Clinical and radiological manifestations of paraneoplastic syndrome of bronchogenic carcinoma

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ǖǠǜǢǚǟǚǡǠǢǗǞǗǼǑǹǚƶǓǗǼǠǹǔǢǥǡǚǣǗƲưƴǚǣǡǠǺǚǠǤǠǜǠǞǤǢǑǹǑǻǑǞǑǝǚǔǟǗǒǠǝǗǣǤǚǑǥǞǑǻǠǹǹǗǡǢǗǤǧǠǖǚǠǻǗǔǠǓǠǹǜǝǚǟǚǩ ǜǠǹǡǠǤǓǢǖǚƯǑǟǚǦǗǣǤǑǨǚǹǗƲưƴǣǥǣǗǡǠǤǡǥǟǠǚǝǚǓǗǼǚǞǖǗǝǠǞǡǠǓǥǜǝǗǡǠǣǝǗǝǗǩǗǻǑƭƣǖǑǒǚǣǗǡǠǟǠǓǠǹǑǓǚǝǗǣǡǠǔǠǢ ǪǑǻǗǞǒǠǝǗǣǤǚƭǑǢǨǚǟǠǞǞǑǝǚǧǼǗǝǚǹǑǹǗǒǚǠǙǑǣǤǥǡǺǗǟǜǠǖǒǠǝǗǣǟǚǜǑǣǑƲưƴǞǑǖǑǣǥǒǚǝǚǙǑǣǤǥǡǺǗǟǚǚǠǣǤǑǝǚǧǚǣǤǠǝǠ ǪǜǚǤǚǡǠǓǚƳǑǖǚǠǝǠǪǜǚǟǑǝǑǙǚǣǥǙǟǑǩǑǹǟǚǙǑǖǚǹǑǔǟǠǣǤǚǜǠǓǑǻǗǜǑǢǨǚǟǠǞǑǒǢǠǟǧǑǜǠǖǑǣǚǞǡǤǠǞǑǤǣǜǚǧǒǠǝǗǣǟǚǜǑǣǑƲưƴ ǚǥǣǞǗǢǑǓǑǻǗǜǝǚǟǚǩǜǠǔǑǝǔǠǢǚǤǞǑ

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»Ñ ÅÎÓÑ¨Î¿Ö§ÑÒÎÔ Rosai-Dorfman) sindrom

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TABELA 2. ƳǑǖǚǠǝǠǪǜǗ ǞǑǟǚǦǗǣǤǑǨǚǹǗ ǡǑǢǑǟǗǠǡǝǑǣǤǚǩǟǚǧ ǣǚǟ ǖǢǠǞǑǜǠǖǒǢǠǟǧǠǔǗǟǠǔǜǑǢǨǚǟǠǞǑ

TABLE 2. Radiologic manifestations of paraneoplastic syndromes in bronchogenic carcinoma. ƨǟǖǠǜǢǚǟǚǗǦǗǜǤǚ Endocrine effects ƭǠǢǤǚǜǠǤǢǠǡǟǚ Corticotropic ƥǠǟǑǖǠǤǢǠǡǟǚ Gonadotropic ƳǑǖǚǠǝǠǪǜǚǟǑǝǑǙǚ Radiological findings ƢǖǢǗǟǑǝǟǑǜǠǢǤǗǜǣǟǑǧǚǡǗǢǡǝǑǙǚǹǑ Adrenal cortical hyperplasia (1) ƥǚǟǗǜǠǞǑǣǤǚǹǑǑǤǢǠǦǚǹǑǤǗǣǤǚǣǑ Gynecomastia, testicular atrophy (2)

ƤǗǙǚǓǟǠǤǜǚǓǟǚ ǗǦǗǜǤǚ Connective tissue effects ƳǠǙǑǚƧǠǢǦǞǑǟǠǓǣǚǟǖǢǠǞ Rosai-Dorfman Syndrome ƲǹǗǢƯǑǢǚƣǑǞǒǗǢǔǗǢǠǓǣǚǟǖǢǠǞ Pierre-Marie-Bamberger Syndrome ƱǒǠǣǤǢǑǟǚǗǔǙǠǦǤǑǝǞǥǣ Bilateral exophtalmos ƳǑǖǚǠǝǠǪǜǚǟǑǝǑǙǚ Radiological findings ƶǓǗǼǑǟǚǝǚǞǦǟǚǩǓǠǢǠǓǚǓǢǑǤǑ Enlarged cervical lymph nodes (2) ƣǑǤǚǩǑǣǤǚǡǢǣǤǚ

