Hypertension as a paraneoplastic syndrome in hepatocellular carcinoma

We report a 66-year-old man with hepatocellular carcinoma who was positive for hepatitis B surface antigen, and was hospitalized because of hypoglycemia and hypertension. His plasma renin activity was normal (2.3 ng/ml per h), but concentrations of angiotensin I (>2500 pg/ml) and II (86 pg/ml) were high. Increased angiotensin I level at sites proximal and distal from the confluence of the hepatic vein and the inferior vena cava indicated that the hypertension was provoked by overproduction of angiotensin I from the hepatocellular carcinoma. Previous reports of patients with hepatocellular carcinoma with hypertension due to abnormality of renin-angiotensin system are reviewed. Received: September 24, 1998 / Accepted: January 22, 1999     

Pulmonary IgG4‐related disease and colon adenocarcinoma: possible paraneoplastic syndrome

Malignancy has a complicated association with immunoglobulin G4‐related disease (IgG4‐RD) both being an item in the differential diagnosis as well as malignancy occurring in the background of IgG4‐RD in the same organ. However, recently there is evidence of higher rates of distant malignancy in patients with IgG4‐RD. Here we report a case of pulmonary IgG4‐RD potentially consistent with a paraneoplastic phenomenon which improved with treatment of the underlying colon adenocarcinoma.     

Massive left atrial thrombus: a possible paraneoplastic complication of breast carcinoma

We describe a patient with long-standing rheumatic mitral valve disease, left atrial dilatation, and a precommissurotomy history of left atrial thrombus. Following operation she was maintained on daily aspirin as an antithrombotic measure. For 6 years she had no evidence, echocardiographically, of left atrial thrombus. She underwent surgery for apparently nonmetastatic breast cancer in early 1986. In May 1986 the left atrium was echocardiographically clear. At approximately the same time, recurrence was found at the suture line. In October 1987, two metastatic lung lesions and a very large left atrial mass were detected by computed tomography. The atrial mass was surgically removed and found to be a thrombus. There was a striking temporal correlation between dissemination of carcinoma and development of a massive atrial thrombus.     

Non-small-cell lung cancer associated with excessive eosinophilia and secretion of interleukin-5 as a paraneoplastic syndrome

Eosinophilia associated with solid tumors is an infrequent occurrence. The pathogenesis of tumor-associated eosinophilia is not well understood. Interleukin-5 (IL-5) is a cytokine that has been implicated in the development of eosinophilia in mice and humans. However, there is little data associating IL-5 production with eosinophilia in the presence of tumor. We report, in a patient with locally advanced NSCLC, the presence of excessive eosinophilia and elevated serum IL-5 levels at diagnosis. Immunohistochemical staining of the primary tumor showed large amounts of intracellular IL-5. Both eosinophil count and IL-5 levels normalized after surgical removal of the tumor. Tumor-associated eosinophilia observed in this case is mediated by IL-5. The production of IL-5 is related to the presence of the tumor.     

Relapsing catastrophic antiphospholipid syndrome: report of three cases

BACKGROUND: The catastrophic variant of the antiphospholipid syndrome (CAPS), also now known as Asherson's syndrome, is defined as a potential life-threatening variant of the antiphospholipid syndrome, which is characterized by multiple small-vessel thrombosis that can lead to multiorgan failure. Relapses in patients with the CAPS are very uncommon. OBJECTIVE: To describe the clinical and laboratory features of patients with relapsing episodes of CAPS. METHODS: Three patients with relapsing CAPS are presented with their clinical and laboratory features. RESULTS: Seven episodes of CAPS that occurred in the 3 patients reported were analyzed. The median time between the episodes of CAPS was 12.5 months (range, 2.5-48). Precipitating factors were identified in 2 episodes only (Legionella respiratory tract infection and periodontal infection). The most significant manifestations of the episodes were renal involvement (5 episodes), central nervous system and cardiac involvement (4 episodes), and pulmonary and hepatic involvement (3 episodes each). Interestingly, laboratory features of definite microangiopathic hemolytic anemia (MHA) were present in 5 of 7 episodes of relapsing CAPS. The remaining episodes presented with thrombocytopenia, schistocytes, and anemia but data concerning hemolysis and Coombs tests were not reported. Rituximab was used in 2 episodes. CONCLUSIONS: Relapses occur very infrequently in patients with the CAPS. The presence of MHA is common in these patients, suggesting that an association between MHA and relapses of CAPS could be present and that a "continuum" between various MHAs might exist, as recently suggested.     

