Paraneoplastic syndrome

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Differential diagnosis



Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2]

Synonyms and Keywords: Paraneoplastic syndrome


A paraneoplastic syndrome is a disease or symptom that is the consequence of the presence of cancer in the body, but is not due to the local presence of cancer cells. These phenomena are mediated by humoral factors (by hormones or cytokines) excreted by tumor cells or by an immune response against the tumor. Sometimes the symptoms of paraneoplastic syndromes show even before the diagnosis of a malignancy. The stage and type of the diagnosis of the cancer determine the prognosis of a paraneoplastic syndrome. The are no cures for paraneoplastic syndrome, but cancer treatment and some medications to reduce autoimmune responses are helpful.


Paraneoplastic syndromes may be classified into 4 main categories:


Common Causes

The major causes of paraneoplastic syndrome include:[13][14][15]

Causes by Organ System

Dermatologic Dermatomyositis, Cutaneous T-cell lymphoma
Ear Nose Throat Oropharyngeal cancer
Endocrine Medullary thyroid cancer, Adrenal cancer
Gastroenterologic Pancreatic cancer, Other GI cancers
Hematologic Myeloproliferative disorders, Myeloma, Melanoma, Lymphoma, HTLV-associated Lymphoma, Hodgkin's lymphoma, Chronic lymphocytic leukemia, Cancers of the T-cells , Adult T-cell leukemia, Acute myeloid leukemia,
Musculoskeletal/Orthopedic Teratoma, Sarcomas, Ewing sarcoma
Neurologic Brain Cancer
Obstetric/Gynecologic ovarian cancer, Endometrial cancer
Oncologic Breast cancer
Pulmonary Small cell lung cancer, Pancoast's tumour, Oat cell carcinoma, Non-small cell lung cancer, Malignant Mesothelioma, Bronchial carcinoid
Renal/Electrolyte Kidney cancer
Rheumatology/Immunology/Allergy No underlying causes
Urologic Ureteral cancer, Prostate cancer, Bladder cancer
Miscellaneous Thymoma, Testicular germ-cell tumors

Differential diagnosis

Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]

On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Small cell lung cancer[16][17] Cough


Weight loss



GI symptoms



Decrease air entry in the lungs

Digital clubbing

Bone tenderness Ca++ Hyponatremia - Chest Ct Scan: Necrotic and hemorrhagic hilar mass, Lymphadenopathy Chest X-ray: hilar mass - Small, round and oval cells.


Squamous lung cancer[18] Asymptomatic in early onset Chronic CoughDyspnea Weight lossFatigue, hemoptysis Confused,


Fingers clubbing


Decreased breath sound - Ca++ - - Chest Ct scan : Ground glass opacity Chest X-ray: Spiculated Mass, bulky hilum - Intracellular bridges, central necrosis with cavitation Biopsy
Hepatocellular carcinoma[19][20] Asymptomatic in early onset. Fatigue, Abdominal painNauseaVomitingFever Loss of appetitePruritus Jaundice Jaundice



Splenomegaly - Prolong PT alpha fetoprotein - - - Biopsy -
Diseases Symptom 1 Symptom 2 Symptom 3 Physical exam 1 Physical exam 2 Physical exam 3 Lab 1 Lab 2 Lab 3 Imaging 1 Imaging 2 Imaging 3 Histopathology Gold standard Additional findings
Breast cancer[21][22][23] Lump in the breast

Nipple discharge

Bone pain Weight loss Loss of appetite Shortness of breath Enlarged Supraclavicular lymph nodes Dimpling of skin Inverted nipples Bloody nipple discharge, Change in personality - - - Mammogram: Soft tissue mass


- - Biopsy
Renal cancer[24][25][26][27] Hematuria

Flank pain

Weight loss


Abdominal mass Fatigue Cachexia

Abdominal bruit Palpable abdominal mass

Supraclavicular lymphadenopathy High blood pressure


ca++ Polycythemiaplatelets ALP



creatininecancer cells in urine cytology Abdominal CT scan: Thickened irregular walls, neoplastic mass - - Depending on the subtypes. Needle Biopsy
Pancreatic cancer[28][29][30][31] Mid-epigastric pain


Dark urine

Weight loss Abdominal pain Anorexia Greasy stools Asthenia Cachexia

Migratory superficial thrombophlebitis on the skin

Abdominal distention and tenderness

Left Supraclavicular lymphadenopathy

Palpable periumbilical mass bilirubin ALP


Low albumin and cholesterol Abdominal Ct scan:

Pancreatic duct dilation

Pancreatic atrophy Obstruction of common bile duct

- U/S: hypoechoic mass Small nuclei Pleomorphism

Granular cytoplasm

Spiral CT scan with contrast
Gastric cancer[32][33][34][35] History of gastric ulcer Early satiety Hematemesis

Weight loss

Loss of appetite


Abdominal discomfort

Palpable abdominal mass Left supraclavicular lymphadenopathy - CA 19-9


- - Abdominal CT scan:

Thickened gastric wall

Loss of rugal fold

Mucosal irregularity Ulcerative lesion

- Endoscopy: Ulcer Irregular tubular structure

Minimal stroma and cellular


Nucleus located at the periphery

Endoscopy and biopsy Microangiopathic hemolytic anemia

Hypercogulable state

Menbranous nephropathy

Polyarteritis nodosa

Acanthosis nigricans

Lymphoma[36][37] Weight loss

Abdominal pain



Night sweat Lymphadenopathy


- - ESR


- - Ct scan of abdomen, pelvic, and chest: for metastasis to distant organs. - - It depends on the type of lymphoma Biopsy
Ovarian cancer[38][39] Asymptomatic in early onset Unexplained thromboses Abdominal pain

Bloating distended

Early satiety

Increase of urinary frequency and urgency

Palpable adnexal mass


Pleural effusion

Legs swelling and tenderness Diminish breath sound from the effusion CA-125


- - Pelvic U/S: Solid irregular mass, irregular thick septation Abdominal Ct scan: findings depend on the subtypes - Nuclear pleomorphism Macronucleolus Eccentric nucleus Psammoma bodies


- Trousseausyndrome




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