for the nationwide population-based retrospective cohort study described herein were obtained from the Taiwan National Health Insurance Research Database (NHIRD). We selected adult patients who had been newly diagnosed with AA and were followed up between 2000 and 2010. We excluded patients who had been diagnosed with AA and malignancy prior to the date of the AA diagnosis. The control cohort was selected from individuals who had no history of AA and was selected with 1:4 matching according to co-morbidities and medication history. The outcome was a diagnosis of malignancy and the cumulative incidence of AA.

Results

A total of 10,933 patients diagnosed with AA were identified. The patients with an AA had a significantly higher cumulative risk of developing malignancies in subsequent years than the patients without an AA (log rank test < 0.001). Similarly, patients with malignancies had a significantly higher cumulative risk of developing an AA in subsequent years than patients without malignancies (log rank test < 0.001).

Conclusions

Patients with an AA were shown to have a substantially increased risk of developing a variety of malignancies compared with patients without AAs. Healthcare professionals should be aware of this increased risk when treating patients with AAs.