Paraneoplastic syndrome: Difference between revisions

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Revision as of 16:04, 25 June 2019

Paraneoplastic syndrome Microchapters

Patient Information

Overview

Classification

Endocrine
Musculocutaneous
Neurological
Hematological
Others

Causes

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

Overview

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.

Classification

Paraneoplastic syndromes can be divided into 4 main categories:

Causes

Common Causes

The major causes of paraneoplastic syndrome include:

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
Ct scan X-ray U/S
Small cell lung cancer[13][14] Cough Weight loss Dyspnea

Weakness

GI symptoms

Lymphadenopathy Chest Ct Scan: Necrotic and hemorrhagic hilar mass, lymphadenopathy Chest X-ray: hilar mass - Small, round and oval cells. Necrotic Biopsy
Squamous lung cancer[15] Asymptomatic in early onset Chronic cough, dyspnea Weight loss, fatigue, hemoptysis Confused,

lymphadenopathy

Fingers clubbing,

weakness,

Decreased breath sound high Ca++ Chest Ct scan : Ground glass opacity Chest X-ray: Spiculated mass, bulky hilum - Intracellular bridges, central necrosis with cavitation Biopsy
Hepatocellular carcinoma[16][17] Asymptomatic in early onset. Fatigue, abdominal pain, nausea, vomiting, fever Loss of appetite, pruritus, jaundice Jaundice, cachexia, ascites Splenomegaly Prolong PT Increase alpha fetoprotein
  • U/S : small hypoechoic
  • Irregular border with fibrosis, and calcification
  • Polygonal tumor cells
  • Granular eosinophilic cytoplasm
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[18] 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 Biopsy
Renal cancer
pancreatic cancer
Leukemia
Gastric Cancer
lymphoma
Ovarian cancer

References

  1. Cohen PR, Kurzrock R (1997). "Mucocutaneous paraneoplastic syndromes". Semin. Oncol. 24 (3): 334–59. PMID 9208889.
  2. Nervous+system+paraneoplastic+syndromes at the US National Library of Medicine Medical Subject Headings (MeSH)
  3. Didelot A, Honnorat J (November 2009). "Update on paraneoplastic neurological syndromes". Curr Opin Oncol. 21 (6): 566–72. doi:10.1097/CCO.0b013e3283306647. PMID 19620862.
  4. Dalmau J, Tüzün E, Wu HY; et al. (2007). "Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma". Ann. Neurol. 61 (1): 25–36. doi:10.1002/ana.21050. PMC 2430743. PMID 17262855. Unknown parameter |month= ignored (help)
  5. Staszewski H (1997). "Hematological paraneoplastic syndromes". Semin. Oncol. 24 (3): 329–33. PMID 9208888.
  6. Blay JY, Favrot M, Rossi JF, Wijdenes J (October 1993). "Role of interleukin-6 in paraneoplastic thrombocytosis". Blood. 82 (7): 2261–2. PMID 8400277.
  7. Paraneoplastic+endocrine+syndromes at the US National Library of Medicine Medical Subject Headings (MeSH)
  8. Stewart AF (January 2005). "Clinical practice. Hypercalcemia associated with cancer". N. Engl. J. Med. 352 (4): 373–9. doi:10.1056/NEJMcp042806. PMID 15673803.
  9. Spinazzé S, Schrijvers D (April 2006). "Metabolic emergencies". Crit. Rev. Oncol. Hematol. 58 (1): 79–89. doi:10.1016/j.critrevonc.2005.04.004. PMID 16337807.
  10. Raftopoulos H (December 2007). "Diagnosis and management of hyponatremia in cancer patients". Support Care Cancer. 15 (12): 1341–7. doi:10.1007/s00520-007-0309-9. PMID 17701059.
  11. Ellison DH, Berl T (May 2007). "Clinical practice. The syndrome of inappropriate antidiuresis". N. Engl. J. Med. 356 (20): 2064–72. doi:10.1056/NEJMcp066837. PMID 17507705.
  12. Teale JD, Marks V (October 1998). "Glucocorticoid therapy suppresses abnormal secretion of big IGF-II by non-islet cell tumours inducing hypoglycaemia (NICTH)". Clin. Endocrinol. (Oxf). 49 (4): 491–8. PMID 9876347.
  13. NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014
  14. Carter, Brett W.; Glisson, Bonnie S.; Truong, Mylene T.; Erasmus, Jeremy J. (2014). "Small Cell Lung Carcinoma: Staging, Imaging, and Treatment Considerations". RadioGraphics. 34 (6): 1707–1721. doi:10.1148/rg.346140178. ISSN 0271-5333.
  15. Rosado-de-Christenson, M L; Templeton, P A; Moran, C A (1994). "Bronchogenic carcinoma: radiologic-pathologic correlation". RadioGraphics. 14 (2): 429–446. doi:10.1148/radiographics.14.2.8190965. ISSN 0271-5333.
  16. Reynolds, Arich R.; Furlan, Alessandro; Fetzer, David T.; Sasatomi, Eizaburo; Borhani, Amir A.; Heller, Matthew T.; Tublin, Mitchell E. (2015). "Infiltrative Hepatocellular Carcinoma: What Radiologists Need to Know". RadioGraphics. 35 (2): 371–386. doi:10.1148/rg.352140114. ISSN 0271-5333.
  17. Flores, Yvonne N.; Lang, Cathy M.; Salmerón, Jorge; Bastani, Roshan (2011). "Risk Factors for Liver Disease and Associated Knowledge and Practices Among Mexican Adults in the US and Mexico". Journal of Community Health. 37 (2): 403–411. doi:10.1007/s10900-011-9457-4. ISSN 0094-5145.
  18. Mišković, Josip (2016). "DIAGNOSTIC VALUE OF FINE NEEDLE ASPIRATION CYTOLOGY FOR BREAST TUMORS". ACTA CLINICA CROATICA: 625–628. doi:10.20471/acc.2016.55.04.13. ISSN 0353-9466.

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