Clinical, histopathological features and malignancy frequency of patients with idiopathic inflammatory myopathy

Yıl 2024, Cilt: 49 Sayı: 2, 314 – 319, 30.06.2024

Elif Altunel Kılınç , Zeynep Tüzün , Gizem Kırmızıer , Gizem Varkal , İpek Türk , Didem Arslan , Hüseyin Turgut Elbek Özer , Süleyman Özbek

https://doi.org/10.17826/cumj.1412123

Öz

Amaç: İdiyopatik inflamatuar miyopati (İİM) grubu hastalıklar kanser ile güçlü bir şekilde ilişkilidir. Bu çalışmada kliniğimizde tanı konulan İİM hastalarının klinik ve histopatolojik özelliklerinin tanımlanması, eşlik eden malignitelerin sıklığı ve alt tiplerinin değerlendirilmesi ve patolojik boyanma paternleri ile İİM alt grupları arasındaki ilişkiyi incelemektir.
Gereç ve Yöntem: Bu retrospektif çalışmaya 2010-2023 yılları arasında İİM tanısı konan ve tanı anında kas biyopsisi yapılan 74 hasta dahil edilmiştir. Yaş, cinsiyet, görüntüleme, elektromiyografi ve kas biyopsisi sonuçları hastanenin elektronik sistemi kullanılarak elde edildi.
Bulgular: İİM’li 74 hastanın 45’i polimiyozit (PM), 27’si dermatomiyozit (DM) ve ikisi inklüzyon cisimciği miyozitidir (İCM). İİM’li 74 hastanın 12’sinde (%16) malignite gelişti, bunların ikisinde (%16,6) İİM tanısından önce malignite vardı (bir meme kanseri, bir tiroid papiller kanseri). PM grubunda beş hastada (%41,6) (en sık meme kanseri), DM grubunda beş hastada (%41,6) (en sık endometriyal kanser) ve İCM grubunda iki hastada (%16,8) malignite tanısı konmuştur. Membran atak kompleksi ile pozitif boyanmanın DM grubunda PM grubuna kıyasla daha yüksek olduğu bulunmuştur.
Sonuç: Bu sonuçlar, İİM hastalarında kanser taramasının düzenli aralıklarla yapılması gerektiğini göstermektedir. Kadın hastalarda meme ve endometriyal kanser taramasına ve erkek hastalarda akciğer kanseri taramasına özel önem verilmelidir. Patolojik boyama modelleri ile İİM alt tipleri arasındaki ilişkiyi açıklamak için geniş kohort çalışmalarına ihtiyaç vardır.

Anahtar Kelimeler

Polimiyozit, dermatomiyozit, inklüzyon cisimcikli miyozit, membran atak kompleksi, malignite

