Paraneoplastic dermatomyositis accompanying nasopharyngeal carcinoma: Diagnosis, treatment and prognosis

Paraneoplastic dermatomyositis associated with urothelial cancer: report of a case and systematic review of the literature

Background

The idiopathic inflammatory myopathies (IIM) are a collection of autoimmune diseases that have a substantial impact on the entire body and include conditions such as dermatomyositis (DM), polymyositis (PM), sporadic inclusion body myositis, and immune-mediated necrotizing myopathy. These disorders are characterized by symptoms such as muscular weakness, pain, and dermal rash. This systematic review is intended to explore the potential link between bladder cancer and DM/PM.

Methods

We performed a comprehensive systematic search on PubMed and Scopus until August 2022 to identify relevant research studies. The studies that met our inclusion criteria focused on patients with urinary bladder cancer and dermatomyositis, and/or polymyositis.

Results

The patients' median age was 65.5 years (47-79), with the majority being male (15, 39.47%). Bladder cancer manifested before PM/DM in 5 (13.15%) patients, while in the majority of cases occurred after the cancer diagnosis. The stage of cancer at the time of the initial PM/DM diagnosis were mostly locally (11/20, 50%).During the first presentation, the patients had a median creatine kinase level of 2227 U/L, ranging between 44 and 10471. In one case, anti-TIF-1γ antibodies were found to be present. Among the cases with reported medical history (20/38), treatment immediately improved DM symptoms in 16 patients(53.8%) and in 3 patients(15%), symptoms of DM resurfaced during the period after the operation. Death was reported in 14 (36.8%) patients.

Conclusion

In conclusion, our study provides knowledge and understanding for identifying specific risk factors in patients with the coexistence of bladder cancer and DM/PM and their management. During the initial and follow-up screening, age, gender, and the clinicopathological subgroup of myositis should be considered to ensure proper management of the condition.

Clinical characteristics of paraneoplastic syndromes in patients with head and neck cancer

Background

To summarize the clinical manifestations, diagnosis, and prognosis of head and neck cancer (HNC) patients with paraneoplastic syndromes (PNS).

Methods

The clinical data of 1958 patients with HNC admitted to our hospital from January 1996 to December 2020 were retrospectively analyzed. Demographic and cancer‐related characteristics were extracted. Kaplan–Meier survival curves were compared by log‐rank test. Cox regression was performed to evaluate prognostic factors and hazard ratio.

Results

Totally 40 HNC patients with PNS were included in the final analysis, including 36 men and four women with a mean age of 60.4 years (range 40–82). PNS was dermatologic or cutaneous in 23 (57.50%) patients, endocrine in 10 (25.00%), neurologic in five (12.50%), and osteoarticular or rheumatologic in two (5.00%). Twenty‐five (62.50%) patients had Stage III/IV cancer. PNS regressed after antitumor therapy in 28 (70.00%) patients. Recurrence of PNS was observed in nine of 12 (75.00%) patients with cancer recurrence or metastasis. The 5‐year overall survival (OS) and disease‐free survival (DFS) rates of patients with PNS were 51.52% and 44.44%, respectively. The DFS (p = .001) and OS (p = .003) of patients presented with PNS prior to HNC diagnosis were significantly longer than those of patients with synchronous or metachronous PNS. PNS diagnosed before HNC (adjusted hazard ratio [aHR]: 0.31, 95% confidence interval [CI]: 0.11–0.85, p = .02), Stage IV disease (aHR: 3.27, 95% CI: 1.18–9.05, p = .02), and smoking history (aHR: 3.69, 95% CI: 1.04–13.05, p = .04) were significantly associated with OS and DFS.

Conclusions

Early recognition of PNS could provide clues about underlying tumor condition and result in early diagnosis. Prompt detection of cancer‐associated syndromes could lead to a more favorable prognosis for these patients.

