Hormone replacement treatment and benign intracranial hypertension.
Authors: J P Sheehan
Journal: BMJ (1982)

patients whose carcinomas responded completely or partially to tamoxifen and who developed dermatomyositis or polymyositis within three months of tumour regression. Case reportsDermatomyositis, polymyositis, or polymyositis-systemic sclerosis over- lap syndrome were diagnosed as definite by the criteria of Bohan et al.2 Results of investigations are shown in the table.In all our cases muscle biopsies gave results compatible with inflammatory polymyositis and tumour recurrences were confirmed histologically.Case 1-A 50-year-old woman had a left mastectomy in 1972.In September 1976 she developed a mass in the right supraclavicular fossa and enlarged mediastinal nodes.The recurrent tumour responded completely to radio- therapy and six courses of combination chemotherapy.In June 1979 tumour recurred in the left supraclavicular fossa.Tamoxifen 10 mg twice daily was started, and by August the nodes had completely regressed but she had developed muscle aches and stiffness.In September she had swelling of both arms, proximal muscle weakness, and the characteristic rash of dermatomyo- sitis.She was treated with prednisolone 60 mg daily and tamoxifen was stop- ped.Dermatomyositis progressed rapidly, however, and she died.Necropsy showed bronchopneumonia and dermatomyositis but no evidence of carci- noma of the breast.Case 2-A 46-year-old woman had a right lumpectomy and postoperative radiotherapy for breast carcinoma in 1973.In April 1977 she had a right axillary recurrence.Tamoxifen 10 mg twice daily was given and the nodes regressed completely, but over the next three months she developed general muscle weakness, dysphagia, Raynaud's phenomenon, and increased skin pigmentation and induration.Tamoxifen was stopped in January 1979.The weakness improved after three weeks but progressed again when tamoxifen was restarted.Tamoxifen was again stopped, but the weakness did not improve.In July a tumour recurrence in the right breast was excised.She developed perioral telangiectasia.In October she was treated with prednisolone 30 mg daily and methotrexate 15 mg by mouth weekly.Her strength gradually improved.Case 3-A 60-year-old woman presented in September 1979 with a mass in the left supraclavicular fossa.Biopsy showed a poorly differentiated mucus- secreting adenocarcinoma.Chest radiography showed probable secondary deposits in the left lower lobe.Tamoxifen 10 mg twice daily was given for presumed secondary carcinoma from an undetected breast primary.By January the nodes had partially regressed (from 4 x 3 to 2 X 2 cm), with no change on the chest x-ray picture.Three months later she developed aches in her knees, elbows, and hands.In July she had a scaly pruritic rash on her fingers and aches in her thighs.In September she had dysphagia, proximal muscle weakness, cardiomegaly with left bundle-branch block, and the characteristic rash of dermatomyositis.Tamoxifen was stopped.She was given prednisolone 60 mg/day, with initial improvement in muscle weakness, but she died from progressive dermatomyositis in December.Necropsy showed a necrotic mucus-secreting adenocarcinoma in the lung, but the primary site was unknown.Dermatomyositis was confirmed.