immune complex production. hormone precursors.Paraneoplastic syndromes
A colection of symptoms and clinical signs ocurring in cancer patients and involving systemic effects taking place in remote sites of the tumor Originates from
± Biologically active substances(hormones. immune supression)
. hormone like substances) ± Modulation of the immunesystem (autoimmunity.
Aberrant hormonal production by the tumor
Related to circulating hormones Localized osteolytic hypercalcemia
Ectopic production of corticotropin releasing-homone Ectopic production ACTH
± Hyperplasi aof adrenal cotex
± Inappropiate ADH production
Hypercalcemia (Cancer is the most common
cause of hypercalcemia by either humoral or metastatic mechanisms) ± Squamous cell lung cancer (PTH-like peptide) ± Renal cell carcinoma (prostaglandins) ± Parathyroid carcinoma (PTH) ± Multiple myeloma and T-cell lymphoma (IL-1 and perhaps TGF-E) ± Breast carcinoma. usually by bone metastasis
± Small cell undifferentiated lung cancer (ACTH) released through cleavage of proopiomelano-cortin gene product. Inappropriate ADH syndrome (Hyponatremia) ± Small cell undifferentiated lung cancer (vassopressin-like hormone) ± Hypothalamic tumors (vasopressin)
Cushing¶s Syndrome ± Adrenal carcinoma (cortisol) more common with benign adrenal processes.
Caused by serotonin.Paraneoplastic syndromes
Syndrome of innapropiate Serotonine production
± Carcinoid syndrome . bradykinin or histamine produced by the tumor
Bronchial carcinoids. Carcinoid tumors of the bowel
. Pancreatic carcinoma.
caused by tumor overproduction of insulin or insulin like activities
Fibrosarcoma. Cerebellar hemangioma.Paraneoplastic Syndromes
Syndromes of inappropiate growyh factor production
± Hypoglycemia . Hepatocarcinoma
± Acanthosis nigricans ± Paraneoplastic leukocytosis ± Facsiitis-panniculitis syndrome
indicates dissemination Likely caused by response to necrotic tumor cells and/or immune response to necrotic tumor proteins.
.RCC asociated Paraneoplastic Syndromes
± Associated with bacterial infections
Common where blockage of drainage occurs Decreased immunity may play a role
± Not associated with infection
Episodic as in Pel-Ebstein fever with Hodgkin¶s lymphoma. poor prognostic sign in sarcomas.
RCC asociated Paraneoplastic Syndromes
Hypertension.caused by inappropiated renin production Polycythemia .caused by tumor production of erythropoietins Stauffer s syndrome
± Hepatitis with lymphocytic infiltration