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The Mediastinum (including pre-and para-spinal lines, neural tumours, and pneumomediastinum).
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Thymic carcinoma - is an uncommon tumour of the thymic epithelium; it is aggressive with both local spread and distant metastases, and has a poor prognosis. It may contain areas of necrosis, haemorrhage calcification and cyst formation. Paraneoplastic syndromes are uncommon. One case the author saw was of a young black West Indian athlete with a large irregular anterior mediastinal mass and multiple lung deposits (he was sent by his GP for chest radiography as persistent cough following 'flu).
Answers
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Paraneoplastic syndromes that may occur with lung cancer include: Hypercalcaemia (due to ↑ PTHrP secretion in squamous cell lung cancer)SIADH (due to ↑ ADH secretion in a small-cell lung cancer)Cushing syndrome (due to ↑ ACTH secretion in a small-cell lung cancer)Lambert–Eaton syndrome (due to antibodies to voltage gated calcium channels in small-cell lung cancer)
Oncological effects on the central nervous system
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Clinical features of a paraneoplastic syndrome include a subacute, relentlessly progressive course, consecutive/simultaneous involvement of different areas of the central and/or peripheral nervous system, and a high individual tumour risk (e.g. smoking, weight loss). In a patient suspected of PNS, a full clinical work-up including neuroimaging is required to exclude other pathologies including metastatic disease, inflammatory disease, or neurodegenerative processes. Subsequent screening for autoantibodies should predict the likelihood of an underlying neoplasm and then the exact diagnostic pathway to identify the autoantibody associated neoplasm. Antibodies against onconeural and/or neuronal cell-surface antigens are present in serum and/or cerebrospinal fluid (CSF) of the majority of patients with paraneoplastic syndromes; in a large European network study of patients with definite paraneoplastic syndromes, around 80% harboured onconeural antibodies (3).
Lambert-Eaton myasthenic syndrome (LEMS) in a patient with lung cancer under treatment with pembrolizumab: a case study
Published in Journal of Chemotherapy, 2023
Jun Ho Lee, Sun Kyung Baek, Jae Joon Han, Hong Jun Kim, Yeon-Ah Lee, Dallah Yoo, Chi Hoon Maeng
Immune checkpoint inhibitors (ICIs), including pembrolizumab, have been widely used for various types of cancer [1]. Blockade of the interaction between PD-1 and programmed death-ligand 1 (PD-L1) prevents tumors from evading immune surveillance [2]. An immune system enhanced by using ICIs often leads to adverse effects termed immune-related adverse events (irAE), including dermatologic, gastrointestinal, hepatic, endocrine, and other less common inflammatory events [1,3,4]. Furthermore, as ICIs have expanded, the reports of adverse effects that were not well known previously are also increasing. Autoimmune diseases, such as autoimmune thyroid disease and myasthenia gravis, have often been reported in patients who treated with ICIs [5,6]. Lambert–Eaton myasthenic syndrome (LEMS) is an uncommon neuromuscular disorder characterized by muscle weakness and autonomic dysfunction. It is better known as a tumor-associated paraneoplastic syndrome that develops at the time of the initial cancer diagnosis. Approximately 60% of cases of LEMS are associated with malignancy, with small cell lung cancer (SCLC) being the most common malignancy [7,8]. Few cases have reported the relationship between LEMS and ICI to date [9–11]. As ICIs have been used in clinical practice for less than 10 years, adverse effects caused by ICI, even very rare adverse events, are worth reporting and studying. Herein, we report a rare case of LEMS presenting as a pembrolizumab-associated irAE.
A systematic review of immune checkpoint inhibitor-related neurological adverse events and association with anti-neuronal autoantibodies
Published in Expert Opinion on Biological Therapy, 2021
Ayesha Salim, G Tapia Rico, A Shaikh, MP Brown
The search revealed 290 articles overall. These were a combination of review articles, systematic reviews, case reports, and case series, which were manually checked for relevance by reading the titles and abstracts by the first author (AS) and peer reviewed by the second author (GTR), articles that were included had solid tumors treated with ICIs, developed neurological irAEs and had autoantibodies. The search included 234 reviews/systematic literature reviews and the remaining 56 articles were case reports. Of the 234 reviews, 202 were excluded based on the following criteria: 10 were repeated, four were written in a foreign language, five were abstracts and three were conference papers. Sixty articles were about general irAEs and discussed safety, tolerability, and management of these adverse events. Fourteen articles concerned rheumatological irAEs whereas 10 included endocrinological adverse events and two described respiratory adverse events. Seven articles were related to hematological adverse events, four with gastroenterological adverse events, and four discussed cardiological adverse events. Two described infectious encephalitis whereas 35 articles discussed MG without ICI therapy and 32 were excluded because of autoimmune neurological syndromes without ICI use. Five articles concerned paraneoplastic syndromes and three remaining articles were related to general oncology and immunomodulatory drugs.
Amelioration of rheumatoid arthritis in a breast cancer patient treated with palbociclib: a case report
Published in Modern Rheumatology Case Reports, 2021
Fumi Murakami, Yoshiya Horimoto, Hideo Shimizu, Kurisu Tada, Ken Yamaji, Naoto Tamura, Mitsue Saito
When considering the clinical condition of this case, we should distinguish this course from paraneoplastic syndrome. Differentiation between RA and paraneoplastic syndrome, among other rheumatic diseases, is important, especially when diagnosing early RA. Paraneoplastic syndrome is not caused directly by the tumour or metastases, but is mediated by hormones and cytokines produced by the tumour, and a cellular or humoral immune response to the tumour, therefore, often occur at regions distant from the underlying tumour [9]. When distinguishing RA from paraneoplastic syndrome, consideration is given to whether or not the joint symptoms are alleviated by treating the malignant tumour. Generally, if symptoms were relieved by treatment of a malignant tumour, it would be interpreted as paraneoplastic syndrome. In the present case, the patient had RA for more than 20 years, and two points are important: (1) determination of whether worsening RA or joint symptoms was due to paraneoplastic syndrome, and (2) determination of whether the improvement of arthritis was by CDK4/6 inhibitor directly or due to the treatment of the malignant tumour. Regarding the first point, RA was initially diagnosed with polyarticular swelling, joint bone erosion determined by X-ray, and elevated CRP, MMP-3 and rheumatoid factor (anti-CCP antibody was measured later and showed a high titre of over 200).