Large-vessel arteritis and myelodysplastic syndrome: report of two cases

Myelodysplastic syndrome (MDS) is frequently associated with autoimmune diseases such as polymyalgia, arthritis, and rarely, with systemic vasculitis. The pathogenesis of these autoimmune complications remains unknown, but there is increasing evidence of profound immune dysregulation in MDS. In the few cases reported so far, vasculitides associated with MDS affected mainly cutaneous vessels. Here we describe two cases of acute large-vessel vasculitis in association with MDS. The first patient is a 67-yr-old male presenting with a massive large-vessel arteritis as primary manifestation of refractory anemia with excess of blasts type 1 (RAEB-1). The second patient is a 60-yr-old male, who presented with acute thoracic aortitis after a 2-yr history of refractory anemia with ringed sideroblasts (RARS). Both patients received immunosuppressive treatment with steroids, leading to rapid improvement of systemic inflammatory symptoms, vessel wall injury and peripheral blood counts. Whereas the first patient displayed sustained favorable hematologic responses under long-term steroid therapy, there was a rapid transformation into secondary acute myeloid leukemia in the second patient. We conclude that large-vessel vasculitis should be added to the list of potential autoimmune complications in MDS. In this clinical setting, steroid therapy may alleviate inflammatory symptoms and result in beneficial hematologic responses.     

原发性肝癌伴癌综合征的临床分析

目的分析原发性肝癌伴癌综合征（PNS）的临床特征,探讨PNS患者生化及病理参数的改变规律。方法对病理或影像学检查确诊的635例原发性肝癌患者资料进行回顾性分析,比较PNS组与非PNS组临床特征、生化及病理参数等指标方面的差异。结果PNS占同期原发性肝癌住院人数的20．0％（127／635）,男女之比为8．77：1。PNS主要表现为6种异常：血小板增多症（占同期原发性肝癌住院人数的6．14％,下同）,高胆固醇血症（5．83％）,白细胞增多症（5．20％）,红细胞增多症（1．10％）,高钙血症（0．94％）,低血糖症（0．79％）。原发性肝癌PNS组与非PNS组相比,在平均AFP水平、肿瘤负荷、肝炎病毒感染率等方面差异有统计学意义（P〈0．05）。结论原发性肝癌PNS患者平均AFP水平、肿瘤负荷和肝炎病毒感染率较高,其临床表现无特异性,容易漏诊和误诊。     

肺活检诊断肺小细胞癌9例临床病理观察

目的探讨肺小细胞癌的临床病理特点。方法回顾性分析9例肺小细胞癌的临床病理资料和免疫组化标记的表达情况。结果肺小细胞癌占同期肺癌总数的14.8%,平均年龄63.5岁。表达神经内分泌标记NSE、CgA、Syn,CD56;淋巴细胞标记LCA阴性。结论肺小细胞癌具有恶性程度高、进展迅速、神经内分泌源性抗体标记阳性等特点。     

肺透明细胞癌1例并文献复习

目的 分析肺透明细胞癌的临床特征、影像学表现及病理诊断要点.方法 报告1例经肺活检病理确诊的肺透明细胞癌病例,并结合文献资料对该病的临床特征、影像学表现及病理诊断要点进行分析.结果 本例患者为女性,45岁,以反复咳嗽2个月为首发症状,胸部CT示两肺多发结节灶合并肺门及纵隔淋巴结肿大,胸腔镜下肺活检病理确诊为原发性肺透明细胞癌.近20年国内外文献报道肺透明细胞癌病例仅27例,其中男性18例,女性9例,平均年龄(55±11)岁.临床表现主要为咳嗽(16/27)、胸痛(12/27)、咯血(10/27).影像学表现以周围型单发结节或团块影多见(22/27),病灶直径0.5～11 cm.该病罕见,属大细胞癌的变异型;确诊多依赖开胸肺组织病理活检,免疫组织化学染色有助于鉴别.结论 肺透明细胞癌的临床表现无特异性;影像学表现以肺部单发结节或团块影多见,亦可为两肺多发和弥漫型;确诊依赖肺组织病理活检,免疫组织化学染色有助于鉴别.     

Clinical and pathological features of bronchiolitis obliterans requiring lung transplantation in paraneoplastic pemphigus associated with Castleman disease

Summary at a glanceBronchiolitis obliterans in paraneoplastic pemphigus associated with Castleman disease possesses the progressive nature even when it is treated with intensive medical therapy. Antibodies were at least in low titers before the Lung transplant and remain negative after the procedure. Explanted lungs showed coexistence of cellular destructive bronchiolitis and constrictive bronchiolitis.BackgroundBronchiolitis obliterans (BO) in paraneoplastic pemphigus (PNP) associated with Castleman disease (CD) possesses the progressive nature of pulmonary disease even when it is treated with intensive medical therapy. Lung transplantation (LT) offers an acceptable form of treatment.MethodsWe conducted a retrospective study of two cases of BO in PNP associated with CD who underwent LT between March 2017 and March 2020 at the China‐Japan Friendship Hospital. We also included one case from the literature.ResultsIn this patient series, PNP was the primary clinical presentation in all patients, and it was accompanied by respiratory symptoms before/after CD excision. In spite of being treated with various combinations of immunosuppressive and anti‐inflammatory agents, the patients had great or total improvement in mucosal erosions, whereas their pulmonary function test (PFT) deteriorated gradually or sharply. The duration times from disease onset to timing of LT were 1, 2 and 5 years. All antibodies were negative or were present at low titers before the LT procedure and remain negative after the procedure. The histopathological features of explanted lungs showed cellular and coexistent destructive bronchiolitis and constrictive bronchiolitis in two cases. Granulation with numerous foamy macrophages, scattered giant cells and cholesterol clefts were especially prominent in case one.ConclusionBO in PNP associated with CD had poor clinical outcomes. LT was preferable choice in end‐stage BO when PNP and CD were controlled.     

