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Systemic Diseases and the Skin
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Jana Kazandjieva, Razvigor Darlenski, Nikolai Tsankov
Overview: Skin markers of malignant diseases may have characteristic skin manifestation, pointing to specific malignant tumors in the internal organs. The recognition of these paraneoplastic syndromes may help in making an earlier diagnosis and even complete elimination of the malignant disease
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
Treatment of paraneoplastic syndromes can be differentiated into treatment of the underlying tumour and immunosuppressive treatment. In PNS with onconeural antibodies, prompt tumour treatment can stabilize symptoms and prevent progression. Elimination of tumour tissue in common paraneoplastic syndromes with onconeural antibodies (e.g. Hu, Yo) has been shown to be beneficial, and standard tumour therapy should be started promptly (9). However, these cases seem to respond poorly to immunotherapy. In comparison to this, the PNSs with neuronal cell-surface antibodies (e.g. anti-NMDA receptor antibody encephalitis), respond well to immunosuppression and tumour removal, even in severely affected patients (4).
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.
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).
A rare case of metastatic small cell neuroendocrine carcinoma of the lung presenting as isolated thrombocytopenia
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Adreana DeMarinis, Fahad Malik, Tommy Matin, Zalmi Rahmany, Taylor Putnam, Jay Nfonoyim
Our patient presented to the emergency room with a chief complaint of dizziness, weakness, and progressive weight loss over the past six months. Patients may present with a paraneoplastic syndrome, which is a byproduct of the malignancy but unrelated to the invasion of the primary tumor. Examples pertaining to small cell lung carcinoma are the following: cushing syndrome, SIADH, eaton-lambert syndrome, and in extremely rare cases like our patient, microangiopathic hemolytic anemia (MAHA). MAHA is a non-immune hematologic process characterized by the destruction of red blood cells which can be seen hemolytic uremic syndrome (HUS), disseminated intravascular coagulation (DIC), and thrombotic thrombocytopenic purpura (TTP), and also malignancy. Cancer-related microangiopathic hemolytic anemia (CR-MAHA) is considered to have a prevalence of <6% in paraneoplastic syndrome in which thrombocytopenia and schistocytes on peripheral smear may be the only presenting clinical features of an underlying non-hematologic malignancy that has metastasized to the bone marrow, as in this particular case [2–4].