Asunto(s)
Adenocarcinoma del Pulmón/complicaciones , Trastornos de Deglución/etiología , Deglución , Acalasia del Esófago/etiología , Neoplasias Pulmonares/complicaciones , Síndromes Paraneoplásicos/etiología , Pérdida de Peso , Adenocarcinoma del Pulmón/diagnóstico por imagen , Adenocarcinoma del Pulmón/terapia , Quimioterapia Adyuvante , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/fisiopatología , Progresión de la Enfermedad , Acalasia del Esófago/diagnóstico , Acalasia del Esófago/fisiopatología , Acalasia del Esófago/cirugía , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/terapia , Persona de Mediana Edad , Síndromes Paraneoplásicos/diagnóstico , Síndromes Paraneoplásicos/fisiopatología , Síndromes Paraneoplásicos/cirugía , Neumonectomía , Piloromiotomia , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Cancer patients often die from symptoms that manifest at a distance from any tumor. Mechanisms underlying these systemic physiological perturbations, called paraneoplastic syndromes, may benefit from investigation in non-mammalian systems. Using a non-metastatic Drosophila adult model, we find that malignant-tumor-produced cytokines drive widespread host activation of JAK-STAT signaling and cause premature lethality. STAT activity is particularly high in cells of the blood-brain barrier (BBB), where it induces aberrant BBB permeability. Remarkably, inhibiting STAT in the BBB not only rescues barrier function but also extends the lifespan of tumor-bearing hosts. We identify BBB damage in other pathological conditions that cause elevated inflammatory signaling, including obesity and infection, where BBB permeability also regulates host survival. IL-6-dependent BBB dysfunction is further seen in a mouse tumor model, and it again promotes host morbidity. Therefore, BBB alterations constitute a conserved lethal tumor-host interaction that also underlies other physiological morbidities.
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Barrera Hematoencefálica/fisiología , Síndromes Paraneoplásicos/fisiopatología , Animales , Transporte Biológico , Barrera Hematoencefálica/metabolismo , Células Cultivadas , Citocinas , Modelos Animales de Enfermedad , Proteínas de Drosophila/metabolismo , Drosophila melanogaster/metabolismo , Células Endoteliales/metabolismo , Interleucina-6/inmunología , Ratones , Ratones Endogámicos C57BL , Neoplasias/patología , Permeabilidad , Factores de Transcripción STAT/metabolismo , Transducción de Señal/fisiologíaAsunto(s)
Carcinoma de Células Renales/diagnóstico , Neoplasias Renales/diagnóstico , Síndromes Paraneoplásicos/diagnóstico , Polimialgia Reumática/diagnóstico , Anciano , Fosfatasa Alcalina/sangre , Carcinoma de Células Renales/complicaciones , Femenino , Humanos , Neoplasias Renales/complicaciones , Síndromes Paraneoplásicos/sangre , Síndromes Paraneoplásicos/etiología , Síndromes Paraneoplásicos/fisiopatología , Polimialgia Reumática/etiología , Polimialgia Reumática/fisiopatología , gamma-Glutamiltransferasa/sangreRESUMEN
BACKGROUND: Immune thrombocytopenia (ITP) is an autoimmune disorder of variable origin that results in bleeding and decreased platelet count. Autoimmune abnormalities have been described in patients with malignancies including non-Hodgkin's lymphoma but are rarely described in patients with Hodgkin's lymphoma. OBJECTIVES: To describe an unusual presentation of Hodgkin's lymphoma in an unusual age and alarm pediatricians of the challenging diagnosis. METHODS: We present two cases that highlight an unusual clinical presentation of childhood Hodgkin's lymphoma occurring at an atypical age. RESULTS: Over a 4-year period, two children aged 5 and 6 years were admitted for suspected ITP, both had cervical lymphadenopathy. Bone marrow examination showed no evidence of tumor or fibrosis. Biopsy of the lymph node was possible only after administration of intravenous immunoglobulins and normalization of the platelet count. Platelet counts increased after initiation of chemotherapy. CONCLUSIONS: The identification of the clinical presentation of ITP as a possible presentation of Hodgkin's lymphoma is important to facilitate timely diagnosis and management.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Enfermedad de Hodgkin/complicaciones , Inmunoglobulinas Intravenosas/administración & dosificación , Síndromes Paraneoplásicos/etiología , Púrpura Trombocitopénica/tratamiento farmacológico , Púrpura Trombocitopénica/etiología , Biopsia con Aguja , Análisis Químico de la Sangre , Niño , Preescolar , Femenino , Estudios de Seguimiento , Enfermedad de Hodgkin/diagnóstico por imagen , Enfermedad de Hodgkin/tratamiento farmacológico , Enfermedad de Hodgkin/inmunología , Humanos , Inmunohistoquímica , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/patología , Masculino , Síndromes Paraneoplásicos/fisiopatología , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Púrpura Trombocitopénica/fisiopatología , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
Skin manifestations of systemic disease and malignancy are extremely polymorphous. Clinicians should be familiarized with paraneoplastic dermatoses in order to perform an early diagnosis of the underlying neoplasm. Lack of familiarity with cutaneous clues of internal malignancy may delay diagnosis and treatment of cancer. In this review, we described several paraneoplastic dermatoses and discussed extensively two paradigmatic ones, namely paraneoplastic pemphigus and paraneoplastic dermatomyositis.
Asunto(s)
Dermatomiositis/fisiopatología , Neoplasias/diagnóstico , Síndromes Paraneoplásicos/diagnóstico , Pénfigo/fisiopatología , Piel/patología , Citocinas/metabolismo , Dermatomiositis/metabolismo , Dermatomiositis/patología , Eritema/metabolismo , Eritema/patología , Eritema/fisiopatología , Humanos , Neoplasias/metabolismo , Neoplasias/fisiopatología , Síndromes Paraneoplásicos/metabolismo , Síndromes Paraneoplásicos/fisiopatología , Pénfigo/metabolismo , Pénfigo/patología , Piodermia Gangrenosa/metabolismo , Piodermia Gangrenosa/patología , Piodermia Gangrenosa/fisiopatología , Piel/metabolismo , Enfermedades de la Piel/metabolismo , Enfermedades de la Piel/patología , Enfermedades de la Piel/fisiopatología , Síndrome de Sweet/metabolismo , Síndrome de Sweet/patología , Síndrome de Sweet/fisiopatologíaRESUMEN
Pheochromocytoma crisis is a rare and possibly fatal emergency. Hypersecreted catecholamines may result in myocardial injury via its direct toxic effect on cardiomyocytes or mediating vasoconstriction which will reduce coronary blood flow in this special setting. Interestingly, several case studies have reported the occurrence of ST-segment elevation myocardial infarction in patients with pheochromocytoma crisis. However, no one found the angiographic evidence of occlusive thrombus in the infarct-related coronary artery. Additionally, pheochromocytoma can induce hypercoagulability and promote thrombosis, but spontaneous coronary thrombosis has never been reported in this condition. Here, we report an unusual case of pheochromocytoma crisis presenting with STEMI due to spontaneous coronary thrombosis.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/complicaciones , Trombosis Coronaria/complicaciones , Feocromocitoma/complicaciones , Infarto del Miocardio con Elevación del ST/etiología , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/metabolismo , Anciano , Catecolaminas/efectos adversos , Catecolaminas/metabolismo , Trombosis Coronaria/diagnóstico , Electrocardiografía , Humanos , Hipertensión/diagnóstico , Hipertensión/etiología , Masculino , Síndromes Paraneoplásicos/complicaciones , Síndromes Paraneoplásicos/diagnóstico , Síndromes Paraneoplásicos/fisiopatología , Feocromocitoma/diagnóstico , Feocromocitoma/metabolismo , Infarto del Miocardio con Elevación del ST/diagnósticoRESUMEN
OBJECTIVES: Paraneoplastic syndromes occur rarely in association with laryngeal cancer. When present, the syndrome may be the first sign of the malignancy. The aim of the present study was to review and report on all published cases in the international literature. METHODS: A search of PubMed was conducted for "paraneoplastic syndromes in laryngeal cancer" without any restrictions on language or publication year. The full texts of all relevant articles were reviewed and all cases of paraneoplastic syndromes associated with any type of laryngeal cancer were extracted and analyzed. RESULTS: We identified 59 cases of paraneoplastic syndromes related to laryngeal cancer in the literature published from 1963 until recently. There were 46 squamous cell carcinomas and 10 neuroendocrine carcinomas. Twenty-two of the paraneoplastic syndromes involved the endocrine system, 21 were dermatologic or cutaneous, 8 neurologic, 5 osteoarticular or rheumatologic, 1 ocular, 1 muscular, and 1 hematologic. Treatment strategies included surgery, radiotherapy, chemotherapy, and often multimodal therapy, depending on the histology and stage of the laryngeal cancer. CONCLUSIONS: Because of their rarity, paraneoplastic syndromes associated with laryngeal cancer are difficult to diagnose. By presenting and systematically reviewing all published cases in the international literature, the present review may help clinicians to recognize them and to suspect the diagnosis of laryngeal cancer at an earlier stage than otherwise might be possible.
