RESUMEN
We experienced a case of nephrotic syndrome (membranous nephropathy) complicated by extensive small cell carcinoma of unknown primary etiology that was diagnosed based on the findings of bilateral cervical and mediastinal lymphadenopathy. A complete cancer response and proteinuria remission following radical chemoradiation therapy were documented. The status of a complete response and nephrosis remission persisted for more than three years. This is the first report to demonstrate the long-term survival of a patient with extensive small cell carcinoma of unknown primary etiology complicated by paraneoplastic nephrotic syndrome.
Asunto(s)
Carcinoma de Células Pequeñas/complicaciones , Glomerulonefritis Membranosa/etiología , Neoplasias Primarias Desconocidas/complicaciones , Síndrome Nefrótico/etiología , Síndromes Paraneoplásicos/etiología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Camptotecina/administración & dosificación , Camptotecina/análogos & derivados , Carboplatino/administración & dosificación , Carcinoma de Células Pequeñas/diagnóstico , Carcinoma de Células Pequeñas/diagnóstico por imagen , Carcinoma de Células Pequeñas/tratamiento farmacológico , Carcinoma de Células Pequeñas/secundario , Terapia Combinada , Irradiación Craneana , Edema/etiología , Etopósido/administración & dosificación , Glomerulonefritis Membranosa/tratamiento farmacológico , Glomerulonefritis Membranosa/radioterapia , Humanos , Irinotecán , Metástasis Linfática , Neoplasias Primarias Desconocidas/diagnóstico , Neoplasias Primarias Desconocidas/tratamiento farmacológico , Síndrome Nefrótico/tratamiento farmacológico , Síndrome Nefrótico/radioterapia , Síndromes Paraneoplásicos/tratamiento farmacológico , Derrame Pleural Maligno/diagnóstico por imagen , Derrame Pleural Maligno/tratamiento farmacológico , Derrame Pleural Maligno/etiología , Proteinuria/etiología , Radioterapia Adyuvante , Inducción de Remisión , Tomografía Computarizada por Rayos XRESUMEN
Paraneoplastic nephropathy is a rare complication of malignant disease. We present a case of cervical cancer with biopsy-proven membranous nephropathy and associated nephrotic syndrome. Irradiation to the specific neoplasm site and to the metastatic paraaortic lymph node tissues lead to regression of the nephrotic syndrome without causing severe adverse events. Radiation therapy can be the first choice in the treatment of paraneoplastic nephrotic syndrome if the primary neoplasm is unresectable. Invasiveness of intervention and patient prognosis should be carefully deliberated in the management of the two diseases.
Asunto(s)
Glomerulonefritis Membranosa/etiología , Glomerulonefritis Membranosa/radioterapia , Síndromes Paraneoplásicos/etiología , Síndromes Paraneoplásicos/radioterapia , Neoplasias del Cuello Uterino/complicaciones , Anciano , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/radioterapia , Femenino , Glomerulonefritis Membranosa/patología , Humanos , Síndrome Nefrótico/etiología , Síndrome Nefrótico/radioterapia , Neoplasias del Cuello Uterino/radioterapiaRESUMEN
Paraneoplastic nephrotic syndrome is rare, bur occurs mostly in lung cancer. The glomerular lesion usually exhibits membranous nephropathy. Although surgical therapy has been shown to be effective, the treatment of a paraneoplastic nephrotic syndrome has always been a challenge. Currently no standard therapy has been established, if the paraneoplastic nephrotic syndrome is associated with advanced cancer with unresectable lesions. We present 2 cases having paraneoplastic nephrotic syndrome associated with advanced squamous cell carcinoma of the lung. Radiation therapy of the primary tumor effectively caused regression of the paraneoplastic nephrotic syndrome without affecting the renal function. Our results suggest that irradiation can be the first choice in the treatment of nephrotic syndrome, if the primary tumor is unresectable.
