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Current Rheumatology Reports

, Volume 4, Issue 5, pp 415–426 | Cite as

Malignancy in patients with inflammatory myopathy

  • Rachelle Buchbinder
  • Catherine L. Hill
Article

Abstract

The most recent evidence from population-based cohort studies confirms the association between malignancy and dermatomyositis and polymyositis. These studies show an even stronger association between polymyositis and malignancy than previous studies, suggesting less misclassification. This is particularly true of one study that used pathologic criteria to distinguish between myositis subtypes. Recent data also confirm that the association for dermatomyositis and polymyositis is not purely caused by diagnostic suspicion or surveillance bias. More data are still required to determine individual cancer risks, although it appears that ovarian and lung cancer are associated with dermatomyositis while lung cancer and non-Hodgkin’s lymphoma are associated with polymyositis. An association between malignant disease and inclusion body myositis has also been verified for the first time. Of interest, too, is the increasing number of reports documenting cases in which the clinical course of the myositis mirrors that of the cancer, supporting the notion that in some instances, myositis is a paraneoplastic disorder.

Keywords

Myositis Connective Tissue Disease Dermatomyositis Inclusion Body Myositis Inflammatory Myopathy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References and Recommended Reading

  1. 1.
    Stockton D, Doherty VR, Brewster DH: Risk of cancer in patients with dermatomyositis or polymyositis, and followup implications: a Scottish population-based cohort study. Br J Cancer 2001, 85:41–45. Like earlier population-based cohort studies, this study identified hospitalized patients with dermatomyositis/polymyositis from a national hospital registry, but did not verify diagnosis by chart review. The authors observed an increased risk of malignancy in dermatomyositis (over seven-fold) and polymyositis (about two-fold).PubMedCrossRefGoogle Scholar
  2. 2.
    Buchbinder R, Forbes A, Hall S, et al.: Incidence of malignant disease in biopsy-proven inflammatory myopathy: a populationbased cohort study. Ann Intern Med 2001, 134:1087–1095. This study identified patients with biopsy-proven myositis from a centralized muscle pathology service thereby ensuring the legitimacy of the diagnosis and reducing the risk of misclassification of polymyositis and dermatomyositis. It verified that the risk of malignancy is increased in dermatomyositis (more than six-fold) and polymyositis (two-fold), especially in the first 3 years after myositis diagnosis. An increased risk of malignant disease in inclusion body myositis (over two-fold) was also observed.PubMedGoogle Scholar
  3. 3.
    Hill CL, Zhang Y, Sigurgeirsson B, et al.: Frequency of specific cancer types in dermatomyositis and polymyositis: a population-based study. Lancet 2001, 357:96–100. This study reported a pooled analysis of previously published Swedish, Danish, and Finnish data revealing an increased relative risk for ovarian, lung, colorectal, stomach, pancreas cancers and non-Hodgkin’s lymphoma in dermatomyositis and lung and bladder cancer and non-Hodgkin’s lymphoma in polymyositis.PubMedCrossRefGoogle Scholar
  4. 4.
    Chen YJ, Wu CY, Shen JL: Predicting factors of malignancy in dermatomyositis and polymyositis: a case-control study. Br J Dermatol 2001, 144:825–831. Factors found to be associated with malignancy in this study were older age at onset of myositis (> 45 years) and with men. Interstitial lung disease was associated with lower risk. These findings need to be interpreted cautiously as it is unclear whether the duration of followup and surveillance for cancer was similar in both groups. Nasopharyngeal carcinoma was the most common cancer associated with dermatomyositis in this study from Taiwan.PubMedCrossRefGoogle Scholar
