Clinical manifestations of vasculitis in patients with solid tumors. A case report and review of the literature.
Vasculitis is characterized by inflammatory changes and necrosis of blood vessels. Involvement of arteries and veins of diverse sizes throughout the body is possible and results in a multiplicity of clinical manifestations. Primary and secondary forms of vasculitis exist. Secondary vasculitis has been linked to several processes, including infections, drugs, and allergic, rheumatologic, and neoplastic disease. The majority of patients with malignant neoplasm-associated vasculitis who have been described had hematologic neoplasms. We report a patient with adenocarcinoma of the colon and vasculitis and review the 36 cases of vasculitis in patients with solid tumors documented in the world literature. The most common malignant neoplasms were non-small-cell lung cancer and prostate, breast, colon, and renal cancer. Cutaneous leukocytoclastic vasculitis and nerve and muscle microvasculitis were the most frequently observed vasculitic subtypes. Importantly, in 71% of the cases, manifestations of vasculitis appeared before or concurrent with the initial recognition or the relapse of the tumor. Management strategies that met with success in at least half the patients in whom they were used included corticosteroids, cyclophosphamide, and treatment of the underlying cancer. Prognosis may be primarily related to the ability to control the malignant neoplasm, as most of the patients who died did so because of tumor progression.
Kurzrock
R
R
Department of Clinical Investigation and Hematology, University of Texas M.D. Anderson Cancer Center, Houston.
Cohen
P R
PR
Markowitz
A
A
D000230:Adenocarcinoma / Q000150:complications; D000328:Adult; D003110:Colonic Neoplasms / Q000150:complications; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications; D009369:Neoplasms / Q000150:complications*; D013997:Time Factors; D014657:Vasculitis / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology