Giant cell arteritis and polymyalgia rheumatica as first manifestation of typical pulmonary carcinoid tumor

Abstract

summary Giant cell arteritis (GCA), a systemic vasculitis of unknown origin, may appear rarely as a paraneoplastic syndrome. Cases secondary to pulmonary neuroendocrine tumors have not been reported. A 75-year-old female developed prednisone-responsive GCA/polymyalgia rheumatica (PMR) shortly followed by syndrome of inappropriate antidiuretic hormone secretion. An 8 mm carcinoid lung tumor with positron emission tomography normal uptake was found. After a thoracoscopic tumor resection the patient experienced complete clinical and laboratory remission. This is the first report of GCA with PMR in the context of carcinoid lung tumor. It emphasizes the role of paraneoplastic vasculitis as a possible cause of GCA.

The real evidence for polymyalgia rheumatica as a paraneoplastic syndrome

“…Whilst it is difficult to make sense of the case report literature in a systematic way, there are some cancers that are frequently encountered in relation to PMR in this literature; leukaemias (24,(27)(28)(29)(30), myelomas (30)(31)(32)(33)(34)(35)(36), lymphomas (30,(37)(38)(39)(40) and lung cancer (41)(42)(43)(44)(45). Whilst we know that there is likely to be substantial publication bias in relation to case reports, it is not known what impact this might have.…”

Paraneoplastic giant cell arteritis and prostate cancer: A case report of a not common association

“…4 The available studies show that this association is more frequently found in hematologic cancers and to a lesser extent in solid cancers (lung, prostate, colon, breast, and kidney). 4 Ji followed 3941 patients admitted with CGA and polymyalgia rheumatica and found an incidence excess of 19% of cancer in those patients, mostly in the first year after the diagnosis but found no excess of mortality. 5 In a retrospective study, Deshayes did not found association between any particular cancer type and GCA but found that only 4% ran a paraneoplastic course.…”

“…The association between vasculitis and cancer is not well defined. It appears to be an immune response disturbance in GCA that might predispose to cancer or relapsing disease 4 . The available studies show that this association is more frequently found in hematologic cancers and to a lesser extent in solid cancers (lung, prostate, colon, breast, and kidney) 4 .…”

“…3 This association has been described mostly with small vessel vasculitis or leukocytoclastic vasculitis. 4 Its appearance may precede or overlap the cancer diagnosis, or herald disease progression. 3…”

“…Some types of vasculitis are more prone to be related with cancer, but this relationship is rare and paraneoplastic vasculitis represents only 5% 3 . This association has been described mostly with small vessel vasculitis or leukocytoclastic vasculitis 4 . Its appearance may precede or overlap the cancer diagnosis, or herald disease progression 3…”