Paraneoplastic Vasculitis in a Patient with Cervical Cancer

Abstract

Východiská: Paraneoplastické syndrómy často predchádzajú dia gnózu malignity. Ich včasná dia gnostika môže viesť ku skorému rozpoznaniu okultného karcinómu ešte v kuratívnon štádiu. Diferenciálna dia gnostika zriedkavej paraneoplastickej vaskulitídy vyžaduje multidisciplinárnu spoluprácu medzi internistami-reumatológmi, rádiodia gnostikmi a onkológmi. Prípad: 41-ročná pacientka s karcinómom cervixu uteru IVB štádium (paraaortálna lymfadenopatia) s klinickými i rádiologickými známkami akútnej vaskulitídy bola prijatá na naše oddelenie k onkologickej liečbe. Začalo sa s chemorádioterapiou, súčasne bola podávaná kortikoterapia. Počas liečby sme pozorovali zmiernenie príznakov vaskulitídy. Pri ďalších dispenzárnych kontrolách sa stav pacientky viac nezlepšoval, čo nás viedlo k podozreniu relapsu malígneho ochorenia, ktoré sa potvrdilo CT vyšetrením. Zahájená paliatívna chemoterapia však nepriniesla očakávaný efekt a kvôli zhoršujúcemu sa výkonnostnému stavu bola ukončená. Záver: Aktivita vaskulitídy bola u našej pacientky pomerne úzko spojená s aktivitou malígneho ochorenia. Rozpoznanie paraneoplastického syndrómu má význam nielen v dia gnostike malignity, ale aj počas dispenzárnych kontrol. Kľúčová slová karcinóm krčka maternice-paraneoplastický syndróm-vaskulitída-angiografi a Summary Background: Paraneoplastic syndromes precede the dia gnosis of malignancy. Early detection of paraneoplastic syndrome may lead to detection of malignancy in its early and potencially curable stage. Diff erential dia gnostic process of rare paraneoplastic vasculitis requires multidisciplinar cooperation between rheumatologists, radiologists and oncologists. Case: 41-year-old female patient with cervical cancer in stage IVB (paraaortic lymphadenopathy) and clinical symptoms of acute vasculitis was admitted to our ward for oncological treatment. Chemoradiotheraphy was initiated concurently with corticotherapy. During the treatment we observed alleviation of vasculitis-related symptoms. Ongoing follow-up, however, brought no further improvement in vasculitis-related symptoms. This lead us to suspiction of recurrence, confi rmed on CT scan. Paliative chemotherapy was without any eff ect and due to worsening performance status was terminated. Conclusion: The activity of vasculitis was closely associated with the activity of primary malignant disease. Early recognition of paraneoplastic syndrome may contribute not only to dia gnosis of malignancy, but is helpfull during follow-up of these patients.

Dermatomyositis presenting as heart failure revealed a concealed cervical malignancy: an infrequent clinical nexus

“…Our patient had SCC of cervix which is the second most common cancer among women in India 12. Despite its higher prevalence, paraneoplastic dermatological manifestations associated with cervical cancer is rare 13–19. A nationwide study done among 1012 DM patients in Taiwan revealed only 3 patients having cervical cancer 11.…”