LONG-TERM GLUCOCORTICOID THERAPY AND THE RAPID DEVELOPMENT OF SQUAMOUS CELL CARCINOMA IN SYSTEMIC SCLEROSIS: IS THERE A CONNECTION?

Broj: 1, 2016 Rubrika: Prikaz bolesnika Autori: Ivona Božić, Dorotea Božić, Marin Petrić, Katarina Borić, Dušanka Martinović Kaliterna

Sistemska skleroza (SSc) autoimunosna je bolest, koju prati rizik od razvoja malignoma, posebice karcinoma pluća, među kojima se prema učestalosti ističu adenokarcinom i planocelularni karcinom. Šezdesettrogodišnja bolesnica sa SSc-om hospitalizirana je zbog nesvjestice, lošeg općeg stanja i gangrenoznih promjena okrajina. Zbog epileptičkih napadaja koji su uslijedili te popratne ljevostrane slabosti učinjena je kompjutorizirana tomografi ja (CT) neurokranija koja je otkrila lezije tipa rasadnica (metastaza). Na CT-u pluća bila je vidljiva novotvorina u desnom hilusu koja je patohistološki evaluirala kao planocelularni karcinom 2. stupnja. Bolesnica je nakon jednomjesečne hospitalizacije uz potpornu terapiju, u klinički poboljšanom stanju, otpuštena na kućnu njegu s preporukom daljnjeg onkološkog liječenja, no nekoliko dana potom je preminula. S obzirom na adenokarcinome, planocelularni karcinomi pluća uobičajeno se razvijaju u znatno dužem razdoblju te držimo da je atipično ubrzan njegov razvoj u ove bolesnice potaknut imunosupresivnim djelovanjem srednje visokih doza glukokortikoida koje je bolesnica samoinicijativno uzimala više godina.

Systemic sclerosis (SSC) is an autoimmune disease associated with the risk of malignancies, especially lung cancer, among which adenocarcinoma and squamous cell carcinoma are the most frequent. A 63-year-old female patient with SSC was hospitalized due to blackouts, poor general condition, and changes in her fi ngers. Because of subsequent epileptic seizures resulting in weakness of the left side of her body, computerized tomography (CT) of the neurocranium was performed which showed metastatic lesions. A CT scan of the thoracic organs displayed pulmonary neoplasia in the right hilum, which were histologically evaluated as grade 2 squamous cell carcinoma. Aft er one month of hospitalization with supportive therapy, the patient’s clinical condition improved, and she was discharged into home care with recommendations for further oncological treatment. However, the patient died several days later. In comparison to adenocarcinomas, squamous cell carcinomas of the lungs usually develop through a signifi cantly longer period. We consider that the unusually rapid development of the carcinoma in this patient was stimulated by the immunosuppressive eff ect of high doses of glucocorticoids that she had been taking for several years on her own initiative.

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