Abstract
A paraneoplastic syndrome, which includes glomerulopathy, is a manifestation of malignancy unexplained by direct tumor burden. Membranous nephropathy (MN) may be associated with malignancies that are primarily solid tumors of the lung, prostate and gastrointestinal tract. It is rarely associated with breast cancer. To our knowledge, we herein report the first case of MN associated with triple-negative carcinoma of the breast. The patient initially presented with MN as a paraneoplastic nephrotic syndrome. Treatment resulting in a complete pathological response of the breast cancer also resolved the MN. Neither has recurred after a 48-month follow-up. The patient exhibited autoantibodies against phospholipase A2 receptor and was also antinuclear antibody (ANA) and anti-Smith (anti-Sm) antibody positive. These results suggest that the neoplasm evoked an autoimmune response, which resolved with treatment. ANA and anti-SM positivity closely correlated with the neoplasm activity supporting this hypothesis.
Highlights
Paraneoplastic syndrome is the manifestation of a malignancy that is not explained by direct tumor burden, the extent of invasion or a metastatic process of the disease [1]
To our knowledge we report the first case of triple-negative breast cancer presenting with Membranous nephropathy (MN) as a paraneoplastic manifestation which resolved with successful treatment of the carcinoma
Paraneoplastic glomerular diseases are rarely linked to breast cancer even though it is the most common malignancy in women
Summary
Paraneoplastic syndrome is the manifestation of a malignancy that is not explained by direct tumor burden, the extent of invasion or a metastatic process of the disease [1]. Systematic reviews and meta-analyses of observational studies in 2014 reported that 10% of patients with membranous nephropathy (MN) had an associated malignancy [3]. To our knowledge we report the first case of triple-negative breast cancer presenting with MN as a paraneoplastic manifestation which resolved with successful treatment of the carcinoma. The pathology report on the subsequent breast tissue biopsy demonstrated invasive ductal carcinoma with medullary carcinoma features, histological grade 3 (overall score 8: tubular differentiation 3, How to cite this article Khan M B, Kaur A, Ali A, et al (September 20, 2021) Complete Resolution of Paraneoplastic Membranous Nephropathy Following Curative Therapy of Triple-Negative Breast Cancer. Mesangial or subendothelial deposits and tubuloreticular inclusions were not seen (Figure 4) These findings were consistent with MN stage III, featuring positive staining for anti-PLA2R and full-house immunoglobulins. Marked decreases in urinary protein excretion corresponding to changes in the antinuclear antibodies (ANA) test in response to chemotherapy
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