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1.
An Bras Dermatol ; 95(1): 67-70, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31952995

RESUMO

Erythroderma as the first manifestation of a solid organ malignancy is rare. The underlying cancer is a challenging condition to diagnose. There are a few cases of erythroderma in cancer patients reported in the literature. We here describe the case of a 70-year-old man who presented with asthenia, weight loss, dry cough and total body erythema with desquamation over the past month. A chest computed tomography scan showed a nodular lesion, which was finally diagnosed as a squamous cell lung carcinoma. To our knowledge, as an erythroderma presentation, only 13 cases have been reported in the literature. This case report demonstrates the need to search for a neoplasm in patients presenting with erythroderma, particularly in the presence of accompanying debilitating symptoms.


Assuntos
Dermatite Esfoliativa/patologia , Neoplasias Pulmonares/patologia , Neoplasias de Células Escamosas/patologia , Idoso , Biópsia , Dermatite Esfoliativa/etiologia , Eritema/patologia , Humanos , Neoplasias Pulmonares/complicações , Masculino , Neoplasias de Células Escamosas/complicações , Síndromes Paraneoplásicas/patologia , Tomografia Computadorizada por Raios X
2.
J Thorac Cardiovasc Surg ; 160(1): 306-314.e14, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31982129

RESUMO

OBJECTIVE: Paraneoplastic syndromes associated with thymomas remain incompletely understood. The objective was to examine the association between surgically resected thymomas and paraneoplastic syndromes over the past half century. METHODS: A primary PubMed/MEDLINE search was used to identify published articles describing paraneoplastic syndromes associated with thymomas from 1960 to 2019. A secondary search identified additional articles referenced in the articles found in the primary search. Kaplan-Meier and log-rank test were used for time-to-event data analyses. RESULTS: From 407 articles describing 507 patients, 123 different paraneoplastic syndromes were associated with thymoma. The 5 most common paraneoplastic syndromes were myasthenia gravis, pure red cell aplasia, lichen planus, Good syndrome, and limbic encephalitis. Complete or partial resolution of paraneoplastic syndrome symptoms after surgery was noted in 76% of patients, of whom 21% had a relapse or new paraneoplastic syndrome onset after surgery. The most common adjunctive therapy associated with resolution of paraneoplastic syndrome was corticosteroids (30%). For all patients after surgery, thymoma recurrence was observed in 17% of cases, whereas recurrence of paraneoplastic syndrome was observed in 34% of cases, and both were observed in approximately 11% of cases. The 5- and 10-year overall survivals were 78% and 66%, respectively. Improved overall survival was associated with patients who had total resolution from paraneoplastic syndrome. CONCLUSIONS: A comprehensive assessment of publications over the past half century suggests that a multimodal treatment approach that includes surgical resection of thymomas is able to achieve paraneoplastic syndrome resolution in a majority of patients. Onset of new paraneoplastic syndromes after surgery is associated with the recurrence of the first paraneoplastic syndrome, and resolution of paraneoplastic syndrome is associated with improved overall survival.


Assuntos
Síndromes Paraneoplásicas , Timoma , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Síndromes Paraneoplásicas/complicações , Síndromes Paraneoplásicas/patologia , Síndromes Paraneoplásicas/terapia , Timoma/complicações , Timoma/patologia , Timoma/terapia , Resultado do Tratamento , Adulto Jovem
3.
Ann Thorac Surg ; 109(3): e203-e206, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31408646

RESUMO

Paraneoplastic leukemoid reaction is a challenging differential diagnosis when it presents at the time of diagnosis of cancer. Severe hyperleukocytosis with elevation of blood neutrophils and monocytes counts can evoke myeloid hematologic malignancies. We report the case of a patient who presented with blood and bone marrow features highly suggestive of chronic myelomonocytic leukemia. The diagnosis of primary lung sarcomatoid carcinoma was performed. Surgical removal of this tumor which will always remain the priority led to full normalization of blood cell count.


Assuntos
Leucemia Mielomonocítica Crônica/patologia , Reação Leucemoide/patologia , Neoplasias Pulmonares/patologia , Síndromes Paraneoplásicas/patologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade
4.
Dermatol Online J ; 25(10)2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31735011

RESUMO

Follicular spicules are a very rare but highly characteristic cutaneous manifestation of multiple myeloma. The spicules typically appear as hyperkeratotic horns in the follicular openings of the face, most commonly on or around the nose and forehead. The pathophysiology of this condition has not been fully elucidated and remains an active area of research and debate. Herein we describe a patient who presented with follicular spicules in the context of unintentional weight loss, anemia, and elevated inflammatory markers. We discuss the diagnostic work-up for such a presentation, review the classification of follicular spicules of multiple myeloma, and describe approaches to manage this uncommon skin condition.