Clubbed fingers (6) ƸǚǡǗǢǡǗǢǚǠǣǤǠǙǑ Hyperperiostosis (2)

ƯƳǠǢǒǚǤǑǑǖǚǡǠǙǟǑǠǦǤǑǝǞǠǡǑǤǚǹǑ MR orbits: adipose ophtalmopathy (1)

ƶǙǑǔǢǑǖǑǞǑǹǗǠǙǟǑǩǗǟǒǢǠǹǒǠǝǗǣǟǚǜǑ * In parentheses is noted a number of the patients

TABELA 1.ƭǝǚǟǚǩǜǗǞǑǟǚǦǗǣǤǑǨǚǹǗǡǑǢǑǟǗǠǡǝǑǣǤǚǩǟǠǔǣǚǟǖǢǠ ǞǑǜǠǖǒǢǠǟǧǠǔǗǟǠǔǜǑǢǨǚǟǠǞǑ

TABLE 1. Clinical manifestations of paraneoplastic syndrome of bron-chogenic carcinoma.

ƨǟǖǠǜǢǚǟǚǗǦǗǜǤǚ

Endocrine effects

ƢǟǤǚǖǚǥǢǗǤǣǜǚǧǠǢǞǠǟ Antidiuretic hormone (2)

ưǗǤǚǡǚǩǟǚƭǥǪǚǟǔǠǓǣǚǟǖǢǠǞ Atypical Cushing’s Syndrome (1) ưǗǞǗǤǑǣǤǑǤǣǜǑǧǚǡǗǢǜǑǝǨǗǞǚǹǑ Nonmetastatic hypercalcemia (1) ƸǚǡǠǔǝǚǜǗǞǚǹǑ Hypoglicaemia (2) ƥǚǟǗǜǠǞǑǣǤǚǹǑ Gynecomastia (2) ưǗǥǢǠǞǥǣǜǥǝǑǢǟǚ ǗǦǗǜǤǚ Neuromuscular effects ƴǥǒǑǜǥǤǟǑǣǗǟǙǠǢǟǑǟǑǥǢǠǡǑǤǚǹǑ Subacute sensory neuropathy (2) ƮǑǞǒǗǢǤƫǤǠǟǠǓǣǚǟǖǢǠǞ Lambert-Eaton Syndrome (4)

ƤǗǙǚǓǟǠǤǜǚǓǟǚ ǗǦǗǜǤǚ

Connective tissue effects

ƣǑǤǚǩǑǣǤǚǡǢǣǤǚ Clubbed fingers (6) Myalgia, Polymyositis (4)

ƢǢǤǢǑǝǔǚǹǑǣǠǤǠǜǠǞǣǜǠǩǟǚǧǙǔǝǠǒǠǓǑ ǚǜǠǝǗǟǑ

Arthralgia with swelling of ankle and knee joints (2)

ƳǠǙǑǚƧǠǢǦǞǑǟǠǓǣǚǟǖǢǠǞ Rosai-Dorfman Syndrome (2) ƱǒǠǣǤǢǑǟǚǗǔǙǠǦǤǑǝǞǥǣ Bilateral exophthalmos (1) ƯǗǤǑǒǠǝǚǩǜǚ

ǗǦǗǜǤǚ

Metabolic effects

ƸǚǡǠǜǝǗǞǚǹǣǜǑǑǝǜǑǝǠǙǑ Hypokalemic alcalosis (2)

ƸǗǞǑǤǠǝǠǪǜǚ ǗǦǗǜǤǚ Hematologic effects ƢǟǗǞǚǹǑ Anaemia (11) ƨǢǚǤǢǠǨǚǤǠǙǑ Erythrocytosis (1) ƮǗǥǜǠǨǚǤǠǙǑ Leucocytosis (14) ưǗǥǤǢǠǦǚǝǚǹǑ Neutrophilia (6) ƨǠǙǚǟǠǦǚǝǚǹǑ Eosinophilia (4) ƵǢǠǞǒǠǨǚǤǠǙǑ Thrombocytosis (6) ƴǗǖǚǞǗǟǤǑǨǚǹǑǗǢǚǤǢǠǨǚǤǑ Erytrocyte sedimentation >50 (11) ƵǢǠǞǒǠǨǚǤǠǡǗǟǚǹǣǜǑǡǥǢǡǥǢǑ Thrombocytopenic purpura (2) ƧǚǣǗǞǚǟǠǓǑǟǑǚǟǤǢǑǓǑǣǜǥǝǑǢǟǑ ǜǠǑǔǥǝǑǨǚǹǑ Disseminated intravascular coagulation (1) ƵǢǠǞǒǠǦǝǗǒǚǤǚǣ Thrombophlebitis (5) ƶǙǑǔǢǑǖǑǞǑǹǗǠǙǟǑǩǗǟǒǢǠǹǒǠǝǗǣǟǚǜǑ * In parentheses is noted a number of the patients

