Manifestation Of Small Cell Lung Cancer Research Articles

Isolated Solitary Intramedullary Spinal Cord Metastasis Presenting as the First Manifestation of Small-Cell Lung Cancer: Report of a Rare Case

Background. Intramedullary spinal cord metastases presenting as the first manifestation of malignancies are extremely rare lesions. Case Description. The authors report a 74-year-old woman who presented with an isolated intramedullary spinal cord metastasis which presents as first manifestation of malignancy without central nervous system and/or other organ involvement. She went under surgery, and after histopathological evaluation, primary focus was determined in lung in positron emission tomography. She is still alive after 9 months since the first diagnosis of primary focus. Conclusion. In patients with solitary intramedullary lesion in the spinal magnetic resonance imaging, whole-body investigation might help for diagnosis of primary focus and approach to treatment.

CNS autoimmunity: new findings and pending issues

CNS autoimmunity: new findings and pending issues

Severe Paraneoplastic Gastroparesis Associated with Anti-Hu Antibodies Preceding the Manifestation of Small-Cell Lung Cancer

Gastroparesis is a common but challenging disorder which can be idiopathic or induced by a variety of underlying diseases, most frequently by diabetes, or post-surgical conditions of the upper abdomen. Clinicians must also consider rare causes of gastric motor dysfunction, such as collagen vascular disorders and paraneoplastic syndromes. Here we present the case of a patient with severe gastroparesis, who was admitted to our hospital for vomiting and weight loss of 25 kg within four months. Endoscopy showed a dilated fluid-filled stomach without peristalsis but no obstruction. High titres of anti-Hu antibodies were detected in patient's serum, supporting the diagnosis of severe paraneoplastic gastroparesis with chronic intestinal pseudo-obstruction. Fine-needle aspiration of suspicious mediastinal lymph nodes guided by endoscopic ultrasound revealed lymphatic metastases of a small-cell lung carcinoma. Jejunal tube feeding and chemotherapy with carboplatin and etoposide were initiated. Paraneoplastic gastrointestinal dysmotility is rare, however, clinicians should consider this differential diagnosis in otherwise unexplained gastrointestinal motor dysfunction. The pathophysiology of paraneoplastic gastroparesis, the diagnostic relevance of anti-Hu antibodies as well as therapeutic options are discussed.

Fulminant Hepatic Failure as the Initial Manifestation of Small-Cell Lung Cancer: Report of 2 Cases

In this report, we describe two cases of small-cell lung cancer (SCLC) presenting with fulminant hepatic failure as the initial manifestation. Neither of the patients had a previous history of liver disease, evidence of viral infection, or exposure to hepatotoxins. Both presented with hepatomegaly and an increase in the serum LDH level. Although they had a history of smoking and respiratory symptoms such as dyspnea on exertion, their most striking initial symptoms were those of hepatic failure, which made it difficult to suspect the underlying primary lung cancer. In one case, contrast-enhanced CT of the abdomen revealed hypovascular nodules that were not visible on plain CT. After a rapidly deteriorating course, both patients died, 8 and 13 days after admission, respectively. Autopsy revealed diffuse infiltration of the hepatic sinusoids and extensive replacement of the liver parenchyma by metastatic small-cell carcinoma. We conclude that metastatic SCLC should be considered in the differential diagnosis in patients of advanced age with a smoking history presenting with rapidly progressive liver failure associated with hepatomegaly and elevation of the serum LDH.