肺炎型肺癌10例临床分析

目的探讨肺炎型肺癌的临床特征,提高认识,减少误诊。方法通过对10例经病理确诊肺炎型肺癌患者的临床表现,实验室、胸部X线、支气管镜及病理资料的回顾性分析,总结其临床特征。结果肺炎型肺癌的X线表现为渗出性病变,但缺乏肺部感染的常见临床特征,抗感染、抗结核治疗无效。结论 ：肺炎型肺癌胸部X线表现大片状或斑片状阴影,但其临床特点、血常规、细菌学检查及对治疗反应不符合一般感染性疾病特征,应积极获取病理诊断。     

Paraneoplastic Opsoclonus-myoclonus Syndrome with Anti-Hu and Anti-SOX-1 Antibodies after Immune-checkpoint Inhibitor Treatment Combined with Chemotherapy in a Patient with Small-cell Lung Cancer

A 69-year-old man with advanced small-cell lung cancer achieved partial remission after 3 courses of immunochemotherapy that included atezolizumab. Ten days after the last treatment, he developed paraneoplastic opsoclonus-myoclonus syndrome and required mechanical ventilation. Serology testing detected anti-Hu and anti-SOX-1 antibodies. Despite steroid pulse therapy, various anticonvulsants, continuous intravenous sedation, and a fourth course of chemotherapy without atezolizumab, his condition failed to improve. Paraneoplastic opsoclonus-myoclonus syndrome with autoantibodies after immune-checkpoint inhibitor treatment has not been reported previously. Although a causal relationship between immune-checkpoint inhibitors and paraneoplastic syndromes has been suggested, the mechanism remains unknown.     

Castleman disease and paraneoplastic pemphigus in a pregnant woman: A case report

Rationale:Orogenital ulcers can be observed in various conditions, such as Behcet disease, infection and also paraneoplastic pemphigus (PNP). Castleman disease (CD), which is a rare cause of paraneoplastic pemphigus represents a heterogenous lymphoproliferative disorder of unknown etiology. Paraneoplastic pemphigus associated with CD in pregnancy is rare and has not been reported yet.Patient concerns:We report a rare case of CD in a 26-year-old pregnant woman with orogenital ulcers. The patient suffered from mucosal erosions and uveitis at 23 weeks of gestation. A retroperitoneal mass (9.7×7.3×11.8 cm) was identified by CT scan.Diagnoses:According to histological and immunohistological findings, a diagnosis of unicentric CD, hyaline vascular type, and PNP was formulated.Intervention:High dose methylpredisonlone was given for the therapy. Pancreatic uncinatectomy, portal vein and superior mesenteric vein repair, pancreaticojejunostomy, and caesarean section were performed on the patient to remove the tumor and the fetus.Outcomes:The fetus did not survive after surgery. The patient did not achieve remission and she died from epidermolysis and sepsis several months later.Lessons:PNP associated with CD is a rare lymphoproliferative disorder and needs to be differentiated from other orogenital diseases by histological features.Ethics and dissemination:Written informed consent was obtained from the patient for publication of this case report and accompanying images. Ethical approval of this study was granted by the Ethics Committee of West China Hospital of Sichuan University. (Ethics Reference No: 2021143).     

Synchronous colorectal and lung cancer：Report of three cases

The incidence of synchronous colorectal and lung cancer is relatively rare. We report three cases of patients with tumors located in the rectum, ascending colon, the lower lobe of the left lung, and the upper lobe of the right lung. Synchronous curative resection of the two lesions was performed in two patients, whereas colectomy was performed in an elderly patient with a poor lung function. Pathological examination showed the colorectal cancer was a moderately differentiated adenocarcinoma and the lung cancer was a squamous cell carcinoma. Surgical treatment and postoperative adjuvant chemotherapy for the lung cancer were different from those for colorectal cancer with pulmonary metastasis. If possible, radical resection should be performed for each cancer when synchronicity is found.     

Excessive eosinophilia as paraneoplastic syndrome in a patient with non-small-cell lung carcinoma: a case report and review of the literature

Hypereosinophilia is a phenomenon which is associated with a broad variety of allergic, infectious, paraneoplastic and systemic diseases. Depending on the aetiology, these disorders differ in severity from self-limiting to life-threatening. Although it is well known that hypereosinophilia can occur in association with a solid tumour, exact numbers of incidence are lacking. We describe a patient with respiratory insufficiency and an elevated level of eosinophils in the peripheral blood. A diagnostic work-up revealed the presence of a disseminated non-small-cell carcinoma of the lung; an association not frequently described.