Dermatomiositis amiopática como primera manifestación de cáncer de uréter
Palabras clave:Síndrome paraneoplásico, dermatomiositis, cáncer ureteral
Description of the clinical case: A 79-year-old man who consulted for an episode of facial angioedema without other symptoms. Upon physical examination, he presented erythema on the face and neck, peri-palpebral angioedema and erythematous macules on the back of the hands. A biopsy of a skin lesion compatible with Gottron papule was performed. A computed tomography urography was performed to rule out systemic disease, observing grade III left ureterohydronephrosis, possibly due to ureteral neoplasia. Extension study negative. Laparoscopic left nephroureterectomy and endovesical instillation of Mitomycin C were performed, with anatomopathological results of multifocal high grade papillary urothelial carcinoma. The patient presented a favorable postoperative evolution with improvement of dermal lesions, but 7 months later he developed multiple metastases and died.
Relevance: The association of dermatomyositis with neoplasms is well known, but few cases have been described with urological malignancy. Ureteral cancer with amyopathic dermatomyositis is extremely rare.
Clinical implications: It is important to perform cancer screening in patients with dermatomyositis in order to treat them and improve their prognosis.
Conclusion: Dermatomyositis is a rare paraneoplastic syndrome that is very infrequently associated with ureteral cancer. Cancer screening in these patients is very important to improve the prognosis. The surgical treatment of this tumor led to the disappearance of the skin changes.
Choi YS, Ryu KH, Kwon GY, Jeon SS, Choi HY, Lee HM. Ureteral cancer associated with dermatomyositis. Int J Urol. 2006 Apr;13(4):442–4. doi: https://doi.org/10.1111/j.1442-2042.2006.01322.x
Targoff IN. Malignancy in dermatomyositis and polymyositis - UpToDate. UpToDate. 2022. [accessed 17 Feb 2022] Available from: https://www.uptodate.com/contents/malignancy-in-dermatomyositis-and-polymyositis/print?source=related_link
Vleugels RA. Cutaneous dermatomyositis in adults: Overview and initial management - UpToDate. UpToDate. 2022. [accessed 17 Feb 2022] Available from: https://www.uptodate.com/contents/cutaneous-dermatomyositis-in-adults-overview-and-initial-management
Shinohara N, Harabayashi T, Suzuki S, Nakamura M, Itoh T, Nonomura K. Advanced renal pelvic carcinoma associated with dermatomyositis. Int J Urol. 2005 Oct;12(10):906–8. doi: https://doi.org/10.1111/j.1442-2042.2005.01178.x
Sacco E, Pinto F, Sasso F, Racioppi M, Gulino G, Volpe A, et al. Paraneoplastic syndromes in patients with urological malignancies. Urol Int. 2009;83(1):1–11. doi: https://doi.org/10.1159/000224860
Portillo-Pineda R, Padilla-Isaula E, Castro NM-, Alvarado ER-, Cruz JO-. Dermatomiositis como primera manifestación de síndrome paraneoplásico, en cáncer de vejiga. Rev Hisp Cienc Salud. 2018 Jun 30;4(2):89–93.
Nevins E, Zayat AS, Browning AJ, Biyani CS, Jarrett S. Renal cell carcinoma-associated adult dermatomyositis treated laparoscopic nephrectomy. Urol Ann. 2013 Oct;5(4):299–301. doi: https://doi.org/10.4103/0974-7796.120302
Joseph JV, Turner KJ, Bramwell SP. Dermatomyositis: a rare initial presentation of adenocarcinoma of the prostate. J Urol. 2002 Aug;168(2):637. doi: https://doi.org/10.1016/s0022-5347(05)64698-8
Xu R, Zhong Z, Jiang H, Zhang L, Zhao X. A rare paraneoplastic dermatomyositis in bladder cancer with fatal outcome. Urol J. 2013;10(1):815–7. doi: https://doi.org/10.22037/uj.v10i1.1979
Yoshie H, Nakazawa R, Usuba W, Kudo H, Sato Y, Sasaki H, et al. Paraneoplastic Dermatomyositis Associated with Metastatic Seminoma. Case Rep Urol. 2016;2016:7050981. doi: https://doi.org/10.1155/2016/7050981
Adili AF, Liaconis H, Gusenbauer K, Kapoor A. Renal cell carcinoma and amyopathic dermatomyositis. Can Urol Assoc J. 2015;9(5–6):E340–2. doi: https://dx.doi.org/10.5489%2Fcuaj.2362