乳腺癌伴甲状腺癌和皮肌炎1例报告及3种疾病关联性文献复习

发布时间：2019-03-04 21:17

【摘要】：目的:观察1例乳腺癌伴甲状腺癌和皮肌炎患者的临床特点,并对3种疾病关联性进行文献复习,增强临床医师对此类患者的认识,以期早期发现和治疗。方法:收集该例患者的病历资料,记录患者的各项信息,包括性别、发病年龄、临床表现和糖皮质激素治疗剂量,并发肿瘤发生的时间、类型和治疗方案等临床资料,并对临床资料进行回顾性分析。结果:该患者确诊皮肌炎后相继发现乳腺癌及甲状腺癌,继续口服地塞米松片50mg·d~(-1)治疗皮肌炎,先行4个疗程吡柔比星和环磷酰胺(AC)方案,序贯4个疗程紫杉醇和赫赛汀(TH)方案乳腺癌新辅助化疗。在化疗的24周内,乳腺癌灶逐渐减小,甲状腺癌灶无明显变化,皮肌炎临床症状改善,血乳酸脱氢酶、α-羟丁酸脱氢酶数值降低,但不明显。8疗程AC-TH新辅助化疗后行甲状腺癌扩大根治术,术后1周皮肌炎症状未有明显改善,心肌酶数值无变化。首次手术1周后行乳腺癌改良根治术,术后1周复查心肌酶,全部降至正常水平,皮肌炎临床症状明显缓解。结论:尽管目前对于3种疾病之间的关系仍存在争议,但本研究收集该患者的临床资料及检索的文献均支持乳腺癌与甲状腺癌存在关联,皮肌炎与甲状腺癌无关联,与乳腺癌有关联。
[Abstract]:Aim: to observe the clinical features of a patient with breast cancer with thyroid cancer and dermatomyositis, and review the literature on the correlation of three diseases, so as to enhance the clinician's understanding of these patients in order to find out and treat them in the early stage. Methods: the medical records of this patient were collected and all kinds of information were recorded, including sex, age of onset, clinical manifestation and dosage of glucocorticoid treatment, time of occurrence of tumor, type and treatment plan, etc. The clinical data were analyzed retrospectively. Results: breast cancer and thyroid cancer were found successively after the diagnosis of dermatomyositis. 50mg 路d ~ (- 1) orally was continued to treat dermatomyositis. Four courses of pirarubicin and cyclophosphamide (AC) regimen were given to the patients with dermatomyositis. Four consecutive courses of paclitaxel and Herceptin (TH) regimen for breast cancer neoadjuvant chemotherapy. Within 24 weeks of chemotherapy, breast cancer foci decreased gradually, thyroid cancer foci did not change significantly, clinical symptoms of dermatomyositis improved, blood lactate dehydrogenase and 伪-hydroxybutyrate dehydrogenase decreased. After 8 courses of AC-TH neoadjuvant chemotherapy extended radical thyroidectomy, the symptoms of dermatomyositis were not improved significantly and the myocardial enzyme value was not changed at 1 week after operation. One week after the first operation, modified radical mastectomy was performed. Myocardial enzymes were reexamined 1 week after operation, all of them were reduced to normal level. The clinical symptoms of dermatomyositis were relieved obviously. Conclusion: although there is still controversy about the relationship among the three diseases, the clinical data and literature collected in this study support that breast cancer is associated with thyroid cancer, and dermatomyositis is not associated with thyroid cancer, but there is no association between dermatomyositis and thyroid cancer. Associated with breast cancer.
【作者单位】：吉林大学第一医院乳腺外科;
【基金】：国家自然科学基金资助课题(C03030303)
【分类号】：R593.26;R736.1;R737.9

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