Asunto(s)
Neoplasias Laríngeas/epidemiología , Síndromes Paraneoplásicos/epidemiología , Humanos , Masculino , Síndromes Paraneoplásicos/fisiopatologíaRESUMEN
PURPOSE OF REVIEW: This paper seeks to highlight GI motility disorders that are frequently present in patients with a malignancy. GI dysmotility can occur due to the cancer itself or as a consequence of medical and surgical treatments. Often, symptoms are nonspecific and the diagnosis requires a high index of suspicion. The goal of the paper is to review the common motility problems seen in patients with cancer, their clinical manifestations, and options for management. RECENT FINDINGS: Studies show that newer endoscopy techniques such as endoscopic mucosal dissection can cause esophageal dysmotility. Opioid-induced constipation is frequently encountered in patients with cancer. Motility disorders in cancer patient can lead to clinical morbidity, poor quality of life, and malnutrition. Newer diagnostic tests and medical and surgical treatments may be helpful in improving the diagnosis and management of these disorders.
Asunto(s)
Analgésicos Opioides/efectos adversos , Enfermedades Gastrointestinales/fisiopatología , Motilidad Gastrointestinal/fisiología , Neoplasias , Estreñimiento/inducido químicamente , Estreñimiento/etiología , Estreñimiento/terapia , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/etiología , Enfermedades Gastrointestinales/terapia , Motilidad Gastrointestinal/efectos de los fármacos , Motilidad Gastrointestinal/efectos de la radiación , Humanos , Neoplasias/fisiopatología , Neoplasias/terapia , Síndromes Paraneoplásicos/etiología , Síndromes Paraneoplásicos/fisiopatología , Síndromes Paraneoplásicos/terapiaAsunto(s)
Adenocarcinoma del Pulmón/fisiopatología , Dedos/irrigación sanguínea , Antebrazo/fisiopatología , Gangrena/fisiopatología , Síndromes Paraneoplásicos/fisiopatología , Enfermedades Vasculares/fisiopatología , Adenocarcinoma del Pulmón/complicaciones , Amputación Quirúrgica , Femenino , Antebrazo/cirugía , Gangrena/cirugía , Humanos , Persona de Mediana Edad , Síndromes Paraneoplásicos/cirugía , Resultado del Tratamiento , Enfermedades Vasculares/complicacionesRESUMEN
Paraneoplastic syndromes (PS) are a rare presentation of cancer, most commonly associated with small cell lung cancer (SCLC), breast cancer and haematologic malignancies. The diagnosis of PS is challenging because it could affect multiple organ systems and it may present before the tumour is visible by imaging. We report a malignant tumour diagnosed in a male patient who referred long-term paraesthesia and proximal muscle strength loss. After ruling out common causes of polyneuropathy, the anti-SOX1 antibody gave light to the diagnosis. A pulmonary opacity in the upper right lobe was observed in the chest X-ray and a pulmonary tumour was later confirmed by CT scan. The biopsy of the cervical lymphadenopathy determined an SCLC, which caused a PS called Lambert-Eaton myasthenic syndrome (LEMS). Our case raises awareness of a rare PS presentation, which can be diagnosed by specific antibodies, allowing early diagnosis and treatment of lung cancer.
