TITLE:
An Unusual Paraneoplastic Syndrome of Synchronous Bladder Tumor and Prostate Cancer: Polymyositis
AUTHORS:
Hüseyin Badem, Mehmet Erol Yildirim, Serife Badem, Özlem Şahin Balçık
KEYWORDS:
Polymyositis, Bladder Tumor, Prostate Cancer, Emg
JOURNAL NAME:
Open Journal of Urology,
Vol.5 No.10,
October
14,
2015
ABSTRACT: Introduction: Polymyositis (PM) is a type
of inflammatory myopathy that is associated with a broad range of malignant
disorders. An association of PM with synchronous carcinoma of the bladder and
prostate is extremely rare. Case: A 65-year-old man admitted to hematology with
complaints of severe progressive weakness of lower extremities, hematuria and
irritative urinary symptoms lasting for a month. The hemogram and erythrocyte
sedimentation rate were normal. ALT was normal but AST was 405.56 U/l. There was
marked elevation of serum creatine kinase (CK) and lactate dehydrogenase, which
were 14,065.15 U/l and 1267.50 U/l, respectively. PSA was 4.28 and DRE was
positive. The abdominal ultrasound revealed a 24 × 20 mm soft tissue
echogenicity lesion at the right wall and a 35 × 21 mm soft tissue echogenicity
lesion at the left wall of the bladder. The rest of the abdominal viscera were
normal. Computed tomography found, two 6 mm solid lesions at left anterolateral
and a 18 × 12 mm solid lesion at inferoanterior bladder wall in addition to the
above findings. Patient counseled to us. We resected all of the bladder masses
with transurethral (TUR-BT) way and pathology revealed T2 high grade bladder
tumor. Two days after TUR-BT, we performed a trans rectal ultrasonography
guided prostate biopsy and pathology revealed a Gleason 3 + 4 prostate cancer.
EMG showed sensorimotor polyneuropathy at the lower extremities, sustaining
polymyozitis. Biopsy of the right peroneus brevis muscle showed no vasculitis
with low grade neurologic changes. We offered to perform a radical
cystoprostatectomy operation but the patient prefered chemotherapy. Two months
after his initial presentation at the second cure of the chemotherapy all
muscle weaknesses showed a dramatic regression. Conclusion: This case report
indicates that both bladder carcinoma and prostate cancer should be kept in
mind in elderly PM patients presenting with lower urinary tract symptoms and
hematuria.