Assuntos
Ceratose/patologia , Mieloma Múltiplo/patologia , Síndromes Paraneoplásicas/patologia , Pele/patologia , Humanos , Ceratose/etiologia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico
5.
J Pediatr Endocrinol Metab ; 32(12): 1403-1406, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31782950

RESUMO

Malignancy-induced hypercalcemia is a very rare condition in children whereas it is more common among adult patients with malignancy. The mechanisms of malignancy-induced hypercalcemia include the over-secretion of parathyroid hormone-related protein (PTHrP), osteolytic metastases and the over-production of 1,25-dihydroxyvitamin D (calcitriol). Although hypercalcemia due to PTHrP secretion has been published before, overproduction of calcitriol has not been reported yet in pediatric squamous cell skin carcinoma cases. Herein, we report calcitriol-mediated severe hypercalcemia in a 5-year-old boy with squamous cell skin carcinoma arising in the background of xeroderma pigmentosum (XP) which responded well to zoledronate treatment. To the best of our knowledge, this is the first pediatric case of malignancy-induced hypercalcemia which is mediated by calcitriol in squamous cell skin carcinoma.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Calcitriol/efeitos adversos , Carcinoma de Células Escamosas/complicações , Hipercalcemia/tratamento farmacológico , Síndromes Paraneoplásicas/tratamento farmacológico , Xeroderma Pigmentoso/complicações , Ácido Zoledrônico/uso terapêutico , Calcitriol/metabolismo , Carcinoma de Células Escamosas/metabolismo , Pré-Escolar , Humanos , Hipercalcemia/etiologia , Hipercalcemia/metabolismo , Hipercalcemia/patologia , Masculino , Síndromes Paraneoplásicas/etiologia , Síndromes Paraneoplásicas/metabolismo , Síndromes Paraneoplásicas/patologia , Prognóstico , Xeroderma Pigmentoso/metabolismo , Xeroderma Pigmentoso/patologia
7.
An Bras Dermatol ; 94(4): 388-398, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644609

RESUMO

Paraneoplastic pemphigus is a rare and severe autoimmune blistering disease characterized by mucocutaneous lesions associated with benign and malignant neoplasms. Diagnostic criteria include the presence of chronic mucositis and polymorphic cutaneous lesions with occult or confirmed neoplasia; histopathological analysis exhibiting intraepidermal acantholysis, necrotic keratinocytes, and vacuolar interface dermatitis; direct immunofluorescence with intercellular deposits (IgG and C3) and at the basement membrane zone (IgG); indirect immunofluorescence with intercellular deposition of IgG (substrates: monkey esophagus and simple, columnar, and transitional epithelium); and, autoreactivity to desmogleins 1 and 3, desmocollins 1, 2, and 3, desmoplakins I and II, envoplakin, periplakin, epiplakin, plectin, BP230, and α-2-macroglobulin-like protein 1. Neoplasias frequently related to paraneoplastic pemphigus include chronic lymphocytic leukemia, non-Hodgkin lymphoma, carcinomas, Castleman disease, thymoma, and others. Currently, there is no standardized treatment for paraneoplastic pemphigus. Systemic corticosteroids, azathioprine, mycophenolate mofetil, cyclosporine, rituximab, cyclophosphamide, plasmapheresis, and intravenous immunoglobulin have been used, with variable outcomes. Reported survival rates in 1, 2, and 5 years are 49%, 41%, and 38%, respectively.


Assuntos
Síndromes Paraneoplásicas/patologia , Síndromes Paraneoplásicas/terapia , Pênfigo/patologia , Pênfigo/terapia , Autoanticorpos/imunologia , Eritema/diagnóstico , Eritema/patologia , Humanos , Doenças da Boca/diagnóstico , Doenças da Boca/patologia , Síndromes Paraneoplásicas/diagnóstico , Síndromes Paraneoplásicas/imunologia , Pênfigo/diagnóstico , Pênfigo/imunologia , Pele/patologia
9.
Niger J Clin Pract ; 22(9): 1271-1275, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489865

