International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 7(24), December, 2015

Pages: 56-58

Date of Publication: 20-Dec-2015


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VITILIGO ASSOCIATED WITH BREAST CANCER - A REPORT OF TWO CASES

Author: Balasubramanian A., N.S. Kannan

Category: Healthcare

Abstract:Aim: Aim of this study is to report two cases of generalised vitiligo (GV) who developed cancer (CA) breast. Case Report: First case is one of CA right breast with history of GV since three years treated with right modified radical mastectomy. Other one is also a case of CA right breast with history of GV since two years treated with neoadjuvant chemotherapy and radiotherapy and followed by right modified radical mastectomy. The second patient developed fresh area of depigmentation at the site of radiotherapy.
Discussion:
Even though the association of autoimmune disease (AD) and cancer is well known, there are not much of reports in the literature. The association might be incidental/coincidental or cause and effect relationship. The association might also be cancer (CA) developing in a patient of AD or development of AD in a cancer patient during or after treatment. AD may increase the risk of developing CA or reduce the risk. AD may worsen pre-existing CA or may be a sign of CA regression. Both our cases were known patients of GV who developed CA breast. One of them had developed fresh area of vitiligo after radiotherapy in the post mastectomy site. Conclusion: Association between AD and CA is well known for a long time. But many aspects of this association with reference to incidence, exact type of association or background of such association whether genetic, environmental or post therapeutic are still not well understood. Our case reports may incite and add up for further studies on these issues..

Keywords: Autoimmune diseases, Generalised vitiligo, Association

Full Text:

INTRODUCTION

Even though the association of autoimmune disease (AD) and cancer is well known, there are not much of reports in the literature. The association might be incidental/coincidental or cause and effect relationship1 . The association might also be cancer (CA) developing in a patient of AD or development of AD in a cancer patient during or after treatment1-4. AD may increase the risk of developing CA or reduce the risk; AD may worsen pre-existing CA or may be a sign of CA regression5-8. We are reporting two cases of generalised vitiligo (GV) who developed CA breast.

Case details:

Case 1
A 66 years old female presented to our department with complaints of painless swelling in the right breast of 2 months duration. She had generalised vitiligo almost all over the body since three years and on examination, a 6 x 4 cm hard irregular lump was detected in the inner upper and lower quadrants of the right breast without any palpable axillary lymphadenopathy and there was no distant metastasis on evaluation. After necessary work up, right modified radical mastectotomy was done. Postoperative histopathological examination of the specimen was reported as Grade I Infiltrating Ductal Carcinoma and 1 out of 15 lymph nodes positive for metastasis (p T3 N1). The tumour was positive for estrogen and progesterone receptors and negative for Her 2 neu receptor status. There was no history of vitiligo or any cancers in her family (Figure 1).

Case 2
A 44 year old woman, a known case of generalised vitiligo for 2 years presented with locally advanced breast carcinoma on the right side. After clinical and radiologic evaluation and core biopsy confirmation of the diagnosis of infiltrating ductal carcinoma, she was treated with neoadjuvant chemotherapy and radiotherapy followed by right modified radical mastectomy. Patient developed fresh area of depigmentation at the site of radiotherapy (Figure 2). There was no history of vitiligo or any cancers in her family.

DISCUSSION

Evidence suggests that parts of the immune system may generate anticancer responses, while other parts may promote cancer1 . In a state of perpetual activation, immune mediators such as cytokines, chemokines and free radicals, may cause tissue damage leading to chronic inflammation, and subsequently increase the risk of carcinogenesis; other factors affecting immune activity, such as genetic mutations, environmental exposure, and immunomodulatory treatments, may also bolster a carcinogenic environment2-7. Vitiligo is one among the diseases generally considered as autoimmune8 . Generalized vitiligo (GV) is the most common depigmentation disorder, in which acquired multifocal patches of white skin and overlying hair result from loss of melanocytes in the involved areas9,10 1,2. Vitiligo is a chronic disorder with an estimated worldwide prevalence of 0.5–4%11. The prevalence of vitiligo in India has been speculated to vary from 0.1% to >8.8%12. Vitiligo is an acquired hypomelanotic disorder characterized by circumscribed depigmented macules in the skin that result from the loss of functional melanocytes. Vitiligo patches can appear anywhere on the skin but common sites are usually around the body orifices, the genitals, or any sun-exposed areas, such as the face and hands13. Examples of autoimmune disorders associated with development of lymphomas are rheumatoid arthritis, lupus erythematosus, Sjögren’s syndrome, Celiac disease and Hashimoto’s thyroiditis14. There have been several papers published related to cancer other than lymphomas in the ADs including rheumatic diseases, particularly inflammatory arthritis, Sjogren’s syndrome, systemic lupus erythematosus, and scleroderma/ systemic sclerosis15. Incidence of pernicious anaemia and carcinoma stomach associated with vitiligo has also been reported earlier16. The association of GV with malignant melanoma is well documented17. The association of GV with SCC and BCC has been reported earlier18-20. Besides, actinic keratosis and keratoacanthoma centrifugum marginatum have been documented in vitiligo patients21,22. Fresh depigmented lesions in the radiation portals - Koebner’s phenomenon (KP) have however been previously reported in patients with vitiligo who underwent radiation for breast cancer or other cancers23-28. Patients with estrogen receptor - negative breast cancer had a statistically significant better overall survival when they had a history of AD especially among premenopausal patients8 . Both of our patients were known case of GV and have developed cancer breast. One of them developed fresh area of vitiligo after radiotherapy in the post mastectomy site.

