Cancer Res Treat.  2016 Apr;48(2):848-852. 10.4143/crt.2014.310.

Dermatomyositis in a Patient with Cholangiocarcinoma Detected by an [18F]-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Scan

• Suh KJ
• Park JK
• Cho S
• Park H
• Baek HW
• Lee K
• Lee DS
• Lee KH

• KMID: 2454365
• DOI: http://doi.org/10.4143/crt.2014.310

Abstract

Cholangiocarcinoma with paraneoplastic dermatomyositis (DM) is extremely rare, and the whole body positron emission tomography-computed tomography (PET-CT) finding of paraneoplastic DM is rarely reported. We report a 66-year-old woman with metastatic cholangiocarcinoma, initially presented with bilateral proximal muscle uptake on PET-CT without clinical muscle symptoms. The initial interpretation of the high muscle uptake was metastasis to the muscles. However, while awaiting for chemotherapy, muscle weakness evolved and rapidly progressed. The level of creatine phosphokinase was significantly elevated. Electromyography revealed moderate myopathy, and a muscle biopsy showed degenerating myofibers with variable sizes. The diagnosis of paraneoplastic dermatomyositis was made. This case highlights that, although rare, paraneoplastic dermatomyositis can be present with cholangiocarcinoma. Also, muscle inflammation can precede the clinical muscle symptoms, and paraneoplastic DM should be considered as a possible differential diagnosis in the assessment of cancer patients who present with abnormal muscle tracer uptake in PET-CT scans.

Keyword

Dermatomyositis; Cholangiocarcinoma; Positron-emission tomography

MeSH Terms

Aged
Biopsy
Cholangiocarcinoma*
Creatine Kinase
Dermatomyositis*
Diagnosis
Diagnosis, Differential
Drug Therapy
Electromyography
Electrons*
Female
Humans
Inflammation
Muscle Weakness
Muscles
Muscular Diseases
Neoplasm Metastasis
Positron-Emission Tomography
Creatine Kinase

Figure

• 

  Fig. 1. Photomicrographs of the liver biopsy. (A) The liver biopsy indicated adenocarcinoma (H&E staining, ×100). (B) The tumor cells were positive for cytokeratin 19 (×200).

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  Fig. 2. Representative [18F]-fluorodeoxyglucose (FDG) positron emission tomography–computed tomography (PET-CT) images of the patient. Whole-body PET-CT was performed using FDG, scanning started 60 to 90 minutes after tracer injection, and images obtained in transverse, coronal, and sagittal planes were reconstructed. (A) Baseline maximum intensity projection (MIP) image. (B) MIP image after two cycles of chemotherapy.

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  Fig. 3. Results of baseline and post-treatment examinations. (A) Baseline whole-body [18F]-fluorodeoxyglucose (FDG) positron emission tomography–computed tomography (PET-CT) scan showed diffuse increased uptake in the proximal muscle groups, including the shoulders, upper arms, back, hips, and thighs, in addition to both of the hepatic lobes, lymph nodes, lung, peritoneum, and L3 vertebra. (B) Whole body FDG PET-CT scan after two cycles of chemotherapy demonstrated a marked reduction in cancer burden and muscle uptake.

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  Fig. 4. Photomicrograph of muscle biopsy. Atrophic myofibers and degenerating and regenerating myofibers of variable sizes are shown (H&E staining, ×400). There was no evidence of vasculitis or tumor cell infiltrates.

Reference

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