RESUMO

Background: Paraneoplastic syndromes (PNS) have been defined as a constellation of symptoms and signs seen in patients with malignancy, which cannot be ascribed to the local or distant spread of the tumor. Renal cell carcinoma (RCC) is most commonly associated with PNS among urological malignancies. We describe the incidence of PNS and the association between the syndromes and oncological outcomes in our patients with RCC. Subjects and Methods: A retrospective cohort study done at Lagos State University Teaching Hospital, Ikeja, Lagos. This was a retrospective review of our patients who had RCC over 11-year period (2006 to 2016). The incidence of PNS syndromes were hypercalcemia, Stauffer's syndrome, hypertension, anemia, elevated erythrocyte sedimentation rate (ESR), persistent leukocytosis, and its correlation to outcome of disease were analyzed. In addition, the age, gender, clinical features, and stage of disease were analyzed. Chi square, Fischer exact test, and Kaplan-Meier survival, curve and logistic regression. Results: : In total, 101 patients were operated within the period. Age of the patients ranged from 11 to 81 years (mean of 45.17 ± 16.3). There were 46 males and 55 females with M:F ratio of 1:1.2. Majority of the patients, 74 (73%), had clear cell variant of RCC. Twenty-seven patients (26.7%) had triad of flank pain, flank mass, and hematuria. The incidence of PNS were hypercalcaemia 7 (6.9%), Stauffer's syndrome 12 (11.9%), hypertension 16 (15.8%), anemia 61 (60.4%), elevated ESR 56 (55.4%), and persistent leukocytosis 3 (3.0%). At a median follow-up of 6 months, 72 patients (71.3%) were alive, whereas 29 patients (28.7%) were dead. Conclusion: Among the PNS, only Stauffer's syndrome was significantly associated with poor outcome.


Assuntos
Carcinoma de Células Renais/diagnóstico , Neoplasias Renais/diagnóstico , Síndromes Paraneoplásicas/diagnóstico , Adulto , Idoso , Anemia/sangue , Sedimentação Sanguínea , Carcinoma de Células Renais/epidemiologia , Carcinoma de Células Renais/patologia , Feminino , Humanos , Hipertensão/complicações , Incidência , Estimativa de Kaplan-Meier , Neoplasias Renais/epidemiologia , Neoplasias Renais/patologia , Leucocitose/sangue , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Síndromes Paraneoplásicas/epidemiologia , Síndromes Paraneoplásicas/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Síndrome
10.
Dermatol Online J ; 25(7)2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31450279

RESUMO

Angioimmunoblastic T-cell lymphoma (AITL) is a rare form of non-Hodgkin lymphoma often accompanied by autoimmune and paraneoplastic phenomena. Up to 50% of patients with AITL present with skin manifestations. This case series highlights two cases of AITL presenting with unusual cutaneous findings: one with a medium-vessel vasculitis and another with a chronic urticarial eruption. Clinicians should consider AITL in the differential diagnosis of vasculitis or urticaria refractory to standard treatment.


Assuntos
Linfoma Cutâneo de Células T/complicações , Síndromes Paraneoplásicas/patologia , Neoplasias Cutâneas/complicações , Pele/patologia , Urticária/etiologia , Vasculite/etiologia , Evolução Fatal , Feminino , Humanos , Linfadenopatia Imunoblástica/patologia , Linfoma Cutâneo de Células T/patologia , Pessoa de Meia-Idade , Neoplasias Cutâneas/patologia , Urticária/patologia , Vasculite/patologia
11.
An. bras. dermatol ; 94(4): 388-398, July-Aug. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1038294

RESUMO

Abstract: Paraneoplastic pemphigus is a rare and severe autoimmune blistering disease characterized by mucocutaneous lesions associated with benign and malignant neoplasms. Diagnostic criteria include the presence of chronic mucositis and polymorphic cutaneous lesions with occult or confirmed neoplasia; histopathological analysis exhibiting intraepidermal acantholysis, necrotic keratinocytes, and vacuolar interface dermatitis; direct immunofluorescence with intercellular deposits (IgG and C3) and at the basement membrane zone (IgG); indirect immunofluorescence with intercellular deposition of IgG (substrates: monkey esophagus and simple, columnar, and transitional epithelium); and, autoreactivity to desmogleins 1 and 3, desmocollins 1, 2, and 3, desmoplakins I and II, envoplakin, periplakin, epiplakin, plectin, BP230, and α-2-macroglobulin-like protein 1. Neoplasias frequently related to paraneoplastic pemphigus include chronic lymphocytic leukemia, non-Hodgkin lymphoma, carcinomas, Castleman disease, thymoma, and others. Currently, there is no standardized treatment for paraneoplastic pemphigus. Systemic corticosteroids, azathioprine, mycophenolate mofetil, cyclosporine, rituximab, cyclophosphamide, plasmapheresis, and intravenous immunoglobulin have been used, with variable outcomes. Reported survival rates in 1, 2, and 5 years are 49%, 41%, and 38%, respectively.


