DERMATOMYOSITIS ASSOCIATED WITH INTRATUBULAR GERM CELL TUMOR AND METASTATIC GERM CELL CANCER

Abstract

The presence of internal malignancy is a specific trigger for some cases of dermatomyositis.' Among such malignancies, testicular tumors seem to be rare.2 We describe a case of a testicular neoplasm associated with dermatomyositis. CASE REPORT A 24-year-old man was diagnosed with dermatomyositis by skin and muscle biopsy (fig. 1). Symptoms did not improve with the administration of predonisolone for 2 months. Physical examination revealed palpable supraclavicular swollen lymph nodes. The pathological specimen of the resected tissue showed poorly differentiated adenocarcinoma. Computerized tomography of the abdomen and lungs revealed multiple para-aortic lymph node and lung metastases. Serum neuron-specific enolase was 20.3 ng./ml. (normal less than 10) and serum a-fetoprotein was 45.12 ng./ml. (normal 0 to 20). Physical examination revealed a hard 2 cm. nodule in the left testis. Diagnosis was testicular cancer and left orchiectomy was performed. Pathological examination revealed a mature teratoma that was mainly composed of intestinal epithelium and intratubular germ cell tumor (fig. 2). Scar tissue was occasionally present within the tumor. The patient was started on a systemic chemotherapy regimen of 350 mg./m.' carboplatin, 500 mg./m.' etoposide and 54 mg./m.2 bleomycin, which was repeated every 4 weeks for 5 cycles. After the chemotherapy lung and lymph node metastases had completely disappeared and dermatomyositis improved. All treatment for dermatomyositis was discontinued, and the patient has been well without any signs of disease for 29 months after the chemotherapy. DISCUSSION