PD8. Sindrom paraneoplazic complex: Dermatomiozita si ihtioza dobandita intr-un caz de cancer sigmoidian
Pacienta D. F. in varsta de 63 de ani prezenta in urma cu doi ani un tablou clinic predominant cutanat: leziuni eritemato-edematoase ale fetei si eritematoase pe dosul mainilor, asociat ulterior cu un deficit muscular progresiv. Cresterea enzimelor musculare. EMG si biopsia stabilesc diagnosticul de dermatomiozita (DM). Corticoterapia este putin eficienta. O stare ihtioziforma a tegumentelor apare 6 luni mai tarziu si se accentueaza progresiv.
La un an si jumatate de la diagnostic, o simptomatologie digestiva, constand in tulburari de tranzit si rectoragii sugereaza o implicare digestiva. Colonoscopic se descopera un adenocarcinom sigmoidian confirmat bioptic. Exereza tumorii conduce la ameliorarea bolii in general si la disparitia leziunilor cutanate, exceptand starea ihtioziforma a tegumentelor, dar numai pentru cateva luni. Ulterior noi leziuni eritemato-violacee apar pe dosul mainilor. Acestea au o remarcabila evolutie spre atrofie, atat a tegumentului cat si a muschilor interososi. Concomitent sunt descoperite si metastaze hepatice.
Concluzii. Dermatomiozita si ihtioza dobandita sunt manifestari paraneoplazice, dovada fiind evolutia lor strans corelata cu cea a cancerului.
PD8. Complex Pareneoplastic Syndrome: Dermatomyositis and Acquired Ichtyosis in a Sigmoid Tumor
A patient D. F. 63-years old has presented 2 years ago a predominant cutaneous clinical aspect: erythematous-edematous lesions of the face and erythematous lesions of the back of the hands associated forward with a progressive muscular deficit.
The increasing muscular enzymes, miography and biopsy established the diagnosis of dermatomyositis (DM).
A ichthyosform state of the skin appear 6 months later and will increase progressively. About 1 year and a half from the diagnosis a digestive simptomathology, consisting in bowel disfunction and hematochezia suggested a digestive implication. The colonoscopy discovered a sigmoid adenocarcinoma confirmed by biopsy The excision of the tumor leads to a better evolution of the disease and to the tumor leads to a better evolution of the disease and to the resolution of cutaneous lesions, excepting the ichthyosiform state of the skin, but only for few months. Afterwards, new erythematous lesions appeard on the back of the hands. These have a remarcable evolution towards atrophy both of the skin and the interosseous muscles. Simultaneously hepatic metastases have been discovered.
Conclusions. DM and acquired ichthyosis are paraneoplastic signs, the proof being the evolution well related with the tumor's evolution.