Letter to the Editor
Primary biliary cholangitis in a patient with metastatic breast cancer
Colangitis biliar primaria en una paciente con cáncer de mama metastásico
Kevin Doello
, María Trinidad Rueda, Víctor Amezcua
Corresponding author
Servicio de Oncología Médica, Hospital Virgen de las Nieves, Granada, Spain
Read
1
Timeswas read the article
0
Total PDF
1
Total HTML
Share statistics
array:24 [ "pii" => "S2387020620306446" "issn" => "23870206" "doi" => "10.1016/j.medcle.2019.10.025" "estado" => "S300" "fechaPublicacion" => "2021-02-12" "aid" => "5055" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2020" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;156:146" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775320300415" "issn" => "00257753" "doi" => "10.1016/j.medcli.2019.10.017" "estado" => "S300" "fechaPublicacion" => "2021-02-12" "aid" => "5055" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;156:146" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Colangitis biliar primaria en una paciente con cáncer de mama metastásico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "146" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Primary biliary cholangitis in a patient with metastatic breast cancer" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Kevin Doello, María Trinidad Rueda, Víctor Amezcua" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Kevin" "apellidos" => "Doello" ] 1 => array:2 [ "nombre" => "María Trinidad" "apellidos" => "Rueda" ] 2 => array:2 [ "nombre" => "Víctor" "apellidos" => "Amezcua" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020620306446" "doi" => "10.1016/j.medcle.2019.10.025" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620306446?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320300415?idApp=UINPBA00004N" "url" => "/00257753/0000015600000003/v1_202101240617/S0025775320300415/v1_202101240617/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020620306434" "issn" => "23870206" "doi" => "10.1016/j.medcle.2019.10.024" "estado" => "S300" "fechaPublicacion" => "2021-02-12" "aid" => "5054" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;156:147" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Oroya fever and autoimmune hemolytic anemia, coexistence or complication?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "147" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fiebre de la Oroya y anemia hemolítica autoinmune: ¿coexistencia o complicación?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gino Patrón-Ordóñez, Luis Alberto Cano-Cárdenas" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Gino" "apellidos" => "Patrón-Ordóñez" ] 1 => array:2 [ "nombre" => "Luis Alberto" "apellidos" => "Cano-Cárdenas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775320300403" "doi" => "10.1016/j.medcli.2019.10.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320300403?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620306434?idApp=UINPBA00004N" "url" => "/23870206/0000015600000003/v1_202102051000/S2387020620306434/v1_202102051000/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2387020620306550" "issn" => "23870206" "doi" => "10.1016/j.medcle.2019.10.027" "estado" => "S300" "fechaPublicacion" => "2021-02-12" "aid" => "5056" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;156:144-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Acute isolated appendicitis caused by aspergillus in a patient suffering from severe aplastic anemia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "144" "paginaFinal" => "146" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Apendicitis aislada aguda causada por aspergillus en un paciente con anemia aplásica grave" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1696 "Ancho" => 1000 "Tamanyo" => 347806 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Aspergilus colonies in the appendix were observed by Histological examination. (a) Hematoxylin and eosin(H & E) staining showed fungal spores(arrows). (b) Periodic acid–Schiff (PAS) staining revealed fungal hyphae with acute-angle branching (arrows). (c) Gomori methenamine silver (GMS) staining showed fungal spores (arrows).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Yaoying Long, Lin Liu, Xiaoqiong Tang" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Yaoying" "apellidos" => "Long" ] 1 => array:2 [ "nombre" => "Lin" "apellidos" => "Liu" ] 2 => array:2 [ "nombre" => "Xiaoqiong" "apellidos" => "Tang" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620306550?idApp=UINPBA00004N" "url" => "/23870206/0000015600000003/v1_202102051000/S2387020620306550/v1_202102051000/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Primary biliary cholangitis in a patient with metastatic breast cancer" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "146" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Kevin Doello, María Trinidad Rueda, Víctor Amezcua" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Kevin" "apellidos" => "Doello" "email" => array:1 [ 0 => "kevindoello@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "María Trinidad" "apellidos" => "Rueda" ] 2 => array:2 [ "nombre" => "Víctor" "apellidos" => "Amezcua" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oncología Médica, Hospital Virgen de las Nieves, Granada, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Colangitis biliar primaria en una paciente con cáncer de mama metastásico" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Primary biliary cholangitis (PBC) is a liver autoimmune disease characterized by laboratory (increased ALP and GGT) and clinical (pruritus, acholia and choluria) signs of cholestasis and positive for anti-mitochondrial antibodies in titers greater than 1/40. Drugs such as ursodeoxycholic acid and cholestyramine resin are often used in its management, and some cases are considered for liver transplantation.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Cases have been described in which this disease has preceded the diagnosis of breast cancer, proposing it as a possible paraneoplastic syndrome. However, there is no reported case of onset in the course of breast cancer. Next, we report a case of PBC diagnosed during treatment for metastatic breast cancer.