From chronic pruritus to neuroendocrine tumor: A case report

Abstract

Chronic pruritus is a major and distressing symptom of many diseases of dermatological, neurological, psychogenic or systemic origin. This chronic itch could be a presenting sign of malignancy; therefore, paraneoplastic pruritus has also been associated with neuroendocrine tumors (NETs). This article focuses on a patient presenting with chronic pruritus for the past 12 months and who received numerous treatment schemes with very poor clinical improvement, that presented in the hospital for worsening of the chronic pruritus associated with skin rash and significant weight loss (approximately 6 kg over a 2-month period). The laboratory tests showed iron deficiency anemia, eosinophilia and negative tumor markers. In order to investigate the hypoanabolic and anemic syndromes, upper gastrointestinal endoscopy and colonoscopy, which showed no lesions or tumors, were employed. Skin biopsy was performed and antihistaminic and local steroid treatment was initiated. The patient's status worsened within a week and the patient was started on systemic steroid treatment with poor results. Computer tomography was performed to identify any tumor(s) located either in the pelvis or abdomen. A lesion was found in the terminal ileum, identified as a hypervascularized associating bulky lymphadenopathy. The patient was transferred to the surgical ward where right hemicolectomy with manual ileotransverse anastomosis L-L was performed. The histopathological result confirmed NET G2. The patient clinically improved, the skin lesions resolved and the itchiness disappeared. The general status improved significantly. NET G2 diagnosing was possible due to the atypic paraneoplastic sign: chronic pruritus. This case study highlights the association between itch and malignancy and presents an atypical way of NET presentation when all tumor markers remain negative.

Anti-amphiphysin antibody-associated paraneoplastic brainstem encephalitis with pruritus and dysphagia as the first symptoms: A case report

“…[ 11 , 12 ] Generally, paraneoplastic pruritus is caused by the lymphatic system, which occurs rarely in solid tumors. [ 13 ] Insulinoma and colon cancer have both been reported to cause paraneoplastic pruritus, [ 14 , 15 ] suggesting that paraneoplastic pruritus and neuroendocrine tumors are closely connected. Furthermore, SCLC with paraneoplastic pruritus symptoms associated with anti-Hu antibodies was reported, [ 11 ] so as a patient with prostate cancer who ultimately diagnosed with paraneoplastic brainstem encephalitis.…”

“…Additionally, tumor tissue secretes excessive interleukin-31 [ 12 ] and 5-hydroxytryptamine. [ 15 ] Paraneoplastic pruritus can also result from them.…”

Current status and perspectives of genetic testing in gastrointestinal cancer (Review)

“…While clinical assessment of GI cancer has been performed with a physical examination, blood test, imaging, and endoscopy, recent advancements in genomics have led to the development of genetic analysis for diagnosis ( 2 , 3 ). In the modern era of precision medicine, genetic testing has been incorporated into routine clinical practice to assist decision-making regarding appropriate genetically matched treatments for patients with GI cancers ( 4 ).…”