The Role of Myositis-Specific Autoantibodies in the Dermatomyositis Spectrum

Dermatomyositis (DM) is a systemic autoimmune disease that affects skeletal muscles, the skin, and the lungs. It is characterized by autoantibodies, tissue inflammation, parenchymal cell damage, death, and vasculopathy. In terms of epidemiology, DM affects both children and adults. The current pathophysiology of DM is described as an autoimmune attack on the afflicted organs driven by environmental variables such as UV exposure, medications, infections, and lifestyle choices in genetically predisposed people. DM is also a paraneoplastic condition, which means that cancer may arise before, along with, or following the development of the symptoms of DM. Myositis-specific autoantibodies are associated with phenotypical features and are used for sub-classification of dermatomyositis patients. Because the risk of interstitial lung disease (ILD), internal malignancy, destructive disease trajectory, and maybe a response to medication differs by DM myositis-specific antibody (MSA) group, a better knowledge of MSAs and the validation and standardization of tests employed for detection is crucial for improving diagnosis and treatment. The diagnostic sensitivity and specificity of tests for various MSAs are not ideal, just like with any other test. However, more antibody tests are anticipated to make their way into formal schemata for diagnosis and actionable risk assessment in DM due to worldwide standardization and more extensive research. In this review, we outline crucial aspects for interpreting clinical and pathologic relationships with MSA in DM and critical knowledge and practice gaps that will optimize the clinical benefit and utility of MSAs as diagnostic and prognostic markers.

Dermatomyositis on 68Ga-FAPI PET/CT in a Patient With Nasopharyngeal Carcinoma

ABSTRACT

Dermatomyositis is an idiopathic inflammatory myopathy often associated with malignancies. 68Ga-FAPI PET/CT was performed on a 58-year-old man with newly diagnosed dermatomyositis. 68Ga-FAPI PET/CT showed multiple increased FAPI activity in whole-body muscles and nasopharyngeal lesion. A biopsy of the nasopharyngeal lesion confirmed nasopharyngeal carcinoma. 68Ga-FAPI PET/CT can provide a "1-stop" imaging method for patients with dermatomyositis.

Paraneoplastic dermatomyositis revealing undifferentiated nasopharyngeal carcinoma at early stage: a case report

Context

Dermatomyositis is a rare autoimmune disease characterized by noninfectious inflammatory damage of skin and predominant muscles in the belts. It is believed to be associated with about 1 in 1000 cases of nasopharyngeal carcinoma. This association has been described for locally advanced stages II and III nasopharyngeal carcinoma. It has rarely been described in the early stages (stage I).

Case presentation

A 65-year-old Moroccan patient residing in Casablanca, with no particular history was referred to the Mohamed VI Center for the treatment of cancers of the University Hospital Center IBN ROCHD in Casablanca, for treatment of nasopharyngeal cancer. He was admitted in poor general condition, performance status 3, with erythema on the face, neck, and extremities. The diagnosis of paraneoplastic dermatomyositis was made owing to progressive muscle weakness and elevation of muscle enzymes associated with the typical rash of the face and hands. He received corticosteroid therapy and then radiotherapy to the nasopharynx with good clinical outcome, disappearance of skin lesions, and recovery of muscle strength.

Conclusions

We report this case of dermatomyositis in early-stage nasopharyngeal carcinoma, which is a rarely described entity. Rapid treatment of dermatomyositis improved the patient’s quality of life and enabled him to support specific cancer treatments. This can be used as an element of early diagnosis and monitoring after treatment.

[Dermatomyositis as a paraneoplastic syndrome of head-neck-cancer: Case series & literature review]

INTRODUCTION

Dermatomyositis (DM) is a rare disease with the clinical manifestation of weakness and pain of proximal muscles as well as lilac-coloured skin lesions. One fifth of the cases is associated with the occurrence of a malignant tumor disease. The aim of this study is to evaluate the relevance of DM as a paraneoplastic syndrome in head and neck cancer taken into account the current literature.

MATERIAL/METHODS

After retrospective analysis of medical records of head-neck-cancer patients treated between 2008 and 2018, 8 patients with DM were detected: 4 patients with tonsil carcinoma, 1 patient with nasopharyngeal carcinoma, 1 patient carcinoma of the parotid gland and two patients with lymphoma. The diagnosis, therapy and treatment results of these cases are described. Furthermore, a selective analysis of the literature (pubmed) about DM with head-neck cancer was conducted. A total of 290 cases were identified: In 283 cases, the tumors were located in the nasopharynx, in five cases in the tonsil and in two cases in the hypopharynx.

CONCLUSION

DM as a paraneoplastic syndrome of head and neck tumors is rare and more often associated with nasopharyngeal cancer and rarely with tonsil cancer. The clustering of DM with head and neck tumors regarding ethnicity (nasopharyngeal carcinoma - Asian origin, tonsillar carcinoma- Caucasian origin) might be due to the regional different incidences of these tumor entities.In patients with DM, especially in presence of cervical lymphadenopathy a tumor in the head and neck area should be evaluated. The course of tumor-associated DM is positively influenced by tumor therapy. The consistent therapy and monitoring of DM is fundamental for a successful tumor treatment as well.