Assuntos
Humanos , Síndromes Paraneoplásicas/patologia , Síndromes Paraneoplásicas/terapia , Pênfigo/imunologia , Pênfigo/patologia , Pênfigo/terapia , Síndromes Paraneoplásicas/imunologia , Pele/patologia , Autoanticorpos/imunologia , Pênfigo/diagnóstico , Eritema/diagnóstico , Eritema/patologia , Doenças da Boca/diagnóstico , Doenças da Boca/patologia
12.
Am J Clin Dermatol ; 20(6): 847-861, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31313078

RESUMO

Autoimmune bullous diseases are a group of chronic inflammatory disorders caused by autoantibodies targeted against structural proteins of the desmosomal and hemidesmosomal plaques in the skin and mucosa, leading to intra-epithelial or subepithelial blistering. The oral mucosa is frequently affected in these diseases, in particular, in mucous membrane pemphigoid, pemphigus vulgaris, and paraneoplastic pemphigus. The clinical symptoms are heterogeneous and may present with erythema, blisters, erosions, and ulcers localized anywhere on the oral mucosa, and lead to severe complaints for the patients including pain, dysphagia, and foetor. Therefore, a quick and proper diagnosis with adequate treatment is needed. Clinical presentations of autoimmune bullous diseases often overlap and diagnosis cannot be made based on clinical features alone. Immunodiagnostic tests are of great importance in differentiating between the different diseases. Direct immunofluorescence microscopy shows depositions of autoantibodies along the epithelial basement membrane zone in mucous membrane pemphigoid subtypes, or depositions on the epithelial cell surface in pemphigus variants. Additional immunoserological tests are useful to discriminate between the different subtypes of pemphigoid, and are essential to differentiate between pemphigus and paraneoplastic pemphigus. This review gives an overview of the clinical characteristics of oral lesions and the diagnostic procedures in autoimmune blistering diseases, and provides a diagnostic algorithm for daily practice.


Assuntos
Vesícula/diagnóstico , Eritema/diagnóstico , Úlceras Orais/diagnóstico , Penfigoide Bolhoso/diagnóstico , Pênfigo/diagnóstico , Algoritmos , Autoanticorpos/análise , Autoanticorpos/imunologia , Vesícula/imunologia , Vesícula/patologia , Diagnóstico Diferencial , Eritema/imunologia , Eritema/patologia , Humanos , Microscopia de Fluorescência , Mucosa Bucal/imunologia , Mucosa Bucal/patologia , Úlceras Orais/imunologia , Úlceras Orais/patologia , Síndromes Paraneoplásicas/diagnóstico , Síndromes Paraneoplásicas/imunologia , Síndromes Paraneoplásicas/patologia , Penfigoide Bolhoso/complicações , Penfigoide Bolhoso/imunologia , Penfigoide Bolhoso/patologia , Pênfigo/complicações , Pênfigo/imunologia , Pênfigo/patologia
13.
Internist (Berl) ; 60(8): 775-782, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31273399

RESUMO

Various specific skin alterations can occur in patients with malignant diseases. If these skin diseases occur as associated symptoms of a malignant process, they are called paraneoplastic. In this overview, obligate and frequent facultative paraneoplastic skin diseases are assigned according to the triggering type of malignancy. Some of the processes predominantly show a link with malignant diseases of the digestive tract, e.g. acanthosis nigricans, florid cutaneous papillomatosis, necrolytic migratory erythema, Leser-Trélat syndrome, palmoplantar keratoderma, panniculitis and pityriasis rubra pilaris. Others are predominantly associated with a hematolymphoid malignoma, e.g. acquired ichthyosis, exfoliative erythroderma, necrobiotic xanthogranuloma, paraneoplastic pemphigus, plane xanthoma, pyoderma gangrenosum, scleromyxedema, Sweet syndrome and leukocytoclastic vasculitis. In a third group paraneoplastic skin diseases are pooled in association with other malignancies, e.g. Trousseau's syndrome, dermatomyositis, erythema gyratum repens, hypertrichosis lanuginosa acquisita and papuloerythroderma of Ofuji. In order to initiate targeted diagnostics for detection of an underlying malignant disease, it is essential that accomplished physicians recognize the skin diseases that represent obligate or potential paraneoplasms as such.


