During the patient's hospitalization, ultrasonography showed a solid mass in the left pelvis and a cystic mass in the right adnexal area, and enhanced CT showed cystic lesions in both adnexa with consideration of cystadenocarcinoma. The patient's symptoms improved significantly after treatment with methylprednisolone (40 mg/d for seven days) and immunoglobulin (10 g/d for five days). The myositis-specific autoantibody (MSA) test was positive for the anti-TIF-1 autoantibody. She was admitted to our department, and physical examination showed bilateral cheek erythema as well as grade III muscle strength for the proximal extremities. The symptoms started worsening in the past month with difficulty walking, combing, head lifting, and swallowing. No edema signal was found in the adductors and posterior thigh compartment.Ī 62-year-old postmenopausal female patient with a history of autoimmune hepatitis developed muscle weakness in the proximal limbs for three months. Fascia involvement was also observed. Specifically, the honeycomb/reticular pattern hyperintensity signal was found in the proximal peripheral area of the vastus lateralis (Figures 1A- 1B) with minimum fatty infiltration (Figure 1C). Her thigh muscle MRI (Siemens, 3.0 T unit Munich, Germany) revealed reticular hyperintensity of subcutaneous adipose tissue on T2 fs (T2-weighted fat saturation)/STIR (short time of inversion recovery) sequences (Figures 1A- 1B). With further confirmation by PET/CT, the diagnosis of ovarian cancer was made, and she was transferred to the oncology department for further chemotherapy treatment with cisplatin, endostatin, and paclitaxel liposome. The pathological result of right inguinal lymph node needle biopsy showed metastatic adenocarcinoma with necrosis, and ovarian cancer was first considered. An enhanced CT scan of the chest, abdomen, and pelvis showed multiple significant lymphadenopathies in the right inguinal region and pelvis. No obvious abnormality in the annex area was found with gynecological ultrasound. Thus, further examinations were performed. Her tumor biomarker was elevated (detailed information shown in Table 1).
The patient's muscle strength improved with treatment of intravenous methylprednisolone injection (80 mg/d for five days then 40 mg/d for five days) followed by oral prednisone intake. Physical examination demonstrated Gottron’s sign and heliotrope rash, with grade IV proximal muscle strength.
#Compartments of leg radiology skin#
Case PresentationĪ 63-year-old postmenopausal female admitted to our hospital presented with skin rash and muscle weakness for two months. In this report, we described three DM patients who were diagnosed with ovarian cancer and detailed their thigh muscle MRI findings. To date, no study has analyzed the MRI signals of dermatomyositis patients with cancer. Some typical MRI signals are also predictors of clinical outcomes (for example, subcutaneous fat signals). Typical MRI edema features like subcutaneous and fascial hyperintensity are considered valuable to identify inflammatory myopathies and their phenotypes. monitoring the disease activity and evaluation of treatment response with follow-up scans. differential diagnosis with other types of myopathies, such as congenital myopathy c. The main functions of MRI are as follows: a. Musculoskeletal MRI is a widely used tool in clinical work to provide information ranging from the subcutaneous tissue, fascia, to muscle. The significant relationship between underlying ovarian cancer and dermatomyositis has recently been studied, with a prevalence of 13.3%. As a possible paraneoplastic disorder, DM is correlated with various types of cancer, including gastrointestinal cancer and nasopharyngeal cancer.
Some researchers have even raised the question of cancer as a cause rather than a consequence of autoimmunity. Cancer is one of the major complications of DM that determines the prognosis of patients.
Dermatomyositis (DM) is a rare autoimmune disease characterized by skin lesions, muscle weakness, and other systemic manifestations, with an estimated prevalence rate of 1-6 per 100,000 adults.
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