Fliciński J

Familial association of laryngeal, lung, stomach and early-onset breast cancer

This study analyzes the incidence of different types of cancer among 2839 first-degree relatives of 760 consecutive, unselected laryngeal cancer patients, compared with the general population. A statistically significant excess was seen for other cancers of the larynx (SIR: 400), lung (SIR: 135) and stomach (SIR: 271), and early-onset breast cancer (SIR: 287). Familial laryngeal cancer may not be a single site-specific cancer syndrome.

Multiple haemangiomas in a psoriatic arthritis patient treated with cyclosporine.

Cyclosporine (CS) is a widely used immunosuppressive drug. Its administration is related to multiple side- effects, most often gastrointestinal, renal impairment, hypertrichosis and hypertension (1). It can also contribute to neoplastic diseases of the skin (2, 3). Only one case of multiple angiomas related to CS has been reported in the literature (4). We describe here a 35-year-old man with psoriatic arthritis who developed haemangiomas on his upper and lower extremities in the course of CS treatment.CASE REpORtA 35-year-old man developed psoriatic arthritis 2 years after the onset of psoriasis. He was primarily treated with sulphasalazine, 1.0 g twice daily. After a flare-up of arthritis sulphasalazine was replaced with methotrexate, 17.5 mg weekly, and methylpredniso-lone, 5 mg daily. Due to insufficient response, CS was added in gradually increasing doses starting from 2.5mg/kg daily up to 4.0 mg/kg daily when remission of arthritis was achieved and this dose was used as the maintenance dose. During the treatment the patient developed gingival hyperplasia, which resolved after CS dose reduction to 3 mg/kg daily. three years after starting the treatment with CS the patient reported appearance of 2 nodules elevated above the surface of the skin, purple, hard and painless, 5 mm in diameter (Fig. 1). One was localized on his left fore-arm and the other on the right thigh. the former was surgically removed. Histological examination revealed a vascular lesion without any features of malignancy, con-sistent of haemangioma (Fig. 2). During the following 2 months another 8 new nodules (5 mm in diameter on average) appeared on the lower and upper extremities, sparing the head and the trunk. the one that was pre-sent previously grew to 8 mm. As the appearance of the lesions was supposed to be related to CS, this dose was reduced. It did not affect the growth of the lesion, and CS was finally discontinued. The exacerbation of arthritis was thereafter managed by increasing the dose of methylprednisolone and methotrexate. Within the following 3 months, only one new nodule appeared and the ones previously present did not grow. During the following 4 months the nodules got smaller and finally disappeared, leaving small depigmentation areas. In the meantime chest and abdominal imaging studies were performed showing no pathologies. Complete blood count, urinalysis, aminotransferases, creatinine and erythrocyte sedimentation rate were normal during the follow-up period. Since then the nodules have never reappeared and the patient has been well for over 2 years. He is currently treated with methotrexate, 15 mg weekly and methylprednisolone, 4 mg daily. DISCUSSIONCS has no mutagenic effect; however, due to its im-munosuppressive effect it may allow the growth of neoplastic cells (5). there are studies proving that CS has a significant influence on occurrence of skin malig-nancies (2, 3). Only one study has countered this (6). CS is known to cause non-malignant dermatological and

Arteriosclerosis or Vasculitis? Color Duplex Sonography in Giant Cell Arteritis

To the Editor: We followed with great interest the report by Czihal, et al 1 presenting new possibilities of objective, noninvasive diagnostic procedures that remain insufficient in giant cell arteritis (GCA). We would like to share our clinical experiences with arteritic changes in patients with GCA. Sonographic presentations of vasculitis may be mistaken for arteriosclerosis, especially in elderly patients who typically have GCA. That was the case in a patient with mild systemic manifestations and insidious disease onset. A 64-year-old woman presented with carotidynia — a rare manifestation of GCA. Color duplex sonography (CDS) revealed hypoechoic, homogenous, circumferential but not symmetrical bilateral wall thickening involving carotid and internal carotid arteries up to 15 mm from the carotid … Address correspondence to Dr. Milchert; E-mail: marcmilc{at}hotmail.com

High prevalence of anti-beta-2 glycoprotein-I and anti-prothrombin antibodies in adult-onset Still’s disease. Comment on “Portal vein thrombosis in adult-onset Still’s disease: a case report and literature review”

We have followed with great interest case report by Morita et al [1]. In our group of eight patients diagnosed with Adult-onset Still’s disease (AOSD) according to Yamaguchi criteria, we reviewed presence of antiphospholipid antibodies. They were detected in six of eight patients: the most common were anti-prothrombin (anti-PT) followed by anti-beta2 glycoprotein-I antibodies (anti-b2GPI) (Table 1). D-dimer level was elevated in all patients; however, no related thrombosis was diagnosed. Only one patient presented with deep vein thrombosis at the time of AOSD relapse, and one woman had a history of miscarriage, however, not fulfilling current antiphospholipid syndrome classification criteria. Our first reflection was how difficult differential diagnosis of liver disease in AOSD is, as raised serum aminotransferase (AT) level may be associated with high

Chronic Urticaria and Mild Arthritis Associated with Autoimmune Thyroid Disease: Successful Treatment with L-Thyroxine

Sir, Some cases of chronic urticaria, regarded so far as idiopathic, are in fact of autoimmune origin (1). Autoimmune thyroid disease (ATD) is characterized by the presence of anti-thyroid antibodies. Association of chronic urticaria and ATD is well known. Most studies have found a 15–30% prevalence of anti-thyroid antibodies in patients with chronic urticaria (2, 3). There have been some reports of successful treatment with L-thyroxine of either arthritis (4, 5) or autoimmune urticaria (1, 3) associated with ATD, as well as in euthyroid patients (3–5).

Nuclear Pedigree Criteria for the Identification of Individuals Suspected to Be at Risk of an Inherited Predisposition to Gastric Cancer

Renal clear cell carcinomas represent about 3% of all visceral cancers and account for approximately 85% of renal cancers in adults. Environmental and genetic factors are involved in the development of renal cancer. Although to date there are 19 hereditary syndromes described in which renal cell cancer may occur, only four syndromes with an unequivocal genetic predisposition to renal cell carcinoma have been identified: VHL syndrome (mutations in the VHL gene), hereditary clear cell carcinoma (translocations t(3:8), t(2:3)), hereditary papillary carcinoma (mutations in the MET protooncogene) and tuberous sclerosis (mutations in the TSC1 and TSC2 genes). Little is known genetically about the other forms of familial renal cell cancer. Since there is a growing awareness about the necessity of early intervention, clinical criteria have been developed that aid in the identification of hereditary forms of renal cancer. The aim of the current study was to identify minimal inclusion criteria so that nuclear pedigree families can be ascertained for risk assessment and/or kidney tumour screening. The results reveal that inclusion features described herein, such as (a) renal clear cell cancer diagnosed before 55 years of age, and (b) renal clear cell cancer and gastric cancer or lung cancer among first degree relatives, are useful in identifying suspected hereditary clear cell renal cancer patients.