TNBC, which is a special subtype of breast cancer, has been demonstrated to have a significantly higher risk of recurrence and death compared with luminal subtypes.6 Numerous studies have addressed the classification of TNBC to assist clinical management. Recently, Zhang et al described subnetwork biomarkers of low oncogenic GTPase activity, low ubiquitin/proteasome degradation, effective protection from oxidative damage, and tightly immune response to be linked with better prognosis through integrative analysis of cancer genomics data and protein interactome data.7However, clinical data on TNBC in male patients are limited, and it is still unclear if the major prognostic factors in MBC are the same as those in women. An abstract presented at the 45th Annual Meeting of the American Society of Clinical Oncology in 2010 by Forester reported that male TNBC had a significantly worse prognosis than female TNBC or than other subtypes.8
Principles of treatment for male occult TNBC are similar to those of female breast cancer. Widely used adjuvant chemotherapy in breast cancer for TNBC is more chemosensitive than the HR-positive/HER2-negative phenotype.9 Compared with that of stage and subtype-matched patients, similar outcome was observed in OBC patients, while there was a trend for higher risk of recurrence and mortality in OBC patients with the triple negative subtype.10
DM is an idiopathic inflammatory myopathy associated with proximal muscle weakness and cutaneous findings such as heliotrope rashes, Gottron’s papules, and periungual telangiectasis.11 Laboratory studies show creatine kinase elevation, electrophysiologic abnormalities, and inflammatory lesions on muscle biopsy. DM carries an increased risk of malignancy and can present as a paraneoplastic syndrome to multiple types of underlying malignancies, especially lung and prostate cancers, gastrointestinal tumors in men, and gynecological tumors in women, rarely in MBC. Polymyositis (PM)/DM can precede or present at the same time of or after the onset of malignant tumor development. Most commonly, however, the literature reports that malignant tumors appear >2 years after the onset of PM/DM. The risk of malignancy within the first year after the diagnosis of PM/DM is the highest, then decreases by each year, but remains higher than in the normal population. Therefore, the screening of malignant tumor should be carried out extensively within the first year after the appearance of PM/DM. Andras et al found that with 309 cases of PM/DM analysis,12 among the 37 cases with malignant tumors, the proportion of malignancy and myositis in the first year was 64.8%. Another study from 2003 to 2012, 246 cases of DM was retrospectively reviewed for 10 years. Including 60 cases with malignant tumors, 39 cases (65.0%) occurred 1 year after diagnosis of DM. Malignancies were detected in 13 (21.7%, 13/60) patients during the second year and 8 (13.3%, 8/60) during the third year after DM.13
There is little evidence to guide treatment of DM. Wolff et al reported a rare case of DM with triple negative female breast cancer managed with chemotherapy and injectable adrenocorticotropic hormone agonist without surgery.14 However, the role of neoadjuvant chemotherapy is debatable. Ideally, detection and surgical removal of the malignant tumor yields the best results in improvement of DM. In this case, the patient developed periorbital erythematous papules 3 months before diagnosis of MBC. It is noteworthy that, after surgery, he experienced remarkable improvement in the dermal erythematous papules with gradual recovery of muscle strength without glucocorticoid therapy. These findings strongly confirm the importance of diagnosis and surgical treatment of the underlying malignancy.
The prognosis of DM patients with malignant tumors is poor. The main causes of death are extensive metastasis of tumor, secondary infection, and systemic failure. The overall survival rate of PM/DM patients with malignant tumors is worse than that of other forms of myositis, and prognosis and life expectancy are determined by the underlying malignancies.15
We presented a rare case of male occult TNBC with DM. No conclusion has been drawn regarding current drug therapy, and surgery is still the main treatment.
Our study received approval from the ethics committee of the Second Affiliated Hospital of Dalian Medical University. The patient and family members also provided written informed consent to publish this case report details.
The authors report no conflicts of interest in this work.
Le Zhang,1 Chenghua Zhang,2 Zhaoying Yang,1 Miao He,3Lijuan Zhang,1 Shereen Ezzat,4 Xi Liang5
1Department of Breast Surgery, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China;2Endoscopy Department, Jilin Cancer Hospital, Changchun, Jilin,China; 3Department of Anesthesia, The Second Hospital of Jilin University, Changchun, Jilin, China;4Ontario Cancer Institute and The Endocrine Oncology Site Group, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada; 5Department of Breast Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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Source: Oncotargets and Therapy
Originally published November 14, 2017.