An Unusual Paraneoplastic Syndrome of Synchronous Bladder Tumor and Prostate Cancer: Polymyositis

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.