Asunto(s)
Síndrome Miasténico de Lambert-Eaton/sangre , Síndromes Paraneoplásicos/diagnóstico , Parestesia/etiología , Factores de Transcripción SOXB1/antagonistas & inhibidores , Carcinoma Pulmonar de Células Pequeñas/patología , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Autoanticuerpos/sangre , Diagnóstico Diferencial , Electromiografía/métodos , Humanos , Síndrome Miasténico de Lambert-Eaton/complicaciones , Síndrome Miasténico de Lambert-Eaton/diagnóstico , Masculino , Síndromes Paraneoplásicos/fisiopatología , Factores de Transcripción SOXB1/sangre , Biopsia del Ganglio Linfático Centinela/métodos , Carcinoma Pulmonar de Células Pequeñas/complicaciones , Carcinoma Pulmonar de Células Pequeñas/diagnóstico por imagen , Carcinoma Pulmonar de Células Pequeñas/tratamiento farmacológico , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
Paraneoplastic syndromes (PNS) are rare clinical syndromes due to the systemic effects of tumours; they are unrelated to tumour size, invasiveness or metastases. Recent years have seen considerable advances leading to improved understanding of their pathophysiology and increased recognition of new PNS entities and PNS associated tumours. While of paramount importance, diagnosis is still frequently missed or delayed. Diverse organs and systems are affected by the associated tumours- which may be benign or malignant. PNS can occur concurrently with tumour diagnosis, before tumour is diagnosed and even after tumours have been resected. Also, there are autoimmune diseases later progressing to PNS when occult tumours are identified. Another confounding factor is that many PNS clinically resemble non-neoplastic diseases. PNS are largely due to two main causes: those due to tumour secretions of hormones, functionally active peptides, enzymes cytokines or to tumours operating through auto-immune/immunological mechanisms with cross-reacting antibodies between neoplastic and normal tissues. Remission of symptoms often follows resection of humoral secretory tumours but not always of tumours due to immunological mechanisms. Classifications schemes vary but most currently place PNS in one of five groups: endocrine, neurological, musculocutaneous, haematological and other. Due to advances both in diagnostic techniques in identifying tumours as well as in therapy, early diagnosis not only results in improved prognosis of both PNS and associated tumours but also enables monitoring response to treatment and early detection of recurrence. This article covers definition, general principals of classification, diagnosis, pathophysiology and treatment, with emphasis on tumour related PNS serving as an introduction to the following articles.
Asunto(s)
Síndromes Paraneoplásicos/clasificación , Síndromes Paraneoplásicos/fisiopatología , Síndromes Paraneoplásicos/terapia , HumanosRESUMEN
Neuroendocrine paraneoplastic syndromes (PNS) consist of metabolic disorders that accompany benign and malignant neoplasms but remain unrelated to mass effects or invasion by the primary tumor or its metastases. The underlying pathogenesis responsible for PNS usual clinical presentation relies on aberrant production of protein hormones, proteins and other substances by the tumor. Prompt recognition of characteristic signs and symptoms combined with serological identification of key substances may result in early diagnosis of PNS and its underlying malignancy. For these reasons, healthcare professionals should familiarize themselves with tumor-induced hypercalcemia, syndrome of inappropriate antidiuretic hormone, carcinoid syndrome, virilisation syndrome, gynecomastia, acromegaly, Cushing syndrome, osteogenic osteomalacia, tumor-induced hypoglycemia, necrolytic migratory erythema, and watery diarrhea, hypokalemia and achlorydria syndrome. Medical awareness for PNS can improve patient outcomes through earlier administration of cancer therapy and treatment, better symptomatic relief and prolong overall survival.
Asunto(s)
Enfermedades Metabólicas/etiología , Tumores Neuroendocrinos/complicaciones , Síndromes Paraneoplásicos/etiología , Humanos , Enfermedades Metabólicas/fisiopatología , Síndromes Paraneoplásicos/fisiopatologíaAsunto(s)
Condrosarcoma , Dermatomiositis , Helicasa Inducida por Interferón IFIH1/inmunología , Síndromes Paraneoplásicos , Neoplasias de la Base del Cráneo , Base del Cráneo/diagnóstico por imagen , Autoanticuerpos/sangre , Biopsia/métodos , Condrosarcoma/complicaciones , Condrosarcoma/patología , Condrosarcoma/terapia , Dermatomiositis/diagnóstico , Dermatomiositis/etiología , Dermatomiositis/fisiopatología , Dermatomiositis/terapia , Resultado Fatal , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Clasificación del Tumor , Síndromes Paraneoplásicos/diagnóstico , Síndromes Paraneoplásicos/fisiopatología , Síndromes Paraneoplásicos/terapia , Manejo de Atención al Paciente/métodos , Piel/patología , Neoplasias de la Base del Cráneo/complicaciones , Neoplasias de la Base del Cráneo/patología , Neoplasias de la Base del Cráneo/terapiaRESUMEN
Cancer cachexia is a multifactorial condition characterized by body weight loss that negatively affects quality of life and survival of patients with cancer. Despite the clinical relevance, there is currently no defined standard of care to effectively counteract cancer-associated progressive tissue wasting. Skeletal muscle atrophy represents the main manifestation of cancer cachexia. However, cancer cachexia is increasingly seen as a systemic phenomenon affecting and/or influenced by various organs. Here, we describe recent developments elucidating the roles of different tissues as well as tissue crosstalk in this wasting syndrome, including potential links to other cancer-associated morbidities. A more comprehensive understanding of cancer cachexia etiology and heterogeneity may enable the development of intervention strategies to prevent or reverse this devastating condition.
