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Recurrent dermatomyositis manifesting as a sign of recurrent transitional cell carcinoma of urinary bladder: Long-term survival.

Fitzpatrick J, Wallace WA, Lang S, Aboumarzouk OM, Windsor P, Nabi G - Urol Ann (2014)

Bottom Line: The association between urological malignancies and paraneoplastic syndromes has been well documented.Description of the case will guide clinicians in the future, in case they encounter such an unusual clinical scenario.This could also serve as a hypothesis-generating source for designing future research as well.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Ninewells Hospital (NHS Tayside), Medical School, Medical Research Institute, University of Dundee, Dundee, Scotland (UK), DD1 9SY.

ABSTRACT
The association between urological malignancies and paraneoplastic syndromes has been well documented. We report a case of recurrent dermatomyositis manifesting as a sign of metastatic recurrence of non-muscle-invasive transitional cell carcinoma of the bladder, a relationship which has only been referred to in a few reports. The case highlights a few important clinical challenges; firstly, the importance of thorough investigation for underlying malignancy in patients with dermatomyositis, as successful treatment of such malignancy can lead to resolution of paraneoplastic symptoms, and secondly, a high index of suspicion of recurrence in cases where paraneoplastic manifestations recur. Metastatic pulmonary recurrence without local evidence of disease at a follow-up of 4 years makes this case unique. Moreover, in the light of our experience and reported literature, a framework is suggested to approach such a diagnostic dilemma in the future. Description of the case will guide clinicians in the future, in case they encounter such an unusual clinical scenario. This could also serve as a hypothesis-generating source for designing future research as well.

No MeSH data available.


Related in: MedlinePlus

(a) Photomicrograph of tumor resected from the left lower lobe showing a carcinoma with morphological features in keeping with metastatic transitional cell carcinoma. This interpretation was supported by immunohistochemical staining which showed characteristic expression of CK7, CK20, and nuclear staining for p63. Similar appearing metastatic carcinoma was also identified within hilar lymph nodes removed at the time of surgery (hematoxylin and eosin stain, ×100 original magnification). (b) Photomicrograph of tumor resected from the urinary bladder showing transitional cell carcinoma (hematoxylin and eosin stain, ×100 original magnification)
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Figure 2: (a) Photomicrograph of tumor resected from the left lower lobe showing a carcinoma with morphological features in keeping with metastatic transitional cell carcinoma. This interpretation was supported by immunohistochemical staining which showed characteristic expression of CK7, CK20, and nuclear staining for p63. Similar appearing metastatic carcinoma was also identified within hilar lymph nodes removed at the time of surgery (hematoxylin and eosin stain, ×100 original magnification). (b) Photomicrograph of tumor resected from the urinary bladder showing transitional cell carcinoma (hematoxylin and eosin stain, ×100 original magnification)

Mentions: Four years after her initial diagnosis of bladder cancer, however, she had a recurrence of DM. Although she did not complain of any urinary symptoms, physicians advised reinvestigation to rule out a recurrence of bladder cancer. A CT urogram and cystoscopy with biopsy were normal; histology showed normal bladder mucosa. In the absence of any positive findings, a CT chest was carried out; this identified a 2-cm lesion in the lower lobe of the left lung [Figure 2]. Further clarification was sought by positron emission tomography (PET) scanning. The radiological impression was of a bronchogenic cancer and the patient was referred for lung lobectomy. Lung histology was reviewed by two independent pathologists and agreed to be metastatic TCC of the bladder [Figure 2]. Six months later, the patient developed bone metastases in the ribs [Figure 3a] with associated fracture and was treated with chemotherapy. Subsequently, she was found to have multiple brain metastases [Figure 3b] and required radiotherapy. Following chemoradiotherapy, repeat CT scans [Figure 3b] showed disease remission with a healed previous fractured rib and reduction in brain metastases. She is alive with some residual disease, however, with no recurrences in the bladder or urinary tract.


