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Journal ArticleDOI

Hypercalcemia-leukocytosis syndrome in a patient with cavitating squamous cell carcinoma of the lung

31 Jan 2009-Cases Journal (BioMed Central)-Vol. 2, Iss: 1, pp 108-108

TL;DR: There should be a high degree of suspicion to diagnose lung cancer in patients presenting with symptoms of paraneoplastic syndrome, including hypercalcemia-leukocytosis syndrome.

AbstractLung cancer is the leading cause of death among the cancers seen in the United States. Hypercalcemia and leukocytosis are two common paraneoplastic syndromes associated with lung cancer. Unfortunately patients presenting with Hypercalcemia- leukocytosis syndrome has a worse prognosis than patients presenting with lung cancer alone. We present a 67 yr old Caucasian male with a history of active smoking presenting as pneumonia being diagnosed as cavitating squamous cell carcinoma of the lung with hypercalcemia-leukocytosis syndrome There should be a high degree of suspicion to diagnose lung cancer in patients presenting with symptoms of paraneoplastic syndrome.

Topics: Lung cancer (62%), Squamous-cell carcinoma of the lung (60%), Leukocytosis (53%), Pneumonia (53%)

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Journal ArticleDOI
Abstract: The aim of this study is to analyse survival and prognostic factors in patients diagnosed with squamous cell carcinoma (SCC) presenting a first episode of cancer-associated hypercalcaemia (CAH). Retrospectively, the authors reviewed data from 220 patients with biopsy proven SCC who presented a first episode of CAH. They were treated in a single centre between 1995 and 2007. The survival analyses were done using the Kaplan–Meier method and Cox analysis. The primary endpoint was the overall survival from the date of hypercalcaemia episode. Median age was 55 years. Median survival was 64 days (1–197). Three independent prognostic factors were identified: brain metastasis (hazard ratio (HR) = 2.58 CI (1.03–6.45)), corrected calcaemia > 3 mmol/l (HR = 1.45 CI (1.05–2.01)) and hypoalbuminaemia (HR = 1.48 CI (1.07–2.04)). Using these factors, the authors performed a bedside prognostic score. In conclusion, median survival in patients diagnosed with SCC and CAH is extremely poor. The bedside prognostic score that the authors developed can help to anticipate patients’ prognosis and adapt the treatment. This score needs to be validated on an independent cohort.

14 citations


Journal ArticleDOI
TL;DR: The case of profound hyponatremia secondary to SIADH occurring in an elderly Vietnamese man in the setting of a large, well­differentiated squamous cell cancer of the hypopharynx led to the conclusion thatSIADH was caused by the tumor itself.
Abstract: Introduction: Hypopharyngeal cancer is an uncommon malignancy, representing only 4.3% of head and neck cancers. It is usually found late in the course, accounting for its high five­ year mortality. SIADH has been seen in other squamous cell cancers mainly of the lungs. Case Report: We report a case of profound hyponatremia secondary to SIADH occurring in an elderly Vietnamese man in the setting of a large, well­differentiated squamous cell cancer of the hypopharynx. Conclusion: SIADH is a common occurrence in squamous cell cancer of the lung. It occurs in only 3% of head and neck tumors. The putative etiologies include direct carotid involvement by the tumor, carotid manipulation during operative dissection, and as a side effect of chemotherapy or radiation. In this case, SIADH preceded operative intervention and there was no carotid involvement of the tumor. SIADH is an uncommon occurrence in head and neck tumors despite majority of them being squamous cell cancers. Usual etiologies for SIADH in this setting include medication side effects and involvement or manipulation of the carotid artery. None of these factors were present in this case leading to the conclusion that SIADH was caused by the tumor itself.

3 citations


Cites background from "Hypercalcemia-leukocytosis syndrome..."

  • ...Paraneoplastic syndromes associated with pharyngeal cancer include hypercalcemia [9], leukocytosis, vasculitis [10, 11], neuropathy [12], polymyositis [13] and the syndrome of CASE REPORT OPEN ACCESS...

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Journal Article

3 citations


Cites methods from "Hypercalcemia-leukocytosis syndrome..."

  • ...The calibration graphs were obtained against reagent blank [29, 32]....