Asunto(s)
Antineoplásicos/uso terapéutico , Caquexia/fisiopatología , Neoplasias/complicaciones , Apoyo Nutricional/métodos , Síndromes Paraneoplásicos/fisiopatología , Antineoplásicos/farmacología , Caquexia/etiología , Caquexia/mortalidad , Caquexia/prevención & control , Terapia Combinada/métodos , Humanos , Músculo Esquelético/fisiopatología , Neoplasias/tratamiento farmacológico , Neoplasias/mortalidad , Neoplasias/fisiopatología , Síndromes Paraneoplásicos/etiología , Síndromes Paraneoplásicos/mortalidad , Síndromes Paraneoplásicos/prevención & control , Calidad de Vida , Resultado del TratamientoRESUMEN
Renal cell carcinoma (RCC) accounts for approximately 80% of all primary renal neoplasms in United States causing approximately 65 000 new cases of RCC and 14 000 deaths each year. Symptoms of RCC typically include weight loss and night sweats but may also feature paraneoplastic phenomena in advanced stages as well as flank pain, gross hematuria, scrotal varicocele, inferior vena cava pathology, and a palpable abdominal mass. In this article, we present the course of a patient with advanced RCC, from initial presentation through workup and to eventual diagnosis. The case features late-onset symptoms, extensive paraneoplastic phenomena, and significant physical examination findings. We also review the literature available on RCC and critically analyze inefficiencies of the workup retrospectively.
Asunto(s)
Carcinoma de Células Renales/complicaciones , Síndromes Paraneoplásicos/complicaciones , Carcinoma de Células Renales/patología , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Síndromes Paraneoplásicos/fisiopatologíaRESUMEN
Paraneoplastic syndromes (PNS) are immune-mediated neurologic diseases that occur as an indirect effect of malignancy, and can be challenging to diagnose. Onconeural antibodies have a greater than 95% association with cancer, and their presence in a patient with neurologic symptoms is reportedly highly indicative of PNS. However, we performed a single-centre retrospective review to determine the positive predictive value of onconeural antibody testing, and found it to be concerningly low (39%). Recognising the limitations of onconeural antibody testing is critical to ensure accurate test interpretation, avoid unnecessary repeated malignancy screening and prevent the use of potentially hazardous immunotherapy.
Asunto(s)
Anticuerpos/metabolismo , Antígenos de Neoplasias/inmunología , Proteínas del Tejido Nervioso/inmunología , Síndromes Paraneoplásicos/diagnóstico , Síndromes Paraneoplásicos/inmunología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndromes Paraneoplásicos/metabolismo , Síndromes Paraneoplásicos/fisiopatología , Valor Predictivo de las Pruebas , Estudios RetrospectivosRESUMEN
Paraneoplastic autoimmune multiorgan syndrome (PAMS) is characterized by a heterogenous group of signs and symptoms including severe desquamative stomatitis, a polymorphous cutaneous eruption, humoral immunity against plakin proteins, contribution of cell-mediated autoimmunity and commonly a progressive respiratory failure. Autoantibodies in PAMS target a wide array of antigens including plakins, cadherins, alpha-2-macroglobulin like 1 (A2ML1), BP180, plakophilin-3, and several neuromuscular antigens. Originally described as paraneoplastic pemphigus in 1990 due to some of its clinical and immunologic similarities to classic pemphigus (pemphigus vulgaris and pemphigus foliaceus), PAMS is a multiorganopathy with several distinct features from these classic forms of pemphigus. Epidemiologically, PAMS is associated with underlying neoplasia and has a differing HLA-II allele predisposition compared to classic forms of pemphigus. Clinically, lesion morphology is polymorphous, and lesion distribution fundamentally differs from that seen in classic pemphigus. PAMS has a significantly higher mortality rate and a poorer response to treatments typically effective in pemphigus. Histologically, PAMS is characterized by the presence of interface dermatitis, vacuolar changes, and dyskeratotic keratinocytes which are not seen in classic pemphigus. PAMS demonstrates not only intercellular IgG as seen in classic pemphigus, but the presence of linear basement membrane zone deposition. Antibodies against desmoglein 3 (Dsg3) map to a broader array of epitopes than in pemphigus vulgaris and there is a higher prevalence of complement binding anti-Dsg3 IgG autoantibodies in PAMS. Autoantibodies can in rare cases be absent in the more cell-mediated form of PAMS. Considering these numerable differences, we review the entity of PAMS, and provide similarities and differences to classic forms of pemphigus.
