A Coin-Like Peripheral Small Cell Lung Carcinoma Associated with Acute Paraneoplastic Axonal Guillain-Barre-Like Syndrome

Abstract

A 65-year-old previously healthy male heavy smoker was hospitalized with a 2-week history of progressive muscle weakness in the lower and upper extremities. After 10 days of hospitalization, urinary sphincter incompetence and fecal incontinence were added and tetraparesis was established. The computer-tomography scan examination revealed a massive right hydrothorax and multifocal solid acinar structures with peripheral localization in the left lung, which suggested pulmonary cancer. Bone marrow metastases were also suspected. Based on the examination results, the final diagnosis was acute paraneoplastic axonal Guillain-Barre-like syndrome. The patient died 3 weeks after hospitalization. At autopsy, bronchopneumonia and a right hydrothorax were confirmed. Several 4 to 5-mm-sized round peripherally located white nodules were identified in the left lung, without any central tumor mass. Under microscope, a coin-shaped peripheral/subpleural small cell carcinoma was diagnosed, with generalized bone metastases. A huge thrombus in the abdominal aorta and acute pancreatitis was also seen at autopsy. This case highlights the difficulty of diagnosis of lung carcinomas and the necessity of a complex differential diagnosis of severe progressive ascending neuropathies. This is the 6th reported case of small cell lung cancer-associated acute Guillain-Barre-like syndrome and the first report about an association with a coin-like peripheral pattern.

Cushing's syndrome secondary to typical pulmonary carcinoid with mutation in BCOR gene

“…[ 1 – 3 ] Usually no obvious clinic features can be observed at early stage and paarneoplastic syndromes are really infrequent manifestation of neuroendocrine tumors, such as Cushing syndrome, Raynaud phenomenon, and Guillain-Barre-like syndrome. [ 11 , 12 ] It is hard to make an exact diagnosis of such disease. So far, there are no ideal tumor markers and lab index of TPC.…”

Paraneoplastic Guillain-Barré Syndrome in Small Cell Lung Cancer

“…This case is different from the existing 6 cases. In the present case, GBS occurred in a patient receiving long-term antineoplastic therapy, whereas GBS had occurred at the initial point of presentation in the 6 other cases [ 2 , 3 , 4 , 5 , 6 , 7 ]. This is the first reported case of paraneoplastic GBS that developed in an SCLC patient with long-term therapy.…”

“…There have been reports of paraneoplastic GBS in different cancers. To the best of the present authors’ knowledge, there are 6 published reports of GBS in SCLC [ 2 , 3 , 4 , 5 , 6 , 7 ]. Here, we report a case of a 52-year-old man who was diagnosed with GBS in SCLC with chemotherapy.…”

Subcutaneous metastasis of a pulmonary carcinoid tumor

“…Patients with neuroendocrine tumors can be diagnosed in 10% of the cases based on a wide variety of paraneoplastic syndromes. [ 9 ] Biochemical testing should be carried out in consideration of clinical symptoms and features including as appropriate 24 hours urine 5-HIAA, adrenocorticotropic hormone, and growth hormone releasing hormone. [ 1 ] Our patient did not present evidence of paraneoplastic syndrome at diagnosis or at time of the progression.…”