Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease, which pathogenesis remains elusive. Patients with SLE have a higher overall risk of malignancy than the general population. Herein, we report an original association of SLE with ovarian and thyroid malignancies.
Case report: A 52-year-old woman was followed-up for 13 years in the dermatology department for SLE. Her disease remained stable under hydroxychloroquin with SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) score less than 5. She was diagnosed 2 years earlier with ovarian cancer and treated with total hysterectomy and bilateral adnexectomy followed by chemotherapy. Her last magnetic resonance imaging showed complete remission 6 months earlier. She reported a history of ovarian cancer in her sister, who also had thyroidectomy for hyperthyroidism. On her last medical visit, physical examination revealed enlarged bilateral cervical nodes. Biological tests showed normal levels of thyroid hormone and thyroid stimulating hormone and positivity of anti-nuclear and anti-dsDNA antibodies (respectively 1/800 and 1/37). Thyroid ultrasound revealed a hypoechoic 3×4 mm thyroid nodule with irregular margins located in the middle right pole, graded EU-TIRADS 5. The diagnosis of thyroid cancer associated with SLE was raised. The patient was referred to the department of otolaryngology to undergo thyroidectomy.
Discussion: SLE patients especially females have an increased risk of developing overall malignancies. Immunological abnormality and cumulative exposure to immunosuppressive drugs are possible causes. Chemotherapy for ovarian cancer may have triggered thyroid cancer in our patient, as she was only taking hydroxychloroquin for her SLE. While we did not have histological confirmation of the thyroid cancer, a score of EU-TIRADS 5 indicated that the nodule was very probably malignant (risk >95%). Based on systematic reviews and meta-analysis, SLE has been correlated with increased risk for thyroid cancer. However, low rates of breast cancer susceptibility gene II (BRCA2)-associated malignancies, including ovarian and breast cancers, were observed among SLE patients. To explain this finding, Hansen et al. suggested the possible role of lupus autoantibodies. They even demonstrated the therapeutic potential of cell-penetrating lupus autoantibodies for BRCA2-deficient human cancers. Therefore, a lack of these antibodies in the present case (SLEDAI score <5) may have been related to the onset of ovarian cancer. BRCA2 mutations were not investigated in our patient, but their presence is very probable given the familial history of ovarian cancer.
18 - 21 May 2019
European Society of Endocrinology