Asunto(s)
Síndromes Paraneoplásicos/fisiopatología , Autoanticuerpos/inmunología , Autoantígenos/inmunología , Humanos , Neoplasias/complicaciones , Síndromes Paraneoplásicos/complicaciones , Síndromes Paraneoplásicos/tratamiento farmacológico , Síndromes Paraneoplásicos/genética , Pénfigo/complicacionesRESUMEN
Seesaw nystagmus is characterized by the rhythmic combination of vertical and torsional dysconjugate oscillations where one eye moves up and inward while the other moves down and outward. Common association of seesaw nystagmus with accessory optic track lesions lead to traditional hypothesis that it is due to the mismatch in the vision and vestibular systems. Here we propose a novel mechanism for seesaw nystagmus. We hypothesize that reverberations due to abnormal increases in the excitability of the reciprocally innervating circuit of excitatory burst neuron in the midbrain interstitial nucleus of Cajal causes the seesaw nystagmus. Analogous oscillations of the brainstem burst generators may be responsible for generation of saccadic oscillations or opsoclonus. The key difference is that the interstitial nucleus of Cajal lacks inhibitory burst neurons, hence the lack of post-inhibitory rebound, and relatively lower frequency of the oscillatory cycles causing pendular seesaw nystagmus. In contrast the brainstem burst generator, with reciprocally innervating excitatory and inhibitory burst neurons, and further inhibitory influence of the omnipause neurons results in the post-inhibitory rebound at the burst neurons, hence high oscillation frequency. This novel concept is supported by a unique observation in a patient with antineuronal nuclear autoantibody type 2 due to breast cancer who had combined seesaw nystagmus and superimposed saccadic oscillations. The patient neither had cerebellar deficits typically thought to cause paraneoplastic opsoclonus nor visual deficits that are known cause of seesaw nystagmus. We propose that hyperexcitability of the burst neurons in the interstitial nucleus of Cajal due to paraneoplastic antibody caused pendular seesaw nystagmus. On the other hand, increased excitability of brainstem burst generators and reduced efficacy of the omnipause neurons caused saccadic oscillations.
Asunto(s)
Mesencéfalo/fisiopatología , Modelos Neurológicos , Nistagmo Patológico/fisiopatología , Trastornos de la Motilidad Ocular/fisiopatología , Síndromes Paraneoplásicos/fisiopatología , Anticuerpos Antinucleares , Anticuerpos Antineoplásicos/inmunología , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/fisiopatología , Carcinoma de Células Pequeñas/complicaciones , Carcinoma de Células Pequeñas/tratamiento farmacológico , Carcinoma de Células Pequeñas/fisiopatología , Simulación por Computador , Femenino , Humanos , Persona de Mediana Edad , Inhibición Neural/fisiología , Vías Nerviosas/fisiopatología , Neuronas/fisiología , Nistagmo Patológico/complicaciones , Nistagmo Patológico/terapia , Trastornos de la Motilidad Ocular/complicaciones , Trastornos de la Motilidad Ocular/terapia , Síndromes Paraneoplásicos/complicaciones , Síndromes Paraneoplásicos/terapia , PeriodicidadRESUMEN
Achalasia secondary to underlying neoplasm is a rare entity. Early recognition of secondary achalasia is important as its treatment involves management of underlying malignancy, while treatment of primary achalasia mainly involves lowering the lower oesophageal sphincter pressure with pneumatic dilatation or Heller's myotomy. We discuss an interesting case of achalasia secondary to non-Hodgkin's lymphoma.