Paraneoplastic Syndromes

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. hormone precursors. hormone like substances) ± Modulation of the immunesystem (autoimmunity. immune supression) . immune complex production.

Endocrine PNS ‡ Aberrant hormonal production by the tumor ± Hypercalcemia ‡ Related to circulating hormones ‡ Localized osteolytic hypercalcemia ± Hypercortisolism ‡ Ectopic production of corticotropin releasing-homone ‡ Ectopic production ACTH ± Hyperplasi aof adrenal cotex ± Inappropiate ADH production .

Endocrine PNS ‡ 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 .

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± 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) .Endocrine PNS ‡ Cushing¶s Syndrome ± Adrenal carcinoma (cortisol) more common with benign adrenal processes.

Carcinoid tumors of the bowel . bradykinin or histamine produced by the tumor ‡ Bronchial carcinoids.Paraneoplastic syndromes ‡ Syndrome of innapropiate Serotonine production ± Carcinoid syndrome . Pancreatic carcinoma.Caused by serotonin.

Hepatocarcinoma ± Acanthosis nigricans ± Paraneoplastic leukocytosis ± Facsiitis-panniculitis syndrome .Paraneoplastic Syndromes ‡ Syndromes of inappropiate growyh factor production ± Hypoglycemia . Cerebellar hemangioma.caused by tumor overproduction of insulin or insulin like activities ‡ Fibrosarcoma.

. poor prognostic sign in sarcomas. indicates dissemination ‡ Likely caused by response to necrotic tumor cells and/or immune response to necrotic tumor proteins.RCC asociated Paraneoplastic Syndromes ‡ Fever ± 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.

caused by tumor production of erythropoietins ‡ Stauffer s syndrome ± Hepatitis with lymphocytic infiltration .caused by inappropiated renin production ‡ Polycythemia .RCC asociated Paraneoplastic Syndromes ‡ Hypertension.

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