RESUMO
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.
Assuntos
Carcinoma de Células Pequenas/complicações , Glomerulonefrite Membranosa/etiologia , Neoplasias Primárias Desconhecidas/complicações , Síndrome Nefrótica/etiologia , Síndromes Paraneoplásicas/etiologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Camptotecina/administração & dosagem , Camptotecina/análogos & derivados , Carboplatina/administração & dosagem , Carcinoma de Células Pequenas/diagnóstico , Carcinoma de Células Pequenas/diagnóstico por imagem , Carcinoma de Células Pequenas/tratamento farmacológico , Carcinoma de Células Pequenas/secundário , Terapia Combinada , Irradiação Craniana , Edema/etiologia , Etoposídeo/administração & dosagem , Glomerulonefrite Membranosa/tratamento farmacológico , Glomerulonefrite Membranosa/radioterapia , Humanos , Irinotecano , Metástase Linfática , Neoplasias Primárias Desconhecidas/diagnóstico , Neoplasias Primárias Desconhecidas/tratamento farmacológico , Síndrome Nefrótica/tratamento farmacológico , Síndrome Nefrótica/radioterapia , Síndromes Paraneoplásicas/tratamento farmacológico , Derrame Pleural Maligno/diagnóstico por imagem , Derrame Pleural Maligno/tratamento farmacológico , Derrame Pleural Maligno/etiologia , Proteinúria/etiologia , Radioterapia Adjuvante , Indução de Remissão , Tomografia Computadorizada por Raios XRESUMO
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.
Assuntos
Glomerulonefrite Membranosa/etiologia , Glomerulonefrite Membranosa/radioterapia , Síndromes Paraneoplásicas/etiologia , Síndromes Paraneoplásicas/radioterapia , Neoplasias do Colo do Útero/complicações , Idoso , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/radioterapia , Feminino , Glomerulonefrite Membranosa/patologia , Humanos , Síndrome Nefrótica/etiologia , Síndrome Nefrótica/radioterapia , Neoplasias do Colo do Útero/radioterapiaRESUMO
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.