Assuntos
Acantose Nigricans/patologia , Dermatomiosite/patologia , Síndromes Paraneoplásicas/patologia , Dermatopatias/patologia , Eritema/patologia , Humanos , Ictiose/patologia , Dermatopatias/etiologia
15.
J Dermatol ; 46(7): 618-621, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31144726

RESUMO

Eosinophilic dermatosis of hematological malignancy is a paraneoplastic skin eruption associated with chronic lymphocytic leukemia and other B-cell malignancies. It clinically resembles an insect bite reaction and it can precede the symptoms of the hematological malignancy or be related to a more aggressive course. Different treatments have been proposed, but partial response and recurrence are frequent. Herein, we describe a case of eosinophilic dermatosis associated with mantle cell lymphoma with remission after lenalidomide therapy.


Assuntos
Eosinofilia/tratamento farmacológico , Exantema/tratamento farmacológico , Lenalidomida/uso terapêutico , Linfoma de Célula do Manto/complicações , Síndromes Paraneoplásicas/tratamento farmacológico , Prurido/tratamento farmacológico , Eosinofilia/etiologia , Eosinofilia/patologia , Exantema/etiologia , Exantema/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes Paraneoplásicas/etiologia , Síndromes Paraneoplásicas/patologia , Prurido/etiologia , Prurido/patologia , Pele/patologia , Resultado do Tratamento
17.
J Am Acad Dermatol ; 80(6): 1544-1549, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30981429

RESUMO

BACKGROUND: Paraneoplastic pemphigus (PNP) occurs more often in patients with hematologic malignancies (HMs) than in patients with solid cancer. Lung bronchiolitis obliterans (BO) is a severe complication of PNP. OBJECTIVE: To determine the precise clinical and biologic features of HM-associated PNP and identify factors associated with mortality and survival. METHODS: Systematic review of previously described cases of PNP associated with HMs. RESULTS: A total of 144 patients were included. The HMs were non-Hodgkin lymphoma (52.78%), chronic lymphocytic leukemia (22.92%), Castleman disease (18.60%), and other underlying hematologic malignancy (5.70%). The mortality rate was 57%, and most deaths occurred within the first year after the diagnosis of PNP. Multivariate analysis showed that (1) the presence of antienvoplakin antibodies and BO were significantly associated with death, and (2) a toxic epidermal necrolysis-like clinical pattern, bullous pemphigoid-like clinical pattern, and BO were significantly associated with decreased survival. LIMITATION: Only case reports with sufficient mortality data were included. CONCLUSION: PNP associated with HM has a high mortality rate. The toxic epidermal necrolysis-like and BO-associated forms are independent survival factors in PNP associated with HMs.


Assuntos
Neoplasias Hematológicas/complicações , Síndromes Paraneoplásicas/mortalidade , Pênfigo/mortalidade , Idoso , Biomarcadores , Biópsia , Bronquiolite Obliterante/etiologia , Hiperplasia do Linfonodo Gigante/complicações , Feminino , Humanos , Estimativa de Kaplan-Meier , Leucemia Linfocítica Crônica de Células B/complicações , Linfoma não Hodgkin/complicações , Masculino , Pessoa de Meia-Idade , Especificidade de Órgãos , Síndromes Paraneoplásicas/etiologia , Síndromes Paraneoplásicas/patologia , Pênfigo/etiologia , Pênfigo/patologia , Prognóstico , Modelos de Riscos Proporcionais , Fatores de Risco , Pele/química , Pele/patologia
18.
J Med Vasc ; 44(3): 209-212, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31029276

RESUMO

We report the case of a 51-year-old patient who presented necrosis affecting all of the toes in a context of confusion and declining general health. The etiology work-up disclosed a lung mass. Biopsy and search for extension led to the diagnosis of adenocarcinoma with liver metastasis. Unfortunately, symptomatic treatment of the digital necrosis did not lead to improvement and the patient was given palliative care. Digital necrosis generally affects the fingers. Localization on the toes is atypical and few cases have been reported in the literature.


Assuntos
Adenocarcinoma de Pulmão/secundário , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/patologia , Síndromes Paraneoplásicas/patologia , Dedos do Pé/irrigação sanguínea , Adenocarcinoma de Pulmão/complicações , Adenocarcinoma de Pulmão/terapia , Evolução Fatal , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/terapia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/terapia , Pessoa de Meia-Idade , Necrose , Cuidados Paliativos , Síndromes Paraneoplásicas/etiologia , Síndromes Paraneoplásicas/terapia
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