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Cutaneous features of DM. (a) Heliotrope erythema, (b) palmar erythema, (c) periungual erythema, and (d) flagellate erythema.
Source publication
Paraneoplastic dermatomyositis (DM) associated with testicular cancer is extremely rare. We report the case of a patient with skin tightening, polymyalgia, hypereosinophilia, and nodular regenerative hyperplasia revealing seminoma and associated paraneoplastic DM.
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Citations
... Breast, colon, lung, and ovarian cancers are frequently reported as associated cancers in paraneoplastic dermatomyositis, but association with testicular tumor has rarely been documented [1]. Our review of the literature identified 13 cases with testicular tumor [2][3][4]. Most were associated with nonseminoma, whereas only 3 cases were accompanied by pure seminoma [4][5][6]. ...
... Our review of the literature identified 13 cases with testicular tumor [2][3][4]. Most were associated with nonseminoma, whereas only 3 cases were accompanied by pure seminoma [4][5][6]. Our case with pure seminoma represents the first such case in Japan and also the oldest patient with this pathology in the literature. ...
... Dermatomyositis has been reported in various stages from stage I to stage III [2][3][4]. In our case, testicular tumor was very advanced, with massive lymph node metastases. ...
We report the first case in Japan of paraneoplastic dermatomyositis with pure seminoma, a tumor that extremely rarely accompanies dermatomyositis. The patient presented to the hospital with muscle weakness and erythema and was diagnosed with dermatomyositis from skin biopsy. Routine radiological screening revealed testicular tumor and massive lymph node metastases. We initially performed orchiectomy along with conventional immunotherapy. However, muscle weakness gradually worsened, and he eventually showed dysphagia and forced respiration and became bedridden. Although he seemed close to being too unstable to tolerate further treatment, we started carefully adjusted chemotherapy comprising 4 courses of etoposide plus cisplatin, which proved highly successful. Lymph node metastases completely disappeared and swallowing and respiration fully normalized after completing chemotherapy. We believe that this clinical success was due to our decision to initiate chemotherapy even in such a weak patient.
... Patients with DM may have other less frequent symptoms, such as systemic (fever, weight loss, arthralgia), gastrointestinal (malabsorption, intestinal dysmotility), cardiac (atrial and ventricular tachyarrhythmia, dilated cardiomyopathy), pulmonary (pulmonary interstitial disease, dyspnea) and vascular (Raynaud's phenomenon, vasculitis) symptoms [19]. The presence of pulmonary interstitial disease decreases the risk of neoplasms, for yet unknown reasons [21]. ...
We report a case of paraneoplastic dermatomyositis in a patient with a diagnosis of neuroendocrine tumor of an unknown primary site. A 49-year-old woman, hypertensive, was admitted to our hospital due to a mass detected by abdominal computed tomography, in contact with the liver and gallbladder, having compressive effect on inferior vena cava, and measuring 10.4 x 7.3 x 7.8 cm. Pathological examination showed signet-ring cell neuroendocrine neoplasm with a ki-67 proliferation index of 60%, and microscopic and immunohistochemical findings indicated a metastatic appendiceal goblet cell carcinoid. The association between malignant neoplasms and dermatomyositis has been described in the literature; however, this is the first report of a case of paraneoplastic syndrome associated with a neuroendocrine tumor.
The risk of malignancy in inflammatory myopathy patients is well recognized. However, the incidence of germ cell tumor (GCT) with inflammatory myopathy is low, and most reported cases of GCT also exhibit testicular tumors. Therefore, a case of extragonadal GCT with dermatomyositis (DM) is reported in the current study to better understand this paraneoplastic syndrome. A 53‑year‑old man presented with bilateral cervical lymph node enlargement. A lymph node biopsy showed embryonal carcinoma, and computed tomography showed multiple lymph node and lung metastases. A period of one month after bleomycin, etoposide and cisplatin (BEP) chemotherapy, this patient developed an erythematous eruption over the extensor surfaces of bilateral fingers, or Gottron's sign and facial erythema. The patient was diagnosed with DM with a positive anti‑TIF‑1γ‑antibody result. High‑dose prednisolone was effective, and there has been no evidence of cancer recurrence for over one year. The literature review identified 17 cases of GCT with inflammatory myopathy that have been reported so far, and it was indicated that this is the first case of extragonadal GCT with DM following chemotherapy. This case highlights the importance of monitoring after the completion of cancer treatment, as distinctive dermal and muscular symptoms should cause us to consider the possibility of paraneoplastic inflammatory myopathy.
A comprehensive and patient-centered safety and risk assessment for an older adult may not only provide immediately actionable clinical information but also insight into potential future risk and opportunities for prevention. Domains explored in this chapter include home safety, high-risk behaviors, and elder mistreatment—three topics that can profoundly affect medical and social outcomes. First, home safety assessments provide clinicians with a valuable window into the patient’s environment and functional status. Next, personal risk behaviors of substance use and sexual health are examined because older adults are not immune to the increasing misuse of prescription medications, to the dangers of alcohol and illicit substances, or to the rising rates of sexually transmitted infections. Lastly, elder mistreatment is reviewed, inclusive of physical and sexual abuse, emotional and psychological abuse, financial exploitation, and the frequently under-recognized phenomenon of elder neglect.
Amyopathic dermatomyositis is a rare, idiopathic, connective tissue disease that presents with dermatologic lesions of classic dermatomyositis but lacks the myopathy of this disease. Cutaneous manifestations may include Gottron’s sign, heliotrope rash, and characteristic patterns of poikiloderma. There is a substantial risk for developing interstitial lung disease or malignancy in patients with amyopathic dermatomyositis. A literature review of amyopathic dermatomyositis was performed using the PubMed medical database. The key features of amyopathic dermatomyositis, including autoantibodies, clinical presentation and dermatologic manifestations, epidemiology, history, associated malignancies, management, and pathogenesis, are summarized in this review. Cancer (solid tumor) (73/79, 89 %) and hematologic malignancies (9/79, 11 %) were reported in 79 patients, with three patients having more than one malignancy. In addition, there were six patients with amyopathic dermatomyositis who had tumor of unknown primary, and eight patients with cancer-associated amyopathic dermatomyositis for whom no additional details were provided. From the group of 73 tumors for whom primary origin and sex were available, malignancy of the genitourinary organs (24/73, 33 %), aerorespiratory organs (15/73, 21 %), and breast (14/73, 19 %) were the most commonly observed solid organ tumors. Tumors of the genitourinary organs (15/48, 31 %) and breast (14/48, 29 %) were the most frequent neoplasms in women, accounting for 29 of 48 (60 %) cancers, with the most common sites being breast (14/48, 29 %), ovary (8/48, 17 %), and cervix or uterus (5/48, 10 %). In men, tumors of the aerorespiratory (9/25, 36 %) and genitourinary (9/25, 36 %) tracts were the most common neoplasms, accounting for 72 % (18/25) of cancers; the most common sites of primary malignancy were nasopharyngeal (6/25, 24 %), bladder (4/25, 16 %), and either colorectal, lung or prostate cancer (three cancers each, 12 %). In summary, the search for an undiagnosed associated malignancy in patients with amyopathic dermatomyositis should focus towards the organs most frequently affected. Similar to classic dermatomyositis, ovarian and nasopharyngeal cancers are also common in amyopathic dermatomyositis. However, in contrast to lung cancer, which is the most frequent malignancy associated with classic dermatomyositis, breast cancer was the most common type of malignancy reported in patients with amyopathic dermatomyosotis.