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 50-year-old woman diagnosed with triple negative metastatic breast cancer with liver involvement. In July 2018, she began with symptoms of acholia, choluria, and elevated cholestasis enzymes. Coinciding with this phenomenon, a metastatic tumour progression was observed in the liver, for which these symptoms were attributed to her underlying cancer disease. Treatment with Xeloda® (capecitabine) 1000 mg/m<span class="elsevierStyleSup">2</span>/every 12 h was initiated. At 3 months, a re-evaluation CT scan was performed, which indicated that the patient was in partial response, so she continued with the treatment. In January 2019, the patient suffered an episode of hematemesis, undergoing an upper digestive endoscopy in which oesophageal varices were observed. The patient was admitted to the ward and an abdominal CT scan was performed considering portal hypertension associated with tumour progression. However, the CT scan showed a partial response to focal liver lesions and intense cirrhotic changes along with oesophageal varices. As there was no clear explanation for this fact, a complete liver disease study was requested including serologies for hepatitis B and C, and a full autoimmunity study. Finally, positive results for anti-mitochondrial antibodies (AMA) were obtained at a titre of 1/80. For this reason, treatment with nadolol, ursodeoxycholic acid, fenofibrate and cholestyramine resin was initiated, despite which hematemesis persisted. However, due to the poor general condition of the patient and the frequent upper gastrointestinal bleeding as a result of oesophageal varices, together with her advanced cancer and liver disease, band ligation was ruled out and comfort measures were initiated, and the patient died after 48 h.</p><p id="par0015" class="elsevierStylePara elsevierViewall">According to Martín-Scapa and Cano<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> the PBC criteria are 3: AMA titers greater than 1/40, an increase in ALP of 2–10 times the normal value for at least 6 months, and compatible histology. The diagnosis is accepted with 2 out of 3 of the above criteria. Our patient only met the first 2 criteria since a liver biopsy was not performed due to her general condition. Still, these criteria would indicate the diagnosis of PBC.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Regarding the relationship between PBC and cancer, Liang et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> published a meta-analysis in which they analysed the previous diagnosis of PBC and the risk of developing cancer. They obtained an increased risk of cancer for PBC patients (relative risk 1.55), mainly at the expense of liver cancer (relative risk 18.80), although tumours from other locations (breast, colon, pancreas, etc.) were also included. If we focus solely on breast cancer, Wolke et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> showed that patients with PBC had an incidence 4.4 times higher than the population without PBC. For this reason, some authors argue that PBC could be a paraneoplastic phenomenon prior to the clinical occurrence of breast cancer.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The case discuss would have a peculiarity, since it would be the first case of PBC diagnosed during the treatment of a metastatic breast cancer. All the cases described to date have been prior to cancer. This case makes us think that probably, and as some authors claim, PBC could be a paraneoplastic phenomenon associated with breast cancer.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Doello K, Rueda MT, Amezcua V. Colangitis biliar primaria en una paciente con cáncer de mama metastásico. Med Clin (Barc). 2021;156:146–146.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cirrosis biliar primaria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.A. Martín-Scapa" 1 => "A. Cano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4321/s1130-01082007000600011" "Revista" => array:5 [ "tituloSerie" => "Rev Esp Enferm Dig." "fecha" => "2007" "volumen" => "99" "paginaInicial" => "358" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17896435" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary biliary cirrhosis and cancer risk: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y. Liang" 1 => "Z. Yang" 2 => "R. Zhong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.25788" "Revista" => array:6 [ "tituloSerie" => "Hepatology." "fecha" => "2012" "volumen" => "56" "paginaInicial" => "1409" "paginaFinal" => "1417" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22504852" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malignancy in primary biliary cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Wolke" 1 => "F. Schaffner" 2 => "B. Kapelman" 3 => "H. Sacks" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0002-9343(84)90861-1" "Revista" => array:6 [ "tituloSerie" => "Am J Med." "fecha" => "1984" "volumen" => "76" "paginaInicial" => "1075" "paginaFinal" => "1078" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6145354" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary biliary cirrhosis in patients with breast cancer: studying the link" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "N. Bergasa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0306-9877(98)90263-8" "Revista" => array:6 [ "tituloSerie" => "Med Hypotheses." "fecha" => "1998" "volumen" => "50" "paginaInicial" => "465" "paginaFinal" => "472" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9710316" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015600000003/v1_202102051000/S2387020620306446/v1_202102051000/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015600000003/v1_202102051000/S2387020620306446/v1_202102051000/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620306446?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
