Figure 3: Punch biopsy of the skin extending to the level of the deep reticular dermis with findings consisting of dermatomyositis. The epidermis is ulcerated with associated fibrinoid necrosis, cellular debris, and a chronic inflammatory infiltrate (A). The deep dermis contains increased dermal mucin and a mild perivascular lymphohistiocytic inflammatory infiltrate (B).
CONCLUSION A combination of paraneoplastic syndromes as the presenting signs of recurrent breast cancer has not beenwell documented. Further studies concerning the relationship of recurrent breast cancer with the development of paraneo- plastic syndrome are warranted. REFERENCES 1) Xi L, Wanshou Q, Yong H, et al. Invasive ductal breast cancer associated polymyositis causing respiratory failure. Breast Cancer Res Treat 2011;126:211–214. 2) SandhuN, Zakaria S, DegnimA, et al. Dermatomyositis presenting as a paraneoplastic syndrome due to underlying breast cancer. BMJ Case Reports 2011;doi:10.1136/bcr.10.2010.3416. 3) Primiano G, Plantone D, Sauchelli D, et al. Resolution of Muscle Inflammation After Tumor Removal in a Woman with Paraneoplastic Dermatomyositis. J Rheumatol 2012;39:2359-2360. 4) Hashida H, Honda T, Morimoto H, et al. Breast cancer presenting with the syndrome of inappropriate secretion of antidiuretic hormone after simple mastectomy. Intern Med 2001;40(9)911-4. 5) Andersen MK, Sorensen JB. Development of syndrome of inappropriate secretion of antidiuretic hormone during progression of metastatic disease. Acta Oncol 1997;36:535-537. 6) Howard AC, Laing RW, Hussein FN. Breast carcinoma presenting with inappropriate ADH secretion. Letter. Eur J Cancer 1993;29A:2339. 7) Gupta A, Sasarula S, Rao PV. The syndrome of inappropriate secretion of antidiuretic hormone in a case of carcinoma of the breast. JAPI 1986;34:44-2. 8) Pelosof L, Gerber D. Paraneoplastic Syndromes: An Approach to Diagnosis and Treatment. Mayo Clin Proc . 2010;85(9):838-854. 9) Levine Stuart M. Cancer and myositis: new insights into an old association. Current Opinion in Rheumatology 2006;18:620–624.
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