Some Unusual Paraneoplastic Syndromes

Abstract

S o m e U n u s u a l P a r a n e o p l a s t i c S y n d r o m e s CASE 1. METASTATIC SQUAMOUS CELL ESOPHAGEAL CANCER TO THE THUMBA 56-year-old white male was received in our outpatient clinic because of slight pain and swelling on the thumb of his left hand. The patient reported a history of trauma with a fishhook 3 days earlier but recognized that the finger was already swollen for a week. The symptoms were confined to the distal phalanx of the thumb, and on examination, it had an inflammatory aspect (Fig 1). He had been diagnosed 3 months earlier with squamous cell esophageal carcinoma with metastatic supraclavicular lymph nodes. He was treated with palliative radiotherapy and cisplatin-fluorouracil chemotherapy. A complete regression of the supraclavicular nodes and a resolution of the dysphagia were obtained.A radiograph of the thumb (Fig 2) showed destruction of the distal phalanx with soft-tissue tumor and lytic lesions in the proximal phalanx. A biopsy was performed, revealing metastatic squamous cell carcinoma. Recurrence of the esophageal tumor was detected by endoscopic examination, and it was the only evidence of disease relapse after work-up. The pain was controlled with nonsteroidal analgesics, but the patient developed recurrent dysphagia and started second-line chemotherapy.Bone metastases are frequent in cancer patients; however, acrometastases or metastases to the hand and foot are rare. Acrometastases have been reported in a variety of malignancies, such as breast, lung, gastrointestinal, and genitourinary tract, especially renal cell carcinoma. 1 In some cases, it can be the first manifestation of an occult cancer. 2,3 A biopsy must be performed to confirm the diagnosis because many cases are often mistaken for benign processes, such as infection or inflammatory arthritis.

Calcinosis Cutis and Calciphylaxis in Autoimmune Connective Tissue Diseases

“…DM has been associated with the occurrence of malignancies in 13–42% of cases [ 79 ]. In this view, it is important to consider that calcinosis may be an unusual but possible paraneoplastic manifestation mainly associated with some hematological neoplasms [ 80 ]. In addition, two cases of malignancies (i.e., osteosarcoma and extranodal B-cell lymphoma) arising from an area of JDM-associated calcinosis have been described [ 81 , 82 ], showing that the [ 81 ] malignant transformation of benign heterotopic bone is extremely rare but possible.…”

Calcinosis Prevalence in Autoimmune Connective Tissue Diseases—A Retrospective Study

“…Associated autoantibodies were anti-NXP2/MJ and PM/Scl [ 84 , 90 ]. Calcinosis in DM may be a paraneoplastic sign, especially in hematologic diseases [ 92 ], and extremely rare malignant tumors may originate from calcinosis lesions [ 93 , 94 ].…”