Clinical improvement of membranous nephropathy after endoscopic resection of double early gastrointestinal cancers

Abstract

A-52-year-old man presented to our hospital with nephrotic syndrome caused by membranous nephropathy. Early gastric adenocarcinoma confined to the submucosa, and well-differentiated adenocarcinoma in a sigmoid adenoma were detected by screening endoscopy. Two years after complete endoscopic resection of these tumors, the estimated 24-h urinary protein excretion decreased, and serum total protein and albumin returned to their normal levels although he had no immunosuppressive therapy. Thus, this case was considered to be a case of secondary membranous nephropathy to cancer, although whether the pathogenesis was due to circulating or in situ immune complexes is unknown. The suspected antigen component of this immune complex can include carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9). In our patient, however, serum CEA and CA19-9 were within normal values during the clinical course, and detected cancers were early stage and very small. Recently, the existence of anti-mucin 1 (MUC1) antibodies before carcinogenesis and their usefulness for early detection of cancer were reported. We tried to stain tumors and glomeruli for MUC1 but, although we had positive findings in both tumors but not in glomeruli, the role of MUC1 in the pathogenesis of membranous nephropathy is unknown. To the best of our knowledge, paraneoplastic nephrosis caused by double early cancers expressing MUC1 in the gastrointestinal tract has not been previously reported.

Nephrotic Syndrome Related to Early Gastric Cancer

“…In several studies on gastric cancer, nephrotic syndrome showed signs of regression after endoscopic or surgical resection of the gastric cancer. 2,17,18 In these studies, the advanced 2 and early gastric cancer 17 cases, nephrotic cancer was shown to regress in the case of complete surgical removal of the tumor, and for only the case of case 18 did the nephrotic cancer show signs of re-gression after complete endoscopic removal. So, the relationship between early gastric cancer that performed ESD and glomerulonephritis not enough to elucidated, still more studies are needed.…”

Membranous nephropathy in a patient with pulmonary tuberculosis infection and lung adenocarcinoma: a case report

“…An interesting finding in our case was the enlargement of paraaortic lymph nodes. Metastasis of gastrointestinal malignancy and malignant lymphoma were initially suspected, both of which are potential secondary causes of MN [20,21]. Given the absence of gastrointestinal tumors on the CT scan and upper and lower gastrointestinal endoscopies, we excluded the diagnosis of gastrointestinal malignancies and followed up on the patient as having a possible case of indolent lymphoma.…”