A. R. ENS, Wada Y, Abdul Rahman Z, Ahmad S, Mohamud R, Mat Lazim N, Yean CY. Prevalence of Nasopharyngeal Carcinoma in Patients with Dermatomyositis: A Systematic Review and Meta-Analysis

Simple Summary

This first systematic review and meta-analysis on the prevalence of nasopharyngeal carcinoma in patients suffering dermatomyositis was necessitated by the absence of a true and reliable prevalence estimate necessary to adequately inform medical preparedness and decisions. Following a careful review of literature and data analyses, a prevalence of 3.3% was found. It is hoped that a clear knowledge of the actual prevalence of nasopharyngeal carcinoma in dermatomyositis patients would not only help sensitize clinicians and patients about the frequency of these disease conditions but would also enhance the adoption of precautions essential to mitigate their co-occurrence in patients.

Abstract

For more than 50 years, nasopharyngeal carcinoma (NPC) has been associated with dermatomyositis (DM), a rare idiopathic inflammatory disorder that mainly affects the skin and muscles. Although the association between these rare diseases is well-documented, the actual prevalence of NPC in DM patients remains unknown. Here, a systematic review and meta-analysis of published data was conducted in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Electronic databases including PubMed, Scopus, ScienceDirect, and Google Scholar were searched without year or language restrictions for studies reporting the occurrence of NPC in DM patients. The study protocol was lodged with PROSPERO (CRD42021225335). A total of 95 studies covering 303 cases of NPC among 16,010 DM patients was included. Summary estimates were calculated using the random-effects model. The pooled prevalence of NPC in DM was 3.3% (95% CI, 2.5–4.3). When stratified according to study location, higher prevalence estimates were obtained for Hong Kong (36.5%), Malaysia (27.7%), and Singapore (11.9%). There was a predominance of cases among male DM patients compared with females, and most patients were aged 40 and above. Many of the NPC cases were found to be diagnosed after the diagnosis of DM. It is therefore pertinent to screen for NPC in DM patients, especially among older DM patients in the Asian region.

[Dermatomyositis and rectal cancer: case study and literature review]

Dermatomyositis is a systemic idiopathic disease characterized by a combination of both muscle and skin symptoms. It is a paraneoplastic dermatosis. Its association with rectal cancer has been rarely described in the literature. We here report the case of a female patient with paraneoplastic dermatomyositis associated with metastatic rectal adenocarcinoma presenting with clinical symptoms commonly found in subjects with paraneoplastic dermatomyositis. Other complementary examinations (CPK test + EMG + skin biopsy) were performed which confirmed this diagnosis. The patient underwent chemotherapy, but after the second cycle, she experienced a rapid worsening of her general condition and died after some days in a state of multisystem organ failure. This study aims to highlight paraneoplastic dermatomyositis' aggressive nature and to update current knowledge on the importance of chemotherapy in the management of neoplastic dermatomyositis.

[Paraneoplastic dermatomyositis revealing an undifferentiated nasopharyngeal carcinoma: about a case]

Dermatomyositis (DM) is an inflammatory disease of unknown origin that manifests as a myopathy associated with typical skin lesions. Association between DM and cancer is frequent (from 18% to 32% according to case series). It was described for the first time by Stertz in 1916 in association with gastric cancer. All histological types and sites of cancer in the general population may be associated with DM. Its association with nasopharyngeal carcinoma (NPC) is rarely described and the incidence proportion is 1 case of nasopharyngeal carcinoma per 1.000 persons.

Dermatomyositis revealing breast cancer: report of a case

Dermatomyositis (DM) is a rare connective corresponding to an inflammatory disease of skeletal muscles. Paraneoplastic origin must always be sought, primarily gynecological tumor in women, but the investigations are often made difficult by the fact that a primary tumor is often not detectable at the time of the cutaneous manifestations. This approach includes in addition to the monitoring report at regular intervals of 6 to 12 months for two years after diagnosis. We report a case of Dermatomyositis revealing breast cancer.

Diffuse cutaneous mucinosis in dermatomyositis: a case report and review of the literature

We present the case of a patient with dermatomyositis and diffuse cutaneous mucinosis and give an up-to-date detailed review of all the published cases in the English literature describing the demographics, clinical picture, pathology management, and outcomes of this unique group of patients.