Recurrent dermatomyositis manifesting as a sign of recurrent transitional cell carcinoma of urinary bladder: Long-term survival.

Fitzpatrick J, Wallace WA, Lang S, Aboumarzouk OM, Windsor P, Nabi G - Urol Ann (2014)

(a) Photomicrograph of tumor resected from the left lower lobe showing a carcinoma with morphological features in keeping with metastatic transitional cell carcinoma. This interpretation was supported by immunohistochemical staining which showed characteristic expression of CK7, CK20, and nuclear staining for p63. Similar appearing metastatic carcinoma was also identified within hilar lymph nodes removed at the time of surgery (hematoxylin and eosin stain, ×100 original magnification). (b) Photomicrograph of tumor resected from the urinary bladder showing transitional cell carcinoma (hematoxylin and eosin stain, ×100 original magnification)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4127871&req=5

Figure 2: (a) Photomicrograph of tumor resected from the left lower lobe showing a carcinoma with morphological features in keeping with metastatic transitional cell carcinoma. This interpretation was supported by immunohistochemical staining which showed characteristic expression of CK7, CK20, and nuclear staining for p63. Similar appearing metastatic carcinoma was also identified within hilar lymph nodes removed at the time of surgery (hematoxylin and eosin stain, ×100 original magnification). (b) Photomicrograph of tumor resected from the urinary bladder showing transitional cell carcinoma (hematoxylin and eosin stain, ×100 original magnification)
Mentions: Four years after her initial diagnosis of bladder cancer, however, she had a recurrence of DM. Although she did not complain of any urinary symptoms, physicians advised reinvestigation to rule out a recurrence of bladder cancer. A CT urogram and cystoscopy with biopsy were normal; histology showed normal bladder mucosa. In the absence of any positive findings, a CT chest was carried out; this identified a 2-cm lesion in the lower lobe of the left lung [Figure 2]. Further clarification was sought by positron emission tomography (PET) scanning. The radiological impression was of a bronchogenic cancer and the patient was referred for lung lobectomy. Lung histology was reviewed by two independent pathologists and agreed to be metastatic TCC of the bladder [Figure 2]. Six months later, the patient developed bone metastases in the ribs [Figure 3a] with associated fracture and was treated with chemotherapy. Subsequently, she was found to have multiple brain metastases [Figure 3b] and required radiotherapy. Following chemoradiotherapy, repeat CT scans [Figure 3b] showed disease remission with a healed previous fractured rib and reduction in brain metastases. She is alive with some residual disease, however, with no recurrences in the bladder or urinary tract.

Bottom Line: The association between urological malignancies and paraneoplastic syndromes has been well documented.Description of the case will guide clinicians in the future, in case they encounter such an unusual clinical scenario.This could also serve as a hypothesis-generating source for designing future research as well.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Ninewells Hospital (NHS Tayside), Medical School, Medical Research Institute, University of Dundee, Dundee, Scotland (UK), DD1 9SY.

ABSTRACT
The association between urological malignancies and paraneoplastic syndromes has been well documented. We report a case of recurrent dermatomyositis manifesting as a sign of metastatic recurrence of non-muscle-invasive transitional cell carcinoma of the bladder, a relationship which has only been referred to in a few reports. The case highlights a few important clinical challenges; firstly, the importance of thorough investigation for underlying malignancy in patients with dermatomyositis, as successful treatment of such malignancy can lead to resolution of paraneoplastic symptoms, and secondly, a high index of suspicion of recurrence in cases where paraneoplastic manifestations recur. Metastatic pulmonary recurrence without local evidence of disease at a follow-up of 4 years makes this case unique. Moreover, in the light of our experience and reported literature, a framework is suggested to approach such a diagnostic dilemma in the future. Description of the case will guide clinicians in the future, in case they encounter such an unusual clinical scenario. This could also serve as a hypothesis-generating source for designing future research as well.

No MeSH data available.


Related in: MedlinePlus