Epithelioid myxofibrosarcoma developing at the injection site of Adalimumab therapy for psoriatic synovitis

Abstract

The interplay between inflammation and cancer is the subject of intense interest. The recent approvalof a number of checkpoint inhibitors has opened novel therapeutic pathways for several cancers.Conversely, biologic suppressors of inflammation, such as Tumor Necrosis Factor (TNF) inhibitors,have been utilized over the past two decades for the management of chronic inflammatory auto-immune diseases. While the overall rates of malignancy in patients using anti TNF therapies are notelevated, increased risk has been established for cutaneous malignancy, particularly carcinoma. Insubsets of patients, such as those with rheumatoid arthritis, a modestly increased incidence of mela-noma is also documented. Herewith, we present the first reported instance of a sarcoma of the dermisand superficial subcutaneous tissue at the injection site of Adalimumab in a woman being treatedfor psoriatic synovitis. We review the literature and suggest that a more nuanced documentation ofadverse events is needed to clarify the iatrogenic risk of rare cancers, such as soft tissue sarcomas, inpatients taking these biological therapies.