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Paraneoplastic Syndromes

  1. That can't be explained by local or distant spread of tumor or by elaboration of hormones:
  2. indigenous to tissue from which tumor arose.        .
  3. Occurs 10% of pts with malignant disease
  4. Earliest manifestation. Significant clinical problem; may mimic Metastatic disease
Table: Paraneoplastic syndromes caused by ectopic hormone production
Clinical Syndromes Major Forms of Underlying Cancer Causal Mechanism
1. Endocrinopathies    
Cushing syndrome Small-cell carcinoma of lung ACTH or ACTH-like substance

Pancreatic carcinoma  

Neural tumors  
Syndrome of inappropriate antidiuretic hormone secretion Small-cell carcinoma of lung; intracranial neoplasms Antidiuretic hormone or atrial natriuretic hormones
Hypercalcemia Squamous cell carcinoma of lung Parathyroid hormone-related protein, TGF-α, TNF, IL-1

Breast carcinoma  

Renal carcinoma  

Adult T-cell leukemia/lymphoma  

Ovarian carcinoma  
Hypoglycemia Fibrosarcoma Insulin or insulin-like substance

Other mesenchymal sarcomas  

Hepatocellular carcinoma  
Carcinoid syndrome Bronchial adenoma (carcinoid) Serotonin, bradykinin

Pancreatic carcinoma  

Gastric carcinoma  
Polycythemia Renal carcinoma Erythropoietin

Cerebellar hemangioma  

Hepatocellular carcinoma  
2. Nerve and Muscle Syndrome    
Myasthenia Bronchogenic carcinoma Immunologic
Disorders of the central and peripheral nervous systems Breast carcinoma  
3. Dermatologic Disorders    
Acanthosis nigricans Gastric carcinoma Immunologic; secretion of epidermal growth factor

Lung carcinoma  

Uterine carcinoma  
Dermatomyositis Bronchogenic, breast carcinoma Immunologic
4. Osseous, Articular, and Soft-Tissue Changes    
Hypertrophic osteoarthropathy and clubbing of the fingers Bronchogenic carcinoma Unknown
5. Vascular and Hematologic Changes    
Venous thrombosis (Trousseau phenomenon) Pancreatic carcinoma
Bronchogenic carcinoma
Tumor products (mucins that activate clotting)

Other cancers  
Nonbacterial thrombotic endocarditis Advanced cancers Hypercoagulability
Anemia Thymic neoplasms Unkown
6. Others    
Nephrotic syndrome Various cancers Tumor antigens, immune complexes

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