皮肌炎與鼻咽癌：一病例報告

Dermatomyositis with Nasopharyngeal Carcinoma: A Case Report

皮肌炎在台灣約有26%的患者並存惡性腫瘤，所涉及的惡性腫瘤以鼻咽癌最具相關。本院經歷一名44歲男性皮肌炎病患。因持續一個月的左側眼睛疼痛、視力變差，複視，左臉麻木感，頭痛及鼻塞等情形於2001年7月住院。電腦斷層掃描發現左側鼻竇腔有病灶顯影，鼻咽部無腫塊。病患接受左側內視鏡鼻竇手術及鼻咽部活體切片。組織病理報告證實鼻咽為分化型未角化上皮癌，左側蝶竇則為慢性鼻竇炎併有局部癌細胞侵犯的情形，最終診斷為鼻咽癌（T4N0M0 stage Ⅳa）。病患經放射治療後六個月無轉移或復發情形。由於皮肌炎併存鼻咽癌在台灣有逐漸增多的趨勢，因此特提出此病例以強調在鼻咽癌盛行地區，凡年齡超過20歲的皮肌炎病人，接受定期詳細的耳鼻喉評估是非常重要的。

In Taiwan, there are about 26% of patients with dermatomyositis combined with a malignancy, and nasopharyngeal carcinoma (NPC) is the most common neoplasm associated with dermatomyositis. A 44-year-old man of dermatomyositis was hospitalized with the complaints about persistent painful sensation with blurred vision on his left eye, diplopia, left side facial numbness, headache and nasal obstruction lasting for one month. The CT scan revealed a left sphenoid sinus lesion and mucosal thickening of the left maxillary sinus. He received endoscopic sinus surgery and nasopharyngeal biopsy. The histopathologic report of nasopharynx was differentiated non-keratinizing squamous cell carcinoma, and that of paranasal sinus was chronic rhinosinusitis with focally invaded by nasopharyngeal carcinoma. The final diagnosis was nasopharyngeal carcinoma, T4N0M0 stage IVa. Six months after the end of radiotherapy, there was no evidence of local extension or metastasis. On account of the increasing intensity of dermatomyositis associated with NPC in Taiwan, this case was reported to enforcing that it is very important to have a detail otorhinolaryngological evaluation regularly for all patients older than 20year-old of dermatomyositis int eh epidemic area of NPC.