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References
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Journal ArticleDOI
TL;DR: An international panel of neurologists interested in PNS recommended new criteria for those in whom no clinical consensus was reached in the past and defined “classical” syndrome and onconeural antibody as “well characterised”.
Abstract: Background: Paraneoplastic neurological syndromes (PNS) are defined by the presence of cancer and exclusion of other known causes of the neurological symptoms, but this criterion does not separate “true” PNS from neurological syndromes that are coincidental with a cancer. Objective: To provide more rigorous diagnostic criteria for PNS. Methods: An international panel of neurologists interested in PNS identified those defined as “classical” in previous studies. The panel reviewed the existing diagnostic criteria and recommended new criteria for those in whom no clinical consensus was reached in the past. The panel reviewed all reported onconeural antibodies and established the conditions to identify those that would be labelled as “well characterised”. The antibody information was obtained from published work and from unpublished data from the different laboratories involved in the study. Results: The panel suggest two levels of evidence to define a neurological syndrome as paraneoplastic: “definite” and “possible” . Each level can be reached combining a set of criteria based on the presence or absence of cancer and the definitions of “classical” syndrome and “well characterised” onconeural antibody. Conclusions: The proposed criteria should help clinicians in the classification of their patients and the prospective and retrospective analysis of PNS cases.

1,224 citations


"Hypercalcemia-leukocytosis syndrome..." refers background in this paper

  • ...[7] There are other syndromes, such as sensorimotor polyneuropathy may have some association with malignancies....

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  • ...These antibodies are generally divided in to three groups, first group belongs to well-characterized antibodies, are reactive with molecularly defined onconeural antigens and has a strongly association to cancer, second group is partially characterized antibodies with an unidentified target antigens which has been reported in few patients and the third group consists of antibodies associated with specific disorders but do no have the ability to differentiate between paraneoplastic and nonparaneoplastic cases [7]...

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Journal ArticleDOI
TL;DR: Paraneoplastic neurologic syndromes are incited by a tumor outside the nervous system that produces a characteristic antigen of the nervous System that damages nerve tissue and inhibits growth of the tumor.
Abstract: Paraneoplastic neurologic syndromes are incited by a tumor outside the nervous system that produces a characteristic antigen of the nervous system. An immune response against the ectopic tumor antigen not only damages nerve tissue but also inhibits growth of the tumor.

834 citations


"Hypercalcemia-leukocytosis syndrome..." refers background in this paper

  • ...[5] The incidence of PNS for solid tumors is < 1%....

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Journal ArticleDOI
TL;DR: The delay between onset of symptoms and diagnosis of PEM/SN suggests a window for improving outcome in these patients, underlines the importance of early diagnosis and start of antitumour treatment when the patient is still in a better functional state.
Abstract: In a retrospective study, we determined clinical and serological findings, associated tumours, outcome and prognostic factors in 73 Hu-Ab positive patients detected in a Dutch reference laboratory. The most frequent signs and symptoms at presentation were sensory neuropathy (55 %), cerebellar degeneration (22 %), limbic encephalitis (15 %) and brainstem encephalitis (16 %). 23 % developed autonomic dysfunction including gastro-intestinal motility disorders in 14 %. In 85 % a tumour was detected, which was a lung tumour in 77 %. Signs, symptoms and associated tumours did not differ in six patients with additional neuronal antibodies (anti-amphiphysine, anti-CV2, anti-Ri). The overall 3 months, one-year and three-year survival rates from the time of diagnosis were 64 %, 40 % and 22 %. Rankin Scale Score (RS) at diagnosis and presence of tumour at the time of diagnosis predicted mortality with hazard ratios (95 % CI) of 2.6 (1.5-4.6) and 1.5 (1.1-2). The median delay between onset of symptoms and Hu-Ab diagnosis was 4 months. There was a negative association between delay RS at diagnosis (P=0.03). In a logistic regression analysis, only older age (OR=0.15; 0.02-0.63) and a higher RS at diagnosis (OR=0.29; 0.11-0.73) were associated with a lower probability of successful functional outcome. Adjusted for these factors, antitumour therapy showed a higher but statistically not significant probability of successful outcome (OR=3.5; 0.87-14.3). Our study underlines the importance of early diagnosis and start of antitumour treatment when the patient is still in a better functional state. The delay between onset of symptoms and diagnosis of PEM/SN suggests a window for improving outcome in these patients.

201 citations


"Hypercalcemia-leukocytosis syndrome..." refers methods in this paper

  • ...Unfortunately there is no cost effective screening method to detect lung cancer but if patients presents with features of PNS, early detection and treatment of the underlying tumor offers the best chance of treatment [2] Case report A 67 year old Caucasian male presented to the emergency department with complaints of high grade fever, cough with yellowish phlegm for the past three days....