  5. 5.
    Villa AR, Kraus A, Jimenez-Corona A: Malignant neoplasms in autoimmune rheumatic diseases: examination of the risk of developing a malignancy among five rheumatic diseased in one institution. Clin Rheumatol 2000, 6:176–183.CrossRefGoogle Scholar
  6. 6.
    Ang P, Sugeng MW, Chua SH: Classical and amyopathic dermatomyositis seen at the National Skin Centre of Singapore: a 3-year retrospective review of their clinical characteristics and association with malignancy. Ann Acad Med Singapore 2000, 29:219–223. Small study suggesting that amyopathic dermatomyositis, without clinical and laboratory evidence of myositis, appears to be less closely associated with malignancy than dermatomyositis. Nasopharyngeal carcinoma was also the most common malignancy observed in this study from Singapore.PubMedGoogle Scholar
  7. 7.
    Hunger, RE, Durr C, Brand CU: Cutaneous leukocytoclastic vasculitis in dermatomyositis suggests malignancy. Dermatology 2001, 202:123–126. Small study suggesting that presence of leucocytoclastic vasculitis on skin biopsy in dermatomyositis may be associated with malignancy.PubMedCrossRefGoogle Scholar
  8. 8.
    Marie I, Hachulla E, Hatron PY, et al.: Polymyositis and dermatomyositis: short term and longterm outcome, and predictive factors of prognosis. J Rheumatol 2001, 28:2230–2237.PubMedGoogle Scholar
  9. 9.
    Marie I, Hatron PY, Levesque H, et al.: Influence of age on characteristics of polymyositis and dermatomyositis in adults. Medicine 1999, 78:139–147.PubMedCrossRefGoogle Scholar
  10. 10.
    Dourmishev LA: Dermatomyositis associated with malignancy: 12 case reports. Adv Exp Med Biol 1999, 455:193–199.PubMedGoogle Scholar
  11. 11.
    Dawkins MA, Jorizzo JL, Walker FO, et al.: Dermatomyositis: a dermatology-based case series. J Am Acad Dermatol 1998 38:397–404.PubMedCrossRefGoogle Scholar
  12. 12.
    Pautas E, Cherin P, Piette JC, et al.: Features of polymyositis and dermatomyositis in the elderly: a case-control study. Clin Exp Rheumatol 2000, 18:241–244.PubMedGoogle Scholar
  13. 13.
    Sigurgeirsson B, Lindelof B, Edhag O, Allander E: Risk of cancer in patients with dermatomyositis or polymyositis: a population-based study. N Engl J Med 1992, 326:363–367.PubMedCrossRefGoogle Scholar
  14. 14.
    Chow WH, Gridley G, Mellemkjaer L, et al.: Cancer risk following polymyositis and dermatomyositis: a nationwide cohort study in Denmark. Cancer Causes Control 1995, 6:9–13.PubMedCrossRefGoogle Scholar
  15. 15.
    Airio A, Pukkala E, Isomaki H: Elevated cancer incidence in patients with dermatomyositis: a population based study. J Rheumatol 1995, 22:1300–1303.PubMedGoogle Scholar
  16. 16.
    Bohan A, Peter JB: Polymyositis and dermatomyositis (first of two parts). N Engl J Med 1975, 292:344–347.PubMedCrossRefGoogle Scholar
  17. 17.
    Banker BQ, Engel AG: The Polymyositis and Dermatomyositis Syndromes. In Myology: Basic and Clinical. Edited by Banker B, Engel A. New York: McGraw Hill; 1986:1385–1422.Google Scholar
  18. 18.
    Mordel N, Margalioth EJ, Harats N, et al.: Concurrence of ovarian cancer and dermatomyositis: a report of two cases and literature review. J Reprod Med 1988, 33:649–655.PubMedGoogle Scholar
  19. 19.
    Maoz CR, Langevitz P, Livneh A, et al.: High incidence of malignancies in patients with dermatomyositis and polymyositis: an 11-year analysis. Semin Arthritis Rheum 1998, 27:319–324.PubMedCrossRefGoogle Scholar
  20. 20.
    Zantos D, Zhang Y, Felson D: The overall and temporal association of cancer with polymyositis and dermatomyositis. J Rheumatol 1994, 21:1855–1859.PubMedGoogle Scholar