CONCLUSION

Association between AD and CA is well known for a long time. But many aspects of this association with reference to incidence, exact type of association or background of such association whether genetic, environmental or post therapeutic (chemotherapy, radiotherapy, hormonal or immuno therapy) are still not well understood. Our case reports may incite and add up for further studies on these issues.

ACKNOWLEDGMENT

Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/ editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.

Source of funding: Nil

Conflict of interest: Authors declare that they do not have any conflict of interest.

References:

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2. Alexandrescu DT, Riordan NH, Ichim TE, Kauffman CL, Kabigting F, Dutton CT, et al. On the missing link between inflammation and cancer. Dermatol Online J. 2011;17:10.

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8. Einefors R, Kogler U, Ellberg C, Olsson H. Autoimmune diseases and hypersensitivities improve the prognosis in ER-negative breast cancer. SpringerPlus 2013;2:357.

9. Taïeb A, Picardo M. Clinical practice: vitiligo. N Engl J Med 2009;360(2):160–9.

10. Birlea SA, Spritz RA, Norris DA: Vitiligo. In Fitzpatrick’s Dermatology in General Medicine. 8th edition. Edited by Wolff K. New York: McGraw-Hill;

11. Forschner T, Buchholtz S, Stockfleth E. Current state of vitiligo therapy-evidence-based analysis of the literature. J Dtsch Dermatol Ges. 2007;5:467–75.

12. Sehgal VN, Srivastava G. Vitiligo: Compendium of clinicoepidemiological features. Indian J Dermatol Venereol Leprol. 2007;73:149–56.

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14. Tai P, Yu E, Joseph K, Miale T. A review of autoimmune diseases associated with cancer. Front Biosci (Elite Ed). 2010;2:122-6.

15. Bernatsky S, Ramsey-Goldman R, Clarke A. Malignancy and autoimmunity. Curr Opin Rheumatol. 2006;18(2):129-34.

16. Wright PD, Venables CW, Dawber RP. Vitiligo and gastric carcinoma. Br Med J. 1970;3:148.

17. Spritz RA. The genetics of generalized vitiligo: autoimmune pathways and an inverse relationship with malignant melanoma. Genome Med. 2010;2(10):78.

18. Dhawan AK, Verma P, Singal A, Sharma S. Squamous cell carcinoma complicating vitiligo in an Indian man. J Cutan Aesthet Surg. 2012;5(1):36-7.

19. Lassus A, Apajalahti A, Blomqvist K, Mustakallio M, Kiistala U. Vitiligo and neoplasms. Acta Derm Venereol. 1972;52:229–32.

20. Ortonne JP, Pelletier N, Chabanon M, Thivolet J. Vitiligo and cutaneous epitheliomas. Ann Dermatol Venereol. 1978;105:1063– 4.

21. Buckley DA, Rogers S. Multiple keratosis and squamous carcinoma after PUVA treatment of vitiligo. Clin Exp Dermatol. 1996;21:43–5.

22. Attili S, Attili VR. Keratoacanthoma centrifugum marginatum arising in vitiligo: A case report. Dermatol Online J. 2006;28:18.

23. Munshi A, Jain S, Budrukkar A, Jalali R, Sarin R. Radiotherapyinduced depigmentation in a patient with breast cancer. Indian J Cancer 2007;44:157-8.

24. Koo SW, Suh CO, Hann SK. Vitiligo following radiotherapy for carcinoma of the breast. Br J Dermatol 1996;135:852-3.

25. Levine EL, Ribeiro GG. Vitiligo and radiotherapy: The Koebner phenomenon demonstrated in patients with vitiligo undergoing radiotherapy for carcinoma of the breast. Clin Oncol (R Coll Radiol) 1994;6:133-4.

26. Weitzen R, Pfeffer R, Mandel M. Benign lesions in cancer patients: Case 3, Vitiligo after radiotherapy for breast cancer in a woman with depigmentation disorder. J Clin Oncol 2005;23:644.

27. Polat M, Yalηin B, Alli N. Vitiligo at the site of radiotherapy for nasopharyngeal carcinoma. Am J Clin Dermatol 2007;8:247-9.

28. Weiss G, Shemer A, Trau H. The Koebner phenomenon: review of the literature. J Eur Acad Dermatol Venereol 2002;16:241-8.

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List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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