Tuberc Respir Dis.  2013 Sep;75(3):111-115.

Multiple Cancers in a Patient with Systemic Sclerosis and Aggravated Interstitial Lung Disease by Chemotherapy

• Park CK
• Lee SJ
• Cho HJ
• Lee KS
• Kim SJ
• Cho GM
• Lee HN

Abstract

Although the relationship between malignancy risk with systemic sclerosis (SSc) has been inconclusive, there are some previous studies for a positive correlation. Most patients with SSc have some degree of lung parenchymal involvement in the form of interstitial thickening and fibrosis. Interstitial lung disease is the most common pulmonary manifestation of SSc. Interstitial lung disease following chemotherapy (5-fluorouracil, leucovorin, and oxaliplatin [FOLFOX]) is an uncommon life-threatening complication and it is induced by oxaliplatin. We report a case of multiple cancers in a patient with SSc and aggravated interstitial lung disease by chemotherapy.

Keyword

Scleroderma, Systemic; Lung Neoplasms; Lung Diseases, Interstitial

MeSH Terms

Fibrosis
Humans
Leucovorin
Lung
Lung Diseases, Interstitial
Lung Neoplasms
Organoplatinum Compounds
Scleroderma, Systemic
Leucovorin
Organoplatinum Compounds

Figure

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  Figure 1 Abdomen and pelvis computed tomography shows about 4.3 cm sized eccentric wall thickening with pericolic infiltration in sigmoid colon.

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  Figure 2 Chest computed tomography shows ground glass opacity and reticular opacities in both lower lobes on admission.

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  Figure 3 Colonoscopy shows about 3 cm sized circumferential ulcerative and fungating mass at anal verge 17-20 cm.

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  Figure 4 Chest computed tomgoraphy shows the interval progression of the ground glass opacity and reticular opacities in both lower lobes after completing 4th 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) chemotherapy.

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  Figure 5 (A) Hematoxylin and eosin stain (×400) shows poorly differentiated adenocarcinoma. Adenocarcinoma staining positive for cytokeratin-7 (CK-7) (B) and thyroid transcription factor-1 (TTF-1, ×400) (C), confirms lung origin. (D) Negative for CDX2 (×400), (E) Negative for CK20 (×400).

Reference

1. Hassoun PM. Lung involvement in systemic sclerosis. Presse Med. 2011; 40(1 Pt 2):e3–e17.

2. Rosenthal AK, McLaughlin JK, Gridley G, Nyren O. Incidence of cancer among patients with systemic sclerosis. Cancer. 1995; 76:910–914.

3. Kang KY, Yim HW, Kim IJ, Yoon JU, Ju JH, Kim HY, et al. Incidence of cancer among patients with systemic sclerosis in Korea: results from a single centre. Scand J Rheumatol. 2009; 38:299–303.

4. Andre T, Boni C, Mounedji-Boudiaf L, Navarro M, Tabernero J, Hickish T, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med. 2004; 350:2343–2351.

5. Jeon HJ, Woo JH, Lee HY, Park KJ, Choi HJ. Adjuvant chemotherapy using the FOLFOX regimen in colon cancer. J Korean Soc Coloproctol. 2011; 27:140–146.

6. Shimura T, Fuse N, Yoshino T, Minashi K, Tahara M, Doi T, et al. Clinical features of interstitial lung disease induced by standard chemotherapy (FOLFOX or FOLFIRI) for colorectal cancer. Ann Oncol. 2010; 21:2005–2010.

7. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, et al. Harrison's principles of internal medicine. 18th ed. New York: McGrow Hill;2012.

8. Steen VD, Medsger TA Jr. Severe organ involvement in systemic sclerosis with diffuse scleroderma. Arthritis Rheum. 2000; 43:2437–2444.

9. Lazarus MN, Robinson D, Mak V, Moller H, Isenberg DA. Incidence of cancer in a cohort of patients with primary Sjogren's syndrome. Rheumatology (Oxford). 2006; 45:1012–1015.

10. Pearson JE, Silman AJ. Risk of cancer in patients with scleroderma. Ann Rheum Dis. 2003; 62:697–699.

11. Siau K, Laversuch CJ, Creamer P, O'Rourke KP. Malignancy in scleroderma patients from south west England: a population-based cohort study. Rheumatol Int. 2011; 31:641–645.