Paraneoplastic syndrome

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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:[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
Ct scan X-ray U/S
Small cell lung cancer[16][17] 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[18] Asymptomatic in early onset Chronic cough, dyspnea Weight loss, fatigue, hemoptysis Confused,

lymphadenopathy

Fingers clubbing,

weakness,

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 pain, nausea, vomiting, fever Loss of appetite, pruritus, jaundice Jaundice, cachexia, ascites Splenomegaly Prolong PT ↑ 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[21][22] 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
  • Numerous mitotic figures
  • Pleomorphism
Biopsy
Renal cancer[23][24][25][26] Hematuria,

Flank pain

Weight loss, Anorexia Abdominal mass, fatigue Cachexia, abdominal bruit, palpable abdominal mass Supraclavicular lymphadenopathy High blood pressure, pallor ↑ ca++, polycythemia, ↑ platelets ↑ ALP

↑ LFT

↑ LDH

↑ creatinine, cancer cells in urine cytology Abdominal CT scan: Thickened irregular walls, neoplastic mass Depending on the subtypes. Needle Biopsy
Pancreatic cancer[27][28][29][30] Mid-epigastric pain, nausea, jaundice, 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

↑ LFT

Low albumin and cholesterol Abdominal Ct scan: Pancreatic duct dilation, pancreatic atrophy, obstuction of common bile duct - U/S: hypoechoic mass Nuclei are small and pleomorphic

Granular cytoplasm

Spiral CT scan with contrast
Leukemia
Gastric cancer[31][32][33][34] History of gastric ulcer, early satiety, hematemesis

Diffuse seborrheic keratosis

Weight loss, lost of appetite Dysphagia, abdominal discomfort, Palpable abdominal mass Left supraclavicular lymphadenopathy ↑ CA 19-9

Anemia

Abdominal CT scan: thickened gastric wall

Loss of rugal fold

mucosal irregularity, ulcerative lesion

Endoscopy: Ulcer Irregular tubular structure, minimal stroma, and cellular pleomorphism, nucleus located at the periphery Endoscopy and biopsy Microangiopathic hemolytic anemia

Hypercogulable state

Menbranous nephropathy

Polyarteritis nodosa, Acanthosis nigricans

Lymphoma Weight loss

Abdominal pain

Fever, Fatigue Night sweat Lymphadenopathy, hepatosplenomegaly ↑ ESR

↑ LDH

Ct scan of abdomen, pelvic, and chest: for metastasis to distant organs. It depends on the type of lymphoma Biopsy
Ovarian cancer[35][36] Asymptomatic in early onset, unexplained thromboses Abdominal pain, bloating, distended Early satiety, increase of urinary frequency and urgency Palpable adnexal mass, ascites, pleural effusion Legs swelling and tenderness Diminish breath sound from the effusion ↑ CA-125 and Ca++ - - Pelvic U/S: Solid irregular mass, irregular thick septation Abdominal Ct scan: findings depend on the subtypes - Nuclear pleomorphism, macronucleolus, eccentric nucleus, psammoma bodies, necrosis - Trousseau syndrome

References

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