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  • ...The importance in diagnosing PNS is at the time of PNS symptoms, most patients would have no been diagnosed with cancer, thus PNS can be used as a early diagnosing tool [2] Antibodies have been used to detect PNS....

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Journal ArticleDOI
TL;DR: Aggressive immunosuppression early in the clinical course should be considered in patients who have paraneoplastic neurological disorders, even when there is no evidence of active malignancy.
Abstract: Paraneoplastic neurological disorders are devastating remote effects of malignancy. Despite compelling evidence of an autoimmune pathogenesis, empiric immunomodulatory treatment of these disorders is often ineffective. However, very few systematic studies have been conducted, and the treatment of patients without active malignancy has not been addressed. We conducted a prospective open-label treatment study of plasma exchange plus conventional cancer chemotherapy (10 patients) or plasma exchange plus continuous oral cyclophosphamide (10 patients). All patients had progressive symptoms and at least moderate disability at enrollment (mean Rankin score, 3.4). Patients who had experienced symptoms for more than 12 months were excluded (mean duration of symptoms at enrollment, 3.6 months). The primary outcome measure was change in quantitative disability measures (Rankin and Barthel scores) after 6 months of treatment; a positive response was defined as stability or improvement in disability. Overall, 50% of patients had a positive response at 6 months (6 patients had improved by at least 1 Rankin grade). Patients with good outcome tended to be those with less disability at time of enrollment. Hematologic toxicity was common among those receiving cyclophosphamide. Aggressive immunosuppression early in the clinical course should be considered in patients who have paraneoplastic neurological disorders, even when there is no evidence of active malignancy.

164 citations


"Hypercalcemia-leukocytosis syndrome..." refers background in this paper

  • ...Studies have shown despite the autoimmune etiology, immunotherapy has been disappointing in the treatment of PSN [16] Immunotherapy modalities currently recommended are plasma exchange, immunoadsorption (extraction of patient IgG over a protein A column), steroids, and intravenous immunoglobin [17]...

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Journal ArticleDOI
TL;DR: Complete response of the tumor seems to have a favorable influence on the course of paraneoplastic encephalomyelitis (PEM).
Abstract: Objective: To evaluate 1) the effect of the tumor treatment on the clinical course of paraneoplastic encephalomyelitis (PEM) with anti-Hu antibodies, 2) the impact of immunotherapy on the tumor evolution, and 3) the outcome of the small cell lung cancer (SCLC) of PEM patients compared with that of patients without PEM. Methods: The authors retrospectively analyzed 51 PEM patients (42 with SCLC, 9 with other tumors) who received antineoplastic treatment with (25 patients) or without (26) concomitant immunotherapy. Tumor response was assessed at the end of the antineoplastic treatment. Progression of PEM was defined as a change of at least 1 point in the Rankin scale measured at the onset and at the end of the tumor treatment. To evaluate the outcome of SCLC, 27 PEM patients with SCLC were matched one-to-one with SCLC patients without PEM for age, performance status, tumor stage, and type of antineoplastic treatment. Results: Thirty-six (70%) patients were neurologically stable at the end of the tumor treatment. In a logistic regression analysis, tumor complete response was the only predictor of PEM stabilization (OR 7.07; 95% CI 1.68 to 29.76; p = 0.006). Immunotherapy did not modify the outcome of the tumor and PEM. Median survival was similar in SCLC patients with and without PEM, but the probability of survival at 30 months was higher in PEM patients with SCLC (OR 5.26; 95% CI 1.0004 to 27.6902; p = 0.03). Conclusions: Complete response of the tumor seems to have a favorable influence on the course of paraneoplastic encephalomyelitis (PEM). Concomitant immunotherapy does not adversely affect the tumor outcome. The small cell lung cancer of PEM patients may have a slightly better evolution than that of patients without PEM.

156 citations


"Hypercalcemia-leukocytosis syndrome..." refers background in this paper

  • ...Studies have shown despite the autoimmune etiology, immunotherapy has been disappointing in the treatment of PSN [16] Immunotherapy modalities currently recommended are plasma exchange, immunoadsorption (extraction of patient IgG over a protein A column), steroids, and intravenous immunoglobin [17]...

    [...]

  • ...[16] Studies have shown despite the autoimmune etiology, immunotherapy has been disappointing in the treatment of PSN [16] Immunotherapy modalities currently recommended are plasma exchange, immunoadsorption (extraction of patient IgG over a protein A column), steroids, and intravenous immunoglobin [17] Conclusion Lung cancer continues to present in advanced stages with metastases at the time of diagnosis making the prognosis poor....

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