Metachronous Bilateral Primary Breast Cancer Associated with Dermatomyositis

Abstract

15-30% of adult patients with dermatomyositis, and 17-18% of them had breast cancer (1). We report an uncommon case of metachronous primary breast cancer associated with dermatomyositis.A 61-year-old woman noticed a left breast mass and was referred to our hospital in August 1999. Pathologically diagnosed as carcinoma, she underwent modified radical mastectomy. Histologic examination revealed invasive ductal carcinoma. Final stage was determined to be T2N0M0, stage IIA. Both estrogen and progesterone receptors were positive.On the 11th day after surgery she developed muscle weakness, dysphasia, and a heliotrope rash on the upper eyelids. According to clinical features and laboratory findings, she was diagnosed with dermatomyositis. Retrospective microscopic examination revealed infiltration of lymphocytes around vessels and edematous changes were detected in the dermis, consistent with the findings of dermatomyositis. After administration of steroids, the symptoms gradually improved.In December 2001, she was withdrawn from steroids. In January 2003, she was diagnosed with right breast cancer and underwent modified radical mastectomy. Histologic examination revealed invasive ductal carcinoma, indicating comedo carcinoma. The findings of the second carcinoma were so inconsistent with those of the first that the final diagnosis of metachronous bilateral primary breast cancer was established. Only progesterone receptor was positive. The final stage was determined to be T3N0M0, stage IIB.The postoperative course was uneventful and administration of steroids was not required. After surgery, endocrine therapy was started. Although 5 months have passed since the second surgery, no recurrence of breast cancer has been detected.The nature of the relationship between dermatomyositis and breast cancer is not well understood. Probably both coincidental and true associations exist. Including our present case, we reviewed the clinicopathologic features of 20 cases of breast cancer associated with dermatomyositis in the Japanese literature. One of them was simultaneous double primary breast cancer in the ipsilateral breast (2). Two cases, including our present case, were metachronous primary breast cancer (3). Others were solitary cancer. As for histopathology, 16 of 23 tumors were invasive ductal carcinoma (69.9%) and 3 were occult carcinoma (13.0%).Treatment for breast cancer was surgery, except in one case of inflammatory breast cancer. Malignancies discovered after onset of dermatomyositis occurred in 8 of 20 patients (40%) and the time to development of carcinoma ranged from 3 months to 11 years (mean 34.8 months). Malignancies preceded by dermatomyositis occurred in 8 of 20 patients (40%) and the time to onset of dermatomyositis ranged from 3 months to 9 years (mean 33.4 months). Simultaneous onset was observed in 4 of 20 patients (20%).In our present case, dermatomyositis may have existed before surgery and symptoms became evident and rapidly progressed after surgery. The most common cause of death in patients with dermat...

Breast Cancer and Dermatomyositis: A Case Study and Literature Review

“…No trends in hormone receptor status were observed in these breast cancer patients with dm. The distribution of triple-negative 8,18 , her2-positive 9,10,12,15,16 , and estrogen or progesterone receptor-positive [12][13][14]16,17 breast cancers was relatively even.…”

“…Median age at the time of initial breast cancer diagnosis in the identified cohort was 58 years (range: 39-74 years), and the most common type of breast cancer was invasive ductal carcinoma (12 of 16 patients with available tumour pathology, 75%) [8][9][10][11][12][13][14][15][16][17] . The median time to diagnosis of breast cancer from presentation with dm was 1 month (range: 29-36 months).…”

“…Most patients were diagnosed with cancer before they were diagnosed with dm; only 6 of the 25 (24%) presented with myositis symptoms first 13,18,19 . The presence of dm was associated with late-stage tumours, 72% of the women (18 of the 25) having presented with stage iii or iv disease 9,10,[12][13][14][15][16][17][18]20 . No trends in hormone receptor status were observed in these breast cancer patients with dm.…”

A Unique Case of Muscle-Invasive Metastatic Breast Cancer Mimicking Myositis

“…Although less common, there are reported cases of paraneoplastic DM related to breast cancer [15, 16]. DM and PM are thought to manifest as paraneoplastic syndromes when cancer cells overexpress myositis-specific antigens (MSA) that cause autoimmune damage to both muscle and cancer mediated by T-cells [17].…”