Dermatomyositis and acquired ichthyosis as paraneoplastic manifestations of ovarian tumor

Case 1 A 37‐year‐old white woman was seen at the Dermatology Clinic presenting muscle weakness of the pelvic and scapular girdles, as well as a violaceous erythema and periorbital infiltration (heliotropium) and erythematous‐violaceous lesions on the dorsum of the finger joints, with periungual telangiectasia. A diagnosis of dermatomyositis was confirmed and treatment with prednisone, 1 mg/kg per day, was started, with improvement. One year and two months later she presented ascites, bilateral pleural effusion, and a 7‐kg weight loss. Cytology of the ascitic fluid revealed cells compatible with adenocarclnoma. Exploratory laparotomy demonstrated peritoneal carcinomatosis, and an implant biopsy confirmed a moderately differentiated adenocarcinoma of the ovary of the endometriold type. The patient died 1 year and 4 months after the diagnosis of dermatomyositis (Fig. 1 and Table 1). Case 2 An 8‐year‐old white girl was seen at the Dermatology Clinic presenting generalized ichthyotic skin of a brovi/nish color, perilabial and palmo‐plantar fissures of 5 months duration, and hair fall. For the last 2 months, she had been presenting daily fever (38°C) and lack of appetite, and had lost 7 kg. Abdominal ultrasound revealed a large pelvic mass (9 × 8 × 7 cm) located in a small basin, with possible right renal invasion, as well as periaortic and pericaval adenomegaly, findings that were later confirmed by computerized tomography. Radiologic examinations of the thorax, skull, spine, and long bones were normal. Exploratory laparotomy confirmed the presence of a dysgerminoma of the right ovary as determined by biopsy (Fig. 2). Chemotherapy was started (carboplatin, bleomycin, and vinblastine) and an abdominal ultrasound taken 1 5 days later showed a 67.5% reduction of the pelvic mass, as well as reduction of rectoperitoneal adenomegaly.