Isolated paraneoplastic optic neuropathy associated with small-cell lung cancer and anti-CV2 antibodies

Sirs: Paraneoplastic neurological syndromes (PNS) are disorders that occur in patients with systemic cancer, which are not due to direct tumour invasion or metastasis, chemotherapy or radiotherapy-induced neurotoxicity, coagulopathy, infection or metabolic or nutritional deficits. They are mediated by immunological mechanisms related to onconeural antigens expression by cancer cells [1]. Paraneoplastic optic neuropathy is an uncommon disorder [2–8]. We describe a patient with an isolated optic neuropathy associated with small-cell lung cancer and anti-CV2 antibodies. The patient was a 64-year-old heavy-smoker male who developed painless, progressive vision loss in his left eye, with only perception of movement 5 days after onset and mild visual loss in his right eye 2 days later. General and neurological examination revealed no abnormalities. Visual acuity was 0.4 in the right eye and only movement perception in the left one; a left relative afferent pupillary defect was present. Funduscopy showed right eye papilledema, whereas the left papilla was pale. Fluorescein angiography showed vitreous turbidity and dye enhancement in both papillae; no signs of retinitis or vasculitis were found. Blood analysis, including ESR, thyroid function tests, angiotensin-converting enzyme levels, autoantibodies and tumour markers (including neuron-specific enolase), were negative. CSF showed five mononuclear cells/ mm, a protein level of 78 mg/dl and no oligoclonal bands. Cytological examination was negative. Anti-CV2 antibodies were found in serum (1/8,000) and CSF (1/400), but not in aqueous humour. Brain MRI showed no abnormalities. Visual evoked potentials showed reduced amplitudes and mildly prolonged P100 latencies. Electroretinography was normal. A thorax CT scan revealed a 3-cm cystic nodule in the right superior lobe. Video-assisted thoracoscopy with lung biopsy was done; smallcell lung cancer was diagnosed. Methylprednisolone (1 g iv. daily for 5 days) was given and chemotherapy (cisplatin plus etoposide) was started after diagnosis of limited-stage disease. Fifteen months after diagnosis visual acuity was 0.7 in both eyes and no further relapses nor new neurological symptoms or signs developed over follow-up. Anti-CV2 antibodies remained in the serum sample at the same titer of 1/8,000. We report a patient with a seven-day history of painless, progressive, asymmetric, optic neuropathy as the only manifestation of small-cell lung cancer associated with anti-CV2 antibodies. Anti-CV2 (also called CRMP5-IgG) is an IgG autoantibody specific for the 62 kDa collapsing response-mediator protein 5 (CRMP-5) [9, 10]. Both the retina and the optic nerve contain full-length CRMP-5 protein. AntiCV2/CRMP-5 antibodies are markers of paraneoplastic autoimmunity related to lung cancer (mainly small-cell type) or thymoma [9, 10]. Graus et al. [11] have recently recommended diagnostic criteria for PNS. Although optic neuropathy is not a classical syndrome, our patient fulfills criteria for PNS as a non-classical syndrome with onconeural antibodies (anti-CV2/CRMP-5) and cancer (small-cell carcinoma). Response to therapy (steroids and chemotherapy) can be interpreted as an additional data supporting the diagnosis. Optic neuropathy is an uncommon paraneoplastic manifestation of cancer. Up to date, only 42 patients with paraneoplastic optic neuropathy have been reported in the English literature. However, nearly always patients had other neurological symptoms or signs, such as neuropathy, cerebellar ataxia, dementia, other cranial nerve abnormalities, A. Ares-Luque (&) L.A. Garcia-Tunon AE B.C. Cabezas L.E. Hernandez-Echebarria AE J. Tejada Neurology Dept. Hospital de Leon C/ Altos de Nava sn. 24071 Leon, Spain Tel.: +34-98/7237400 Fax: +34-98/7240503 E-Mail: adrianares@telefonica.net

Small-Cell Lung Cancer Presenting as Diabetes Insipidus and Cushing's Syndrome

Small-cell lung cancer presenting with a combination of cranial diabetes insipidus and Cushing's syndrome secondary to ectopic adrenocorticotropin (ACTH) secretion is very rare and has only been described previously in one case report Our patient was a 49 year old man, in whom the initial presenting features of small-cell lung cancer were cranial diabetes insipidus secondary to pituitary metastases and severe hypokalaemia resulting from ectopic ACTH hormone secretion. This case is a remarkable example of the complex metabolic endocrine manifestations of small-cell lung cancer.