類風濕性關節炎病患接受抗腫瘤壞死因子治療後發現轉移性腺癌

Metastatic Adenocarcinoma in a Patient with Rheumatoid Arthritis after Anti-Tumor Necrosis Factor α Therapy

ㄧ位65歲女性病患經診斷為類風濕性關節炎多年後，經過評估後接受抗腫瘤壞死因子治療。在第一次接受抗腫瘤壞死因子24次治療時，並無重大感染或任何嚴重副作用出現。第二次接受抗腫瘤因子治療時，右臀骨疼痛加劇，X 光發現在腸骨有溶骨性病灶。右臀骨切片病理檢查發現為轉移性腺癌，經過一系列檢查後，胸部電腦斷層發現右上肺葉塌陷，正子斷層造影發現右上肺葉葡萄糖攝取量增加，懷疑是右肺有惡性腫瘤。病人因此停止注射抗腫瘤壞死因子，接受化學和放射治療。類風濕性關節炎接受抗腫瘤壞死因子治療後發現轉移性腺癌，癌症和接受抗腫瘤壞死因子治療以及類風濕性關節炎之間的關係為何，值得進ㄧ步研究。

The relationship between the anti-tumor necrosis factor alpha (anti-TNF α) agents and malignancies remains unresolved. A 65 year-old female was diagnosed with rheumatoid arthritis for 8 years. She received anti-TNF α therapy with a course of 24 vials since Sep. 2003. No significant side effects including serious infection were found during the first course of treatment. She started to receive a second course of Enbrel from 2005. Unfortunately, right hip pain developed in Aug. 2005 despite the treatment. Osteolytic lesions over acetabulum and ischium area were found by x ray. Abdominal CT scan showed multiple osteolytic changes over bilateral pelvic bones. Chest CT scan revealed segmental atelectasis in right upper lung. Right hip bone biopsy revealed metastatic adenocarcinoma. Positron emission tomography showed increased uptake in right upper lung. The relationship between the anti-TNF α agents and malignancies will be discussed.