Heterotopic bone formation caused by urothelial carcinoma is rare. The precise mechanism of heterotopic ossification is still unknown. We report a case of urothelial carcinoma with heterotopic bone formation in a metastatic site and investigate the expression of bone morphogenetic protein 2 (BMP-2) and the BMP receptor (BMPR)-Ib using immunohistochemistry. Positive staining of BMP-2 was observed in the cytoplasm of tumor cells in both bladder and psoas lesions. In addition, positive staining of BMPR-Ib was seen in osteoblast-like cells adjacent to bone formation in the psoas metastasis. The heterotopic ossification may result from the metaplasia of pluripotent stem cells into osteoblast cells induced by BMP-2 in a paracrine fashion.
KEY WORDS: dermatomyositis, prostatic neoplasms, prostatectomy Dermatomyositis is associated with internal malignancy in 15% to 34% of adult cases. 1 In most cases malignancy is diagnosed within 1 year of the onset of dermatomyositis and is thought to represent a paraneoplastic syndrome. 2 This hypothesis is supported by the observation that clinical resolution of dermatomyositis symptoms frequently occurs after successful treatment of cancer. Moreover, when symptoms recur they are typically a harbinger of cancer recurrence. 2 We report a case of improvement of dermatomyositis associated with prostatic adenocarcinoma following radical prostatectomy.
CASE REPORTA 71-year-old man presented with an erythematous rash appearing on the periorbital skin (heliotrope rash) and symmetrically on the extensor aspect of the elbow and knee, as well as photosensitivity eruption on the face and neck. Biopsy of the skin lesion showed thickening of the granular layer with edema and perivascular lymphocytic infiltration. A clinical diagnosis of dermatomyositis was made despite the absence of muscle weakness. The patient had no other symptoms, but screening for internal malignancy revealed an increased prostate specific antigen (PSA) of 12.4 ng./ml. Needle biopsy confirmed Gleason score 6 adenocarcinoma of the prostate. Staging investigations for prostatic carcinoma confirmed localized cancer (clinical T1cN0M0).The patient was treated with hormone therapy (100 mg. chlormadinone acetate per day) to investigate the link between prostatic carcinoma and dermatomyositis. After 2 months of treatment PSA decreased to 3.0 ng./ml. and the skin lesions improved. Subsequently the patient underwent radical retropubic prostatectomy with bilateral pelvic lymphadenectomy. Pathological examination of the prostate specimen demonstrated moderately differentiated adenocarcinoma with focal extraprostatic extension (Gleason score 6). There was no evidence of involvement of the seminal vesicles, bladder or lymph nodes. PSA immediately decreased to less than 0.2 ng./ml. and the dermatomyositis completely resolved. At 12-month followup the patient was well without hormonal therapy.
DISCUSSIONTo date only 3 cases of prostatic carcinoma associated with dermatomyositis have been reported, all of which were advanced disease. 3 Thus, to our knowledge ours is the first documented case of improved dermatomyositis following surgical resection of prostatic carcinoma. Also, in our case dermatomyositis was an early and sole manifestation of cancer. This case illustrates the importance of PSA measurement in patients with dermatomyositis. REFERENCES
Positive HSP60 expression prior to CRT may predict good pathological response to low-dose neoadjuvant CRT in invasive or high-risk superficial bladder cancer.
A 78-year-old woman was presented with bleeding in the region of the genitalia. The tumor arose from the urinary meatus and biopsy was performed. The pathological examination revealed sarcomatoid carcinoma which was composed of squamous cell carcinoma and spindle cell sarcoma. She underwent urethrectomy and suprapubic cystostomy. She is alive at 26-month follow-up, after local radiation therapy of 50 Gy to the recurrence sites.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.