Ê¨®Ñ¨ÉÎÊ»Î¸Ò¨®Ñ¨¾ÑÊ¨´ÑÀÊ¨§É¿ÀÊ¨§Ñ ÃÔÑ¨À É¨ÊÑÒ¨»Ñ ³¸¨»Ña, b, c½ÎÃµÃÒÎ²¾Î¸ÀÒ¨»Ñ¾¨Î µ¶Î´¹¨ÔÒÊ¨É¨´ÑÒ½¶¼¨Ò²ÎÔ Cushing) sindrom

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neadekvatne sekrecije antidiuretskog hormona

(3)

SLIKA 1.ƭǢǑǟǚǠǜǑǥǖǑǝǟǚǞǑǞǠǔǢǑǞǚǜǠǖǔǠǖǚǪǻǗǔǞǥǪǜǑǢ ǨǑ ǣǑ ǡǝǑǟǠǨǗǝǥǝǑǢǟǚǞ ǜǑǢǨǚǟǠǞǠǞ ǒǢǠǟǧǑ ǡǠǜǑǙǥǹǥ ǖǗǟǖǢǚǤǚ ǩǟǚǤǚǡǔǚǟǗǜǠǞǑǣǤǚǹǗǣǑǣǚǞǗǤǢǚǩǟǚǞǢǑǣǡǠǢǗǖǠǞǡǢǠǝǚǦǗǢǚ ǣǑǟǚǧǖǥǜǤǥǣǑǚǙǑǞǑǞǚǝǑǖǠǹǜǚ

FIGURE 1. Craniocaudal mammograms of a 57-year-old man with pla-no-cellular bronchogenic carcinoma show dendritic pattern of gyne-comastia with symmetrical distribution of ductal proliferation posteri-or to nipple.

SLIKA 2.ƭǢǑǟǚǠǜǑǥǖǑǝǟǚǞǑǞǠǔǢǑǞǚǜǠǖǔǠǖǚǪǻǗǔǞǥǪǜǑǢ ǨǑǣǑǣǚǤǟǠǼǗǝǚǹǣǜǚǞǜǑǢǨǚǟǠǞǠǞǒǢǠǟǧǑǡǢǚǜǑǙǥǹǥǠǒǠǣǤǢǑǟǥǔǚ ǟǗǜǠǞǑǣǤǚǹǥǣǑǟǠǖǥǝǑǢǟǠǖǗǟǖǢǚǤǚǩǟǠǞǧǚǡǗǢǡǝǑǙǚǹǠǞǢǗǤǢǠǞǑ ǞǚǝǑǢǟǠǥǙǟǑǔǝǑǪǗǟǥǟǠǖǥǝǑǢǟǠǣǤǥǖǗǣǟǠǹǖǠǹǨǚ

FIGURE 2. Craniocaudal mammograms of a 69-year-old man with small-cell bronchogenic carcinoma show bilateral gynecomastia with nodular-dendritic hyperplasia beneath nipple and accentuated nodu-larity in the right breast.

SLIKA 3.ƶǝǤǢǑǙǓǥǩǟǚǟǑǝǑǙǖǗǣǟǗǖǠǹǜǗǜǠǖǚǣǤǠǔǒǠǝǗǣǟǚǜǑǡǢǚ ǜǑǙǥǹǗǟǠǖǥǝǑǢǟǠǖǗǟǖǢǚǤǚǩǟǚǤǚǡǔǚǟǗǜǠǞǑǣǤǚǹǗ

FIGURE 3. Ultrasound of the right breast in the same patient shows nodular-dendritic type of gynecomastia.

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(4)

SLIKA 5.ƶǡǠǢǗǖǟǚǣǟǚǞǨǚǡǠǖǝǑǜǤǚǨǑ a_{ǡǠǤǜǠǝǗǟǚǨǑ}b_{ǚǣǤǠǡǑǝǑ}c_{ǜǠǖǔǠǖǚǪǻǗǔǞǥǪǜǑǢǨǑǡǢǚǜǑǙǥǹǥǧǚǡǗǢǡǗǢǚǠǣǤǠǙǥǖǥǘǖǚǹǑ} ǦǚǙǑǜǠǣǤǚǹǥǗǜǣǤǢǗǞǚǤǗǤǑǚǥǙǤǥǒǥǝǟǗǜǠǣǤǚǣǤǠǡǑǝǑ ǧǚǡǗǢǤǢǠǦǚǩǟǑǡǥǝǞǠǟǑǝǟǑǠǣǤǗǠǑǢǤǢǠǡǑǤǚǹǑ=ƲǹǗǢƯǑǢǚƣǑǞǒǗǢǔǗǢǠǓǣǚǟǖǢǠǞ FIGURE 5. Parallel radiographs of the forearms (a), the lower legs (b) and the feet (c) in a 43-year-old man show periosteal hyperperiostosis along all long and tubular bones (hypertrophic pulmonary osteoarthropathy – Pierre-Marie-Bamberger Syndrome).

SLIKA 6. ƶǝǤǢǑǙǓǥǩǟǚ ǡǢǗǔǝǗǖ ǟǑǖǒǥǒǢǗǘǟǚǧ ǘǝǗǙǖǑ ǠǤǜǢǚǓǑ

ǻǚǧǠǓǥǠǒǠǣǤǢǑǟǥǧǚǡǗǢǡǝǑǙǚǹǥ

FIGURE 6. Ultasound showing bilateral hyperplasia of the adrenal glands.

di se da je kod mikrocelularnog KB povišen nivo

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(5)

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LITERATURA

1. Beckles MA, Spiro SG, Colice GL, Rudd RM. Initial evaluation of the patients with lung cancer symptoms, signs, laboratory tests and paranaoplastic syndromes. Chest 2003; 123(Suppl 1):97S-104S. 2. Richardson GE, Johnson BE. Paraneoplastic syndromes in lung

cancer. Curr Opin Oncol 1992; 4(2):323-33.

3. Patel AM, Davila DG, Peters SG. Paraneoplastic syndromes asso-ciated with lung cancer. Mayo Clin Proc 1993; 68:278-87. 4. Grunwald GB. Autoimmune paraneoplastic syndromes. In:

Fish-man AP, editor. Update pulmonary diseases and disorders. New York, NY: McGraw Hill; 1992. p.137-46.

5. Radosavljević-Ašić G. Tumori pluća. In: Sekulić S, editor. Plućne bolesti. Beograd: Elit Medica; 2000. p.555-73.

6. Maddison P, Newson-Davis J, Mills KR, et al. Favourable progno-sis in Lambert-Eaton Myastenic Syndrome and small-cell carcino-ma. Lancet 1999; 353:117-8.

7. Gomez-Uria A, Payinos AG. Syndromes resulting from ectopic hormone-producing tumors. Med Clin North Am 1975; 59:431-40.

8. Mendelsohn G, Baylin SB. Ectopic hormone production: biologi-cal and clinibiologi-cal implications. Prog Clin Biol Res 1984; 142:291-316.

9. Popović V. Diabetes insipidus – poremećaj balansa vode. In: Slijepčević D, et al. Urgentna endokrinologija. Beograd: Savreme-na administracija; 1997. p.3-15.

10. Moses AM, Scheinman SJ. Ectopic secretion of neurohypophyseal peptides in patients with malignancy. Endocrinol Metabol Clin North Am 1991; 20:489-506.

11. List AF, Hainsworth JD, Davis BM, et al. The syndrome of inappro-priate secretion of antidiuretic hormone (SIADH) in small-cell lung cancer. J Clin Oncol 1986; 4:1191-8.

12. Johnson BE, Chute JP, Rushin J, et al. A prospective study of patients with lung cancer and hyponatremia of malignancy. Am J Respir Crit Care Med 1997; 156:1669-78.

