皮肌炎合并肾肿瘤2例报告并文献复习

Dermatomyositis with kidney neoplasm:two cases report and literature review

目的探讨皮肌炎合并肾肿瘤的临床诊治特点。方法回顾性分析2022年1—2月华中科技大学同济医学院附属同济医院收治的2例皮肌炎合并肾肿瘤患者的临床资料。例1,女,55岁,因反复双上肢红斑2个月,颜面部红斑1个月入院。查体:双上肢及面部可见红斑,肾区无压痛、叩击痛。肌炎酶谱检查示抗Mi-2抗体和抗SSA/Ro-52抗体阳性。增强CT检查示,右肾可见结节状不均匀强化灶,大小约20 mm×23 mm。例2,女,58岁,因面部红斑3个月,发现左肾占位1个月入院。查体:面部可见片状红斑,肾区无压痛、叩击痛。肌炎酶谱检查示抗Ro-52抗体和抗MDA5抗体阳性。增强CT检查示,左肾明显不均匀强化肿块,大小约为50 mm×41 mm。2例术前均诊断为皮肌炎合并肾肿瘤,均行腹腔镜肾部分切除术。结果2例术后均规律口服泼尼松治疗。例1术后病理示乳头状肾细胞癌;术后1个月面部红斑消退,随访13个月无瘤生存。例2术后病理示肾透明细胞癌;术后2周面部红斑消退,随访12个月无瘤生存。结论皮肌炎的诊断需结合临床表现和实验室检查,重点排除合并恶性肿瘤的可能。对于皮肌炎合并肾肿瘤的患者,主要治疗手段是手术切除肿瘤,同时使用糖皮质激素治疗。

Objective To investigate the clinical characteristics,diagnosis and treatment of dermatomyositis with kidney neoplasm.Methods The data of two patients with dermatomyositis complicated with kidney neoplasm in Tongji Hospital from January to February 2022 were retrospectively analyzed.The first case was a 55-year-old female,who was admitted with the chief complaints of recurrent erythema of upper extremities for 2 months and facial erythema for 1 month.Physical examination:erythema can be seen on upper limbs and face,no tenderness or percussion pain in kidney area.Myositis enzyme profile test showed that anti-Mi-2 antibody and anti-SSA/Ro-52 antibody were positive.Contrast CT showed nodular uneven enhancement in the right kidney with a size of 50 mm×41 mm.The second case was a 58-year-old female,who was admitted with the chief complaints of kidney occupying for a month.Physical examination:flaky erythema on face,no tenderness or percussion pain in kidney area.Myositis enzyme profile test showed that anti-Ro-52 antibody and anti-MDA5 antibody were positive.Contrast CT showed a significantly uneven enhanced mass with a size of about 50 mm×41 mm on left kidney.Both patients were diagnosed with kidney neoplasm before surgery and underwent laparoscopic partial nephrectomy in Tongji Hospital.Results Both patients received regular oral prednisone after surgery.The pathological presentation of case 1 was papillary renal cell carcinoma,the facial erythema subsided 1 month after surgery,and there was no tumor recurrence for 13 months.The pathological presentation of case 2 was clear cell renal cell carcinoma,facial erythema subsided 2 weeks after surgery,and there was no tumor recurrence for 12 months.Conclusions The diagnosis of dermatomyositis should be combined with clinical manifestations and laboratory examination,and the possibility of malignant tumor should be excluded due to the high likelihood of concomitant malignancy.For patients with dermatomyositis with kidney neoplasm,the main treatment is still surgery,and supplemented with glucocorticoid therapy.