  21. 21.
    Fujita J, Tokuda M, Bandoh S, et al.: Primary lung cancer associated with polymyositis/dermatomyositis, with a review of the literature. Rheumatol Int 2001, 20:81–84.PubMedCrossRefGoogle Scholar
  22. 22.
    Yang Y, Fujita J, Tokuda M, et al.: Lung cancer associated with several connective tissue diseases: with a review of literature. Rheumatol Int 2001, 21:106–111.PubMedCrossRefGoogle Scholar
  23. 23.
    Peng JC, Sheen TS, Hsu MM: Nasopharyngeal carcinoma with dermatomyositis: analysis of 12 cases. Arch Otolaryngol Head Neck Surg 1995, 121:1298–1301.PubMedGoogle Scholar
  24. 24.
    Raffel GD, Gravallese EM, Schwab P, et al.: Diagnostic dilemmas in oncology: case 2: dermatomyositis and ovarian cancer. J Clin Oncol 2001, 19:4341–4343.PubMedGoogle Scholar
  25. 25.
    Subramonian K, Sundaram SK, MacDonald Hull SP: Carcinoma of the prostate associated with dermatomyositis. BJU Int 2000, 86:401–402.PubMedCrossRefGoogle Scholar
  26. 26.
    Borgia F, Vaccaro M, Guarneri F, et al.: Dermatomyositis associated with IgG myeloma. Br J Dermatol 2001, 144:200–201.PubMedCrossRefGoogle Scholar
  27. 27.
    Lalla SC, Aldridge RD, Tidman MJ: Carcinoma of the penis presenting with dermatomyositis. Clin Exp Dermatol 2001, 26:558.PubMedCrossRefGoogle Scholar
  28. 28.
    Sugiyama T, Nakagawa T, Inui M, Tagawa T: Tongue carcinoma in a young patient with dermatomyositis: a case report and review of the literature. J Oral Maxillofac Surg 2001, 59:925–928.PubMedCrossRefGoogle Scholar
  29. 29.
    Yamashita K, Hosokawa K, Hirohashi S, et al.: Epstein-Barr virus-associated gastric cancer in a patient with dermatomyositis. Int Med 2001, 40:96–99.Google Scholar
  30. 30.
    Vattemi G, Tonin P, Martignoni G, et al.: Dermatomyositis and retroperitoneal germ cell cancer. Eur Neurol 2001, 45:52–53.PubMedCrossRefGoogle Scholar
  31. 31.
    Katsinelos P, Stavros D, Pirpilidis I, et al.: Unobstructed biliary tract dilatation in a patient with breast carcinoma and dermatomyositis: a new paraneoplastic manifestation? Am J Gastroenterol 1999, 94:3383–3385.PubMedCrossRefGoogle Scholar
  32. 32.
    Ago T, Nakamura M, Iwata I, et al.: Dermatomyositis associated with invasive thymoma. Int Med 1999, 38:155–159.Google Scholar
  33. 33.
    Piura B, Meirovitz M, Cohen Y, Horowitz J: Dermatomyositis and peritoneal papillary serous carcinoma. Eur J Obstet Gynecol Reprod Biol 1999, 82:93–96.PubMedCrossRefGoogle Scholar
  34. 34.
    Tanabe S, Mitomi H, Sada M, et al.: Parathyroid hormonerelated protein production by adenocarcinoma in Barrett’s esophagus patient with dermatomyositis. Dig Dis Sci 2001, 46:1584–1588.PubMedCrossRefGoogle Scholar
  35. 35.
    Robinson AJ, Alcock CJ: Dermatomyositis in association with transitional cell carcinoma of the bladder. Clin Oncol (R Coll Radiol) 2001, 13:50–51.Google Scholar
  36. 36.
    Fujii K, Moriya Y, Fujita S, et al.: Dermatomyositis accompanied by rectal cancer: report of a case. Surg Today 2000, 30:302–304.PubMedCrossRefGoogle Scholar
  37. 37.
    Brown H, Steven M: Myositis and malignancy: is there a true association? Hosp Med 1999, 60:51–53.PubMedGoogle Scholar
  38. 38.
    Orth T, Galle PR, Mayet WJ: Severe dermatomyositis associated with lymph node recurrence of an endometrial carcinoma. Clin Rheumatol 1999, 5:41–42.Google Scholar
  39. 39.
    Nakanishi K, Cualing H, Husseinzadeh N: Dermatomyositis as a presenting symptom of ovarian cancer. Obstet Gynecol 1999, 94:836–838.PubMedCrossRefGoogle Scholar
  40. 40.
    Celebi S, Gul A, Kamali S, et al.: Amyopathic dermatomyositis associated with cervical cancer. Clin Rheumat 2001, 20:438–440.CrossRefGoogle Scholar
  41. 41.