13. Martin TJ, Mosley JM, Gillespie MT. Parathyroid hormone related protein. Crit Rev Biochem Mol Biol 1991; 26:377-95.

14. Orth DN, Kovacs WJ, Deboled CR. The adrenal cortex. In: Wilson JD, Foster DF, editors. William’s Textbook of Endocrinology. 8th ed. Philadelphia: WB Saunders Co; 1992. p.489-619.

15. Jančić-Zguricas M, Spužić I, editors. Osnovi onkologije. Beograd: Elit Medica; 1995. p.68-9.

16. Damjanović S. Poremećaji metabolizma kalcijuma. In: Slijepčević D, et al. Urgentna endokrinologija. Beograd: Savremena adminis-tracija; 1997. p.266-7.

17. Diacon AH, Schuurmans MM, Colesky FJ, Bolliger CT. Paraneo-plastic bilateral proptosis in a case of non-small cell lung cancer. Chest 2003; 123(2):627-9.

18. Luttenbach J, Henne K, Pagenstecher A, Bohm J. Lung cancer and Rosai-Dorfman’s Disease. A clinico-pathological study. Strahlenter Onkol 2003; 179(7):486-92.

19. Yapp RG, Siegel JH. Unexplained biliary tract dilation in lung can-cer patients (PNS). Endoscopy 1992; 24(6):593-5.

20. Saito H. Paraneoplastic Syndrome-haematologic abnormalities. Gan To Kagoki Ryoho 1991; 18(3):337-42.

21. Fietz T, Schneider P, Knauf WU, Thiel E. Clubbed fingers and arthralgia as a reversible Paraneoplastic Syndrome (Pierre-Marie-Bamberger Syndrome) in non-small-cell carcinoma. Dtsch Med Wochenschr 1998; 123(50):1507-11.

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ABSTRACT

The objective of this study was to present some clinical and radiological manifestations of PNS in relation to bronchogenic carcinoma (BC) and to evaluate the usefulness of imaging find-ings in the diagnosis of asymptomatic BC. In the study group of 204 patients (146 male and 58 female) with proven bron-chogenic carcinoma, PNS was present in 18 (8.62%) patients. The patients with PNS were divided into two groups. The first one consisted of 13 (72.2%) patients with symptoms related to primary tumours while the second one consisted of 5 (27.7%) patients with symptoms, at initial appearance, indicative of dis-orders of other organs and systems. The predominant disor-der was Lambert-Eaton Syndrome, associated with small-cell carcinoma. Endocrine manifestations included: inappropriate antidiuretic hormone production syndrome (small-cell carci-noma), a gonadotropin effect with gynaecomastia and testic-ular atrophy (planocelltestic-ular carcinoma, small-cell carcinoma), a case of Cushing Syndrome (small-cell carcinoma), and hyper-calcaemia, due to the production of the parathyroid hormone-related peptide, which was associated with planocellular carci-noma. A rare case of bilateral exophthalmos was found as PNS at adenocarcinoma. Digital clubbing and hypertrophic

osteo-arthropathy (HO) were associated with planocellular and ade-nocarcinoma, while clubbing was much more common than HO, especially among women. The differences between the two groups were related to the time of PNS appearance. In the first group, PNS occurred late on in the illness, while in the sec-ond group, PNS preceded the diagnosis of BC. Alternatively, the disappearance of a clinical or a radiological manifestation of PNS after surgery or chemotherapy may be an indicator of an improvement in health or PNS may be the first sign of illness recurrence. Radiological manifestations of PNS in asymptomat-ic patients may serve as a useful screen for identifying primary BC. In symptomatic patients, it may be an indicator of a higher likelihood of metastatic disease.

Key words: bronchogenic carcinoma; paraneoplastic syn-drome

Branislav GOLDNER Gočka 4, 11000 Beograd Tel: 011 2321 777 E-mail: goldy@ptt.yu

CLINICAL AND RADIOLOGICAL MANIFESTATIONS OF

PARANEOPLASTIC SYNDROME OF BRONCHOGENIC CARCINOMA

Branislav GOLDNER1_{, Zorica MILOŠEVIĆ}2_{, Sead SADIKOVIĆ}3_{, Milan STOJANOVIĆ}4 1_{School of Medicine, University of Belgrade, Belgrade;}2_{Diagnostic Imaging Centre,} Clinical Hospital Centre “Bežanijska Kosa”, Belgrade; 3_{Health Centre, Prijepolje;}4_{Health Centre, Berane}