以风湿病症状为突出表现的恶性肿瘤28例临床分析

Clinical Analysis of 28 Cases of Paraneoplastic Rheumatic Syndromes

目的提高对以风湿病症状为首发或突出表现的恶性肿瘤的认识,并结合文献,复习风湿病与恶性肿瘤的相关性.以减少该类恶性肿瘤的漏诊。方法总结28例以风湿病症状为突出表现,拟诊风湿性疾病,但最终确诊为恶性肿瘤患者的临床资料.分析其临床表现、拟诊风湿病类型和罹患肿瘤类型。结果 28例患者中,可见到多种风湿病表现。其中以血管炎居多,为14例(50.0%),未分化结缔组织病3例,皮肌炎、脊柱关节病各2例.系统性红斑狼疮、成人斯蒂尔病、类风湿关节炎、风湿性多肌痛、复发性多软骨炎、缓和性对称性血清阴性滑膜炎伴可凹性水肿、脂膜炎各1例。罹患肿瘤中以血液系统肿瘤居多,为19例(67.9%),其中淋巴瘤11例,白血病5例,多发性骨髓瘤3例;实体瘤共9例(32.1%),包括转移癌2例,肺癌、胰腺癌、鼻咽癌各2例,前列腺癌1例。结论多种恶性肿瘤可出现风湿病表现.对于风湿病难以解释的临床表现、常规治疗效果差者,要警惕恶性肿瘤的可能。

Objective To improve awareness that cancer can cause certain rheumatic symptoms and to avoid misdiagnosis, we retrospectively reviewed paraneoplastic rheumatic syndrome patients in our hospital and discussed the relationship of cancer and rheumatic diseases. Methods Totally 28 patients were admitted to rheumatic ward with suspected rheumatic diseases, and were finally diagnosed as malignant neoplasms. Their rheumatic manifestations and occult malignancies were analyzed. Results A wide variety of rheumatic manifestations were presented tentatively. Among 28 patients, 14 （50.0%） were diagnosed as vasculitis, undifferentiated connective tissue disease 3, dermatomyositis 2, spondyloarthropathies 2, systemic lupus erythematosus 1, adult onset Still＇s disease 1, rheumatoid arthritis 1, polymyalgia rheumatica 1, relapsing polychondritis 1, remitting seronegative symmetrical synovitis with pitting edema syndrome （RS3PE） 1, and panniculitis 1. The associated tumors were： hematological tumors in 19 （67.9%）, lymphoma in 11, leukemia in 5, multiple myeloma in 3. Nine （32.1%） patients were diagnosed as solid tumor, including metastasis tumor 2, lung cancer 2, pancreatic tumor 2, nasopharyngeal cancer 2, and prostate cancer 1. Conclusion Cancer associated rheumatic syndromes can present a variety of rheumatic conditions. An extensive search for occult malignancy in some rheumatic syndromes is recommended when some findings suggest the presence of malignancy.