Sensomotorische Polyneuropathie und systemische Amyloidose als paraneoplastische Symptome eines karzinoidartig differenzierten Mammakarzinoms

Krüger, Stefan; Kreft, B; Heide, Wolfgang; Siebel, U; Djonlagić, H.; Reusche, E.

doi:10.1055/s-2007-1023924

Cited by 5 publications

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“…A paraneoplastic etiology has been proposed for some neuropathies [3, 7,13] but unlike with other tumors [11], a paraneoplastic vasculitic neuropathy (VN) has never been described with carcinoid. We describe a patient with metastatic carcinoid tumor who developed a VN in conjunction with increasing tumor activity.…”

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Paraneoplastic vasculitic neuropathy related to carcinoid tumor

2008

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LETTER TO THE EDITORSJON 2825 muscle groups. Cutaneous sensibility was diminished in the right ulnar and left median distribution and in both feet. Vibratory perception was reduced at the toes, ankles and knees but proprioception was normal. Reflexes were trace at the knees and ankles but were normal in the arms. Toes were flexor.Serum chromogranin A and serotonin levels were elevated at 464 ng/ml (Normal: 0-76 ng/ml) and 602 ng/ml, respectively. A slight elevation of the β fraction and slight reduction in the γ fraction was seen on serum immunofixation electrophoresis. ANCA IgG was < 1:16 and anti-nuclear antibody < 1. Bone marrow aspirate and biopsy showed 2 % plasma Sirs: Non-metastatic neuromuscular complications of carcinoid include a neuropathy, serotonin-related myopathy and inflammatory myopathy [1, 3, 4, 6-8, 10, 11, 13-15]. A paraneoplastic etiology has been proposed for some neuropathies [3, 7, 13] but unlike with other tumors [11], a paraneoplastic vasculitic neuropathy (VN) has never been described with carcinoid. We describe a patient with metastatic carcinoid tumor who developed a VN in conjunction with increasing tumor activity. Tumor resection led to stabilization of the VN suggesting a paraneoplastic etiology.A 71 year old male developed symmetric painless proximal leg weakness over three days in February 2004. He also developed episodic palpitations, sweating and chest pain -symptoms which were later recognized as carcinoid syndrome. He was seen by us in September 2004 and reported acute onset of severe pain, weakness and numbness in the right hand, in the ulnar distribution. Examination revealed atrophy of the ulnar innervated muscles of the right hand (first dorsal interosseus MRC grade 3.5). Strength was normal in other cells. CSF analysis showed protein level of 69 mg/dl but was otherwise unremarkable. Anti-ENA antibodies, rheumatoid factor, complement levels, hepatitis B and C serology, serum cryoglobulin levels and antineuronal antibodies were unremarkable.Abdominal CT scan showed a small soft tissue structure in the small bowel mesentery which, on biopsy, showed a well-differentiated endocrine tumor that was positive for chromogranin, synaptophysin and cytokeratin 20 and negative for cytokeratin 7 supporting the diagnosis of a carcinoid tumor. Octreoscan revealed increased

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Paraneoplastic vasculitic neuropathy related to carcinoid tumor

2008

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P

Woolliscroft

1999

Diagnose- Und Therapielexikon Für Den Hausarzt

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Amyloidosis of the breast

et al. 2002

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We report on three cases of amyloidosis of the breast, two of which coincided with breast cancer. Patient no. 1, a 60-year-old woman, presented with two mass lesions measuring 2 cm in diameter, one in each breast. Histologically, a tubulo-lobular carcinoma was found in the left breast accompanied by vascular, interstitial, and periductal amyloid deposits; the lesion in the right breast consisted of amyloid deposits only. Patient no. 2, an 86-year-old woman, presented with an ulcerated breast tumor measuring 5 cm in diameter on the left side. A poorly differentiated invasive ductal carcinoma was found in the mastectomy specimen, and it coincided with interstitial and vascular amyloid deposits. In both patients, tumor cells had invaded the amyloid deposits. Patient no. 3, a 73-year-old woman, presented with a mass measuring 5 x 3 x 3 cm in her left breast. Fibrocystic changes, as well as interstitial and periductal amyloid deposits, were found histologically. In each case electron microscopy showed rigid, non-branching fibrils of indefinite length and measuring 10-12 nm in diameter; these were consistent with amyloid fibrils. Clinical data, immunohistochemistry, and/or amino acid sequencing of the fibril proteins extracted from formalin-fixed and paraffin-embedded tissue specimens provided evidence that the amyloid deposits were of immunoglobulin light chain origin in all three cases. A review of the literature revealed that kappa-light chain has been described more frequently than lambda-light chain in the breast and that there are no specific clinical or radiological symptoms of amyloidosis affecting the breast; a diagnosis can be achieved only by histology.

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Sensomotorische Polyneuropathie und systemische Amyloidose als paraneoplastische Symptome eines karzinoidartig differenzierten Mammakarzinoms

Abstract: In case of amyloidosis and polyneuropathy of uncertain cause a paraneoplastic pathogenesis should be considered in the differential diagnosis, even in the absence of proven malignancy.

Cited by 5 publications

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Paraneoplastic vasculitic neuropathy related to carcinoid tumor

Paraneoplastic vasculitic neuropathy related to carcinoid tumor

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Amyloidosis of the breast

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