    Hashefi M, McHugh TR, Smith GP, et al.: Seropositive rheumatoid arthritis with dermatomyositis sine myositis, angioimmunoblastic lymphadenopathy with dysproteinemia-type T cell lymphoma, and B cell lymphoma of the oropharynx. J Rheumatol 2000, 27:1087–1090.PubMedGoogle Scholar
  42. 42.
    Russ BW, English JC 3rd, King DH, Halbach DP: Amyopathic dermatomyositis associated with transitional cell carcinoma of the bladder. Cutis 1999, 63:73–76.PubMedGoogle Scholar
  43. 43.
    Goyal S, Nousari HC: Paraneoplastic amyopathic dermatomyositis associated with breast cancer recurrence. J Am Acad Dermatol 1999, 41:874–875.PubMedCrossRefGoogle Scholar
  44. 44.
    Satoh H, Ohtsuka M, Yamashita YT, et al.: Breast cancer shortly after the diagnosis of interstitial pneumonia associated with polymyositis. Oncol Rep 2000, 7:105–106.PubMedGoogle Scholar
  45. 45.
    Pautas E, Cherin P, Wechsler B: Polymyositis as a paraneoplastic manifestation of rectal adenocarcinoma. Am J Med 1999, 106:122–123.PubMedCrossRefGoogle Scholar
  46. 46.
    Arnardottir S, Ansved T, Nennesmo I, Borg K: Report of a patient with inclusion body myositis and CD8+ chronic lymphocytic leukaemia: post-mortem analysis of muscle and brain. Acta Neurol Scand 2001, 103:131–135.PubMedCrossRefGoogle Scholar
  47. 47.
    Talanin NY, Bushore E, Raspberry R, et al.: Dermatomyositis with the features of inclusion body myositis associated with carcinoma of the bladder. Br J Dermatol 1999, 141:926–930.PubMedCrossRefGoogle Scholar
  48. 48.
    Di Stasi SM, Poggi A, Giannantoni A, Zampa G: Dermatomyositis associated with testicular germ cell cancer. J Urol 2000, 163:240.PubMedCrossRefGoogle Scholar
  49. 49.
    von Heyden B, Kliesch S, Nashan D: Re: dermatomyositis associated with testicular germ cell cancer. J Urol 2000, 164:2030.CrossRefGoogle Scholar
  50. 50.
    Federman DG, Radonich M, Kirsner RS: Fatal bladder cancer and dermatomyositis. South Med J 2000, 93:492–493.PubMedGoogle Scholar
  51. 51.
    Till SH, Jones AC: Dermatomyositis: how far to go! Ann Rheum Dis 1998, 57:198–200.PubMedCrossRefGoogle Scholar
  52. 52.
    Tagawa A, Kashima R, Kaneda K, et al.: Polymyositis successfully treated with surgical resection of colon cancer. Eur Neurol 2000, 44:251–252.PubMedCrossRefGoogle Scholar
  53. 53.
    Hasegawa K, Uesugi H, Kubota K, et al.: Polymyositis as a paraneoplastic manifestation of hepatocellular carcinoma. Hepatogastroenterology 2000, 47:1425–1427.PubMedGoogle Scholar
  54. 54.
    Hagman JH, Bianchi L, Campione E, et al.: Dermatomyositis associated with ovarian transitional cell carcinoma. J Am Acad Dermatol 2001, 45:642–644.PubMedCrossRefGoogle Scholar
  55. 55.
    Nousari HC, Kimyai-Asadi A, Spegman DJ: Paraneoplastic dermatomyositis presenting as erythroderma. J Am Acad Dermatol 1998, 39:653–654.PubMedCrossRefGoogle Scholar
  56. 56.
    Inuzuka M, Tomita K, Tokura Y, Takigawa M: Acquired ichthyosis associated with dermatomyositis in a patient with hepatocellular carcinoma. Br J Dermatol 2001, 144:416–417.PubMedCrossRefGoogle Scholar
  57. 57.
    Seishima M, Shimizu H, Oyama Z: Skin metastasis of breast cancer clinically undistinguished from amyopathic dermatomyositis. Eur J Dermatol 2001, 11:131–133.PubMedGoogle Scholar
  58. 58.
    Rini BI, Gajewski TF: Polymyositis with respiratory muscle weakness requiring mechanical ventilation in a patient with metastatic thymoma treated with octreotide. Ann Oncol 1999, 10:973–979.PubMedCrossRefGoogle Scholar
  59. 59.
    Raschilas F, Mouthon L, Andre MH, et al.: Concomitant polymyositis and myasthenia gravis reveal malignant thymoma: a case report and review of the literature. Ann Med Intern 1999, 150:370–373.Google Scholar

Copyright information

© Current Science Inc 2002

Authors and Affiliations

  • Rachelle Buchbinder
    • 1
  • Catherine L. Hill
    • 1
  1. 1.Cabrini Medical CentreMalvernAustralia

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