A case of dermatomyositis with esophageal fistula in whom blind mucosal biopsy detected occult oropharyngeal carcinoma

We present a case of anti-transcription intermediary factor 1 (anti-TIF-1) antibody-positive dermatomyositis with concomitant esophageal fistula and extensive truncal erythema. The characteristic cutaneous features and presence of anti-TIF-1 antibodies were predictive for internal malignancy. However, repeated examinations for internal malignancy showed none, and blind mucosal biopsy was needed to diagnose oropharyngeal carcinoma. We should note the possibility of occult nasopharyngeal carcinoma and consider performing blind mucosal biopsy in dermatomyositis with esophageal fistula, especially with extensive truncal erythema.

Paired study of 172 cases of nasopharyngeal carcinoma with or without dermatomyositis

CONCLUSION

The prognosis and late adverse effects of radiotherapy (RT) in the patients with nasopharyngeal carcinoma (NPC) with or without dermatomyositis (DM) were similar, although the NPC patients with DM had higher Epstein-Barr virus (EBV) VCA-IgA titers and more severe acute side effects. Gender, TNM stage, and chemotherapy were independent prognostic factors of overall survival for NPC with DM. Glucocorticoid treatment did not affect the survival of NPC patients with DM.

OBJECTIVES

We evaluated the clinical characteristics, prognosis, and differences in the toxicity of RT in patients with NPC with or without DM.

METHODS

A paired study of 172 NPC cases with DM (DM group) or without DM (control group) from Sun Yat-sen University Cancer Center was conducted.

RESULTS

The DM group had higher EBV VCA-IgA titers than the control group (p = 0.017) and more acute adverse effects of RT (p < 0.001). No significant differences in the overall survival or late adverse effects were found between the two groups. Gender, TNM stage, and chemotherapy were independent prognostic factors for the overall survival in the DM group. No significant differences in the overall survival were found between the patients in the DM group who were taking glucocorticoids and those who were not.

Dermatomyositis paraneoplastic syndrome before symptomatic tonsillar squamous cell carcinoma: a case report

BACKGROUND

Paraneoplastic syndromes are systemic or organ-related functional tumor-associated changes that arise distant to the tumor.

METHODS AND RESULTS

We present a rare case of a 63-year-old man with dermatomyositis as a paraneoplastic syndrome developing more than a year before clinical manifestations of tonsillar squamous cell carcinoma (SCC). He subsequently developed stage T1N2bM0 IVA tonsillar SCC. He was treated on a research protocol with 3 weeks of neoadjuvant rapamycin therapy before right transoral lateral pharyngectomy and modified radical neck dissection with preservation of CN XI. His symptoms of dermatomyositis subsequently improved and he was weaned off immunosuppressive therapy.

CONCLUSION

To our knowledge, this is the first report of dermatomyositis as a paraneoplastic syndrome of tonsillar SCC in North America. We suggest that clinicians should monitor for signs of persistent or recurrent dermatomyositis symptoms as this may herald development or a return of the underlying malignancy.

Meta-analysis of the association between GSTT1 null genotype and risk of nasopharyngeal carcinoma in Chinese

Glutathione S-transferase T1 (GSTT1) null genotype has been proven to be associated with risks of many cancers. There were also many studies assessing on the association between GSTT1 null genotype and nasopharyngeal carcinoma risk in Chinese, but the findings from those studies were inconsistent. We performed a meta-analysis to provide a more precise assessment on the effect of GSTT1 null genotype on nasopharyngeal carcinoma risk. The PubMed and Wanfang databases were searched to identify eligible case-control studies on the association between GSTT1 null genotype and risk of nasopharyngeal carcinoma in Chinese. The pooled odds ratios (OR) with corresponding 95% confidence intervals (95% CI) were used to assess the association. Eight case-control studies with a total of 3,702 individuals were finally included in the meta-analysis. Meta-analysis of a total of eight studies showed that GSTT1 null genotype was significantly associated with increased risk of nasopharyngeal carcinoma in Chinese (OR = 2.27; 95% CI 1.41-3.67; P = 0.001). The finding from cumulative meta-analysis showed that there was a trend of more obvious association between GSTT1 null genotype and risk of nasopharyngeal carcinoma in Chinese as data accumulated by publication year. Therefore, the GSTT1 null genotype is significantly associated with increased risk of nasopharyngeal carcinoma in Chinese.