Kaynakça

• Dalakas MC. Polymyositis, dermatomyositis, and inclusion-body myositis. N Engl J Med. 1991;325:1487–98.
• Chahin N, Engel AG. Correlation of muscle biopsy, clinical course, and outcome in PM and sporadic IBM. Neurology. 2008;70:418-24.
• McGrath ER, Doughty CT, Amato AA. Autoimmune myopathies: Updates on evaluation and treatment. Neurotherapeutics. 2018;15:976-94.
• Tiniakou E, Mammen AL. Idiopathic inflammatory myopathies and malignancy: A comprehensive review. Clin Rev Allergy Immunol. 2017;52:20–33.
• Panicker JB, Chacko G, Patil AK, Alexander M, Muliyil J. Immunohistochemical differentiation of inflammatory myopathies. Neurol India. 2011;59:513-20.
• Kissel JT, Mendell JR, Rammohan KW. Microvascular deposition of complement membrane attack complex in dermatomyositis. N Engl J Med. 1986;314:329-34.
• Emslie-Smith AM, Engel AG. Microvascular changes in early and advanced dermatomyositis: a quantitative study. Ann Neurol. 1990;27:343-56.
• Braczynski AK, Harter PN, Zeiner PS, Drott U, Tews D-S, Preusse C et al. C5b-9 deposits on endomysial capillaries in non-dermatomyositis cases. Neuromuscul Disord. 2016;26:283–91.
• Hoogendijk JE, Amato AA, Lecky BR, Choy EH, Lundberg IE, Rose MR et al. 119th ENMC international workshop: trial design in adult idiopathic inflammatory myopathies, except inclusion body myositis. Neuromuscul Disord. 2004;14:337–45.
• Loarce-Martos J, Lilleker JB, Parker M, McHugh N, Chinoy H. Polymyositis: is there anything left? A retrospective diagnostic review from a tertiary myositis center. Rheumatology (Oxford). 2021;60:3398-3403.
• Hill CL, Zhang Y, Sigurgeirsson B, Pukkala E, Mellemkjaer L, Airio A et al. Frequency of specific cancer types in dermatomyositis and polymyositis: A population-based study. Lancet. 2001;357:96–100.
• Ungprasert P, Leeaphorn N, Hosiriluck N, Chaiwatcharayut W, Ammannagari N, Raddatz DA. Clinical features of inflammatory myopathies and their association with malignancy: A systematic review in Asian population. ISRN Rheumatol. 2013;509354.
• Fujino M, Kawashima M, Yoshifuji H, Nakashima R, Yamada Y, Matsumoto Y et al. Remarkable remission of symptomatic dermatomyositis after curative breast cancer surgery. Int Cancer Conf J. 2024;13:111-18.
• Kim H, Sung YK, Choi S, Im SG, Jung SY, Jang EJ et al. Increased risk of malignancy in patients aged over 50 with idiopathic inflammatory myositis compared to patients with osteoarthritis of the knee. Mod Rheumatol. 2020;30:870-77.
• Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med. 1975;292:344–7.
• Lundberg IE, Tjärnlund A, Bottai M, Werth VP, Pilkington C, Visser M et al. International myositis classification criteria project consortium, The Euromyositis register and the juvenile dermatomyositis cohort biomarker study and repository (JDRG) (UK and Ireland). 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis. 2017;76:12:1955-64.
• Kardes S, Gupta L, Aggarwal R. Cancer and myositis: Who, when, and how to screen. Best Pract Res Clin Rheumatol. 2022;362:101771.
• Maoz CR, Langevitz P, Livneh A, Blumstein Z, Sadeh M, Bank I, et al. High incidence of malignancies in patients with dermatomyositis and polymyositis: an 11-year analysis. Semin Arthritis Rheum. 1998;27:319-24.
• Leatham H, Schadt C, Chisolm S, Fretwell D, Chung L, Callen JP et al. Evidence supports blind screening for internal malignancy in dermatomyositis: data from 2 large US dermatology cohorts. Medicine (Baltimore). 2018;97:e9639.
• Huang K, Li QX, Bi FF, Duan HQ, Mastaglia F, Luo YB et al. Comparative immune profiling of polymyositis and dermatomyositis muscles. Int J Clin Exp Pathol. 2018 1;11:3984-93.
• Uruha A, Nishikawa A, Tsuburaya RS, Hamanaka K, Kuwana M, Watanabe Y et al. Sarcoplasmic MxA expression: a valuable marker of dermatomyositis. Neurology. 2017;88:493-500.
• Ikenaga C, Kubota A, Kadoya M, Taira K, Uchio N, Hida A et al. Clinicopathologic features of myositis patients with CD8-MHC-1 complex pathology. Neurology. 2017;89:1060-8.

Clinical, histopathological features and malignancy frequency of patients with idiopathic inflammatory myopathy

Yıl 2024, Cilt: 49 Sayı: 2, 314 – 319, 30.06.2024

Elif Altunel Kılınç , Zeynep Tüzün , Gizem Kırmızıer , Gizem Varkal , İpek Türk , Didem Arslan , Hüseyin Turgut Elbek Özer , Süleyman Özbek

https://doi.org/10.17826/cumj.1412123

Öz

Purpose: Idiopathic inflammatory myopathy (IIM) group diseases are strongly linked to cancer. This study aims to describe the clinical and histopathological features of IIM patients diagnosed in our clinic, evaluate the frequency and subtypes of accompanying malignancies, and examine the relationship between pathological staining patterns and IIM subgroups.
Materials and Methods: This retrospective study included 74 patients with IIM diagnosed between 2010 and 2023 who had a muscle biopsy at the time of diagnosis. Age, gender, imaging, electromyography, and muscle biopsy results were obtained using the hospital’s electronic system.
Results: Of the 74 patients with IIM, 45 are polymyositis (PM), 27 are dermatomyositis (DM) and two are inclusion body myositis (IBM). Malignancy developed in 12 (16%) of 74 IIMs, two (16.6%) of whom had malignancy before the diagnosis of IIM (one breast cancer, one thyroid papillary cancer). Malignancy was diagnosed in five patients (41.6%) in the PM group (the most common breast cancer), five patients (41.6%) in the DM group (the most common endometrial cancer, and two patients (16.8%) in the IBM group. It was found that positive staining with membrane attack complex was higher in the DM group compared to the PM group.
Conclusion: Cancer screening should be performed at regular intervals in IIM patients. Breast and endometrial cancer screening should be prioritized in female patients, as well as lung cancer screening in male patients. Large cohort studies are needed to explain the relationship between pathological staining patterns and IIM subtypes.

