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

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50 mg·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。

A case report of breast cancer complicated with thyroid cancer and dermatomyositis and literature review about relationships between three kinds of diseases

Objective:To provide clinicians with insights about the patients with breast cancer complicated with thyroid cancer and dermatomyositis,and to improve early detection of the diseases by observing the clinical characteristics of 1 case of breast cancer complicated with thyroid cancer and dermatomyositis and reviewing the literatures about the relationships between these three kinds of diseases.Methods:The medical information of this patient,including gender,age,clinical manifestations,glucocorticoid treatment dose,type of concurrent tumor and the time point it occured and therapeutic regimen were collected and recorded.These clinical data were retrospectively analyzed.Results:The patient with dermatomyositis was diagnosed with breast cancer and thyroid cancer in succession.Oral administration of 50 mg dexamethasone per day was continued in the treatment of dermatomyositis.Then the patient received 4 cycles of pirarubicin/cyclophosphamide (AC) followed by 4 cycles of paclitaxel/Hessaitin (TH) as neoadjuvant chemotherapy for breast cancer.During the 24 weeks of chemotherapy,the breast tumor size was gradually decreased while there was no significant change in thyroid tumor size.The clinical symptoms of dermatomyositis were also improved.The blood lactic acid dehydrogenase and alpha hydroxybutyrate dehydrogenase levels were decreased,but not obviously.After 8 courses of AC-TH neoadjuvant chemotherapy followed by radical resection of thyroid cancer,there was no significant improvement in the symptoms of dermatomyositis 1 week after operation and the myocardial enzyme levels remained unchanged.Then modified radical mastectomy was performed.The myocardial enzymes were examined again 1 week after the second operation all of them were decreased to the normal levels.The clinical symptoms of dermatomyositis were also improved.Conclusion:Although the relationships between the three diseases is still controversial,the clinical data of the patient and relevant literatures collected in this paper support that breast cancer is associated with thyroid cancer and dermatomyositis is associated with breast cancer,but not thyroid cancer.