Anahtar Kelimeler

polymyositis, dermatomyositis, inclusion body myositis, membrane attack complex, malignancy

Kaynakça

• Dalakas MC. Polymyositis, dermatomyositis, and inclusion-body myositis. N Engl J Med. 1991;325:1487–98.
• Chahin N, Engel AG. Correlation of muscle biopsy, clinical course, and outcome in PM and sporadic IBM. Neurology. 2008;70:418-24.
• McGrath ER, Doughty CT, Amato AA. Autoimmune myopathies: Updates on evaluation and treatment. Neurotherapeutics. 2018;15:976-94.
• Tiniakou E, Mammen AL. Idiopathic inflammatory myopathies and malignancy: A comprehensive review. Clin Rev Allergy Immunol. 2017;52:20–33.
• Panicker JB, Chacko G, Patil AK, Alexander M, Muliyil J. Immunohistochemical differentiation of inflammatory myopathies. Neurol India. 2011;59:513-20.
• Kissel JT, Mendell JR, Rammohan KW. Microvascular deposition of complement membrane attack complex in dermatomyositis. N Engl J Med. 1986;314:329-34.
• Emslie-Smith AM, Engel AG. Microvascular changes in early and advanced dermatomyositis: a quantitative study. Ann Neurol. 1990;27:343-56.
• Braczynski AK, Harter PN, Zeiner PS, Drott U, Tews D-S, Preusse C et al. C5b-9 deposits on endomysial capillaries in non-dermatomyositis cases. Neuromuscul Disord. 2016;26:283–91.
• Hoogendijk JE, Amato AA, Lecky BR, Choy EH, Lundberg IE, Rose MR et al. 119th ENMC international workshop: trial design in adult idiopathic inflammatory myopathies, except inclusion body myositis. Neuromuscul Disord. 2004;14:337–45.
• Loarce-Martos J, Lilleker JB, Parker M, McHugh N, Chinoy H. Polymyositis: is there anything left? A retrospective diagnostic review from a tertiary myositis center. Rheumatology (Oxford). 2021;60:3398-3403.
• Hill CL, Zhang Y, Sigurgeirsson B, Pukkala E, Mellemkjaer L, Airio A et al. Frequency of specific cancer types in dermatomyositis and polymyositis: A population-based study. Lancet. 2001;357:96–100.
• Ungprasert P, Leeaphorn N, Hosiriluck N, Chaiwatcharayut W, Ammannagari N, Raddatz DA. Clinical features of inflammatory myopathies and their association with malignancy: A systematic review in Asian population. ISRN Rheumatol. 2013;509354.
• Fujino M, Kawashima M, Yoshifuji H, Nakashima R, Yamada Y, Matsumoto Y et al. Remarkable remission of symptomatic dermatomyositis after curative breast cancer surgery. Int Cancer Conf J. 2024;13:111-18.
• Kim H, Sung YK, Choi S, Im SG, Jung SY, Jang EJ et al. Increased risk of malignancy in patients aged over 50 with idiopathic inflammatory myositis compared to patients with osteoarthritis of the knee. Mod Rheumatol. 2020;30:870-77.
• Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med. 1975;292:344–7.
• Lundberg IE, Tjärnlund A, Bottai M, Werth VP, Pilkington C, Visser M et al. International myositis classification criteria project consortium, The Euromyositis register and the juvenile dermatomyositis cohort biomarker study and repository (JDRG) (UK and Ireland). 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis. 2017;76:12:1955-64.
• Kardes S, Gupta L, Aggarwal R. Cancer and myositis: Who, when, and how to screen. Best Pract Res Clin Rheumatol. 2022;362:101771.
• Maoz CR, Langevitz P, Livneh A, Blumstein Z, Sadeh M, Bank I, et al. High incidence of malignancies in patients with dermatomyositis and polymyositis: an 11-year analysis. Semin Arthritis Rheum. 1998;27:319-24.
• Leatham H, Schadt C, Chisolm S, Fretwell D, Chung L, Callen JP et al. Evidence supports blind screening for internal malignancy in dermatomyositis: data from 2 large US dermatology cohorts. Medicine (Baltimore). 2018;97:e9639.
• Huang K, Li QX, Bi FF, Duan HQ, Mastaglia F, Luo YB et al. Comparative immune profiling of polymyositis and dermatomyositis muscles. Int J Clin Exp Pathol. 2018 1;11:3984-93.
• Uruha A, Nishikawa A, Tsuburaya RS, Hamanaka K, Kuwana M, Watanabe Y et al. Sarcoplasmic MxA expression: a valuable marker of dermatomyositis. Neurology. 2017;88:493-500.
• Ikenaga C, Kubota A, Kadoya M, Taira K, Uchio N, Hida A et al. Clinicopathologic features of myositis patients with CD8-MHC-1 complex pathology. Neurology. 2017;89:1060-8.

Toplam 22 adet kaynakça vardır.

Ayrıntılar

Kaynak Göster

Download or read online: Click here