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A coin-like peripheral small cell lung carcinoma associated with acute paraneoplastic axonal Guillain-Barre-like syndrome.

Jung I, Gurzu S, Balasa R, Motataianu A, Contac AO, Halmaciu I, Popescu S, Simu I - Medicine (Baltimore) (2015)

Bottom Line: Based on the examination results, the final diagnosis was acute paraneoplastic axonal Guillain-Barre-like syndrome.At autopsy, bronchopneumonia and a right hydrothorax were confirmed.This is the 6th reported case of small cell lung cancer-associated acute Guillain-Barre-like syndrome and the first report about an association with a coin-like peripheral pattern.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Pathology (IJ, SG, AOC, SP); Department of Neurology (RB, AM); and Department of Radiology, University of Medicine and Pharmacy of Tirgu-Mures, Tirgu-Mures, Romania (IH, IS).

ABSTRACT
A 65-year-old previously healthy male heavy smoker was hospitalized with a 2-week history of progressive muscle weakness in the lower and upper extremities. After 10 days of hospitalization, urinary sphincter incompetence and fecal incontinence were added and tetraparesis was established. The computer-tomography scan examination revealed a massive right hydrothorax and multifocal solid acinar structures with peripheral localization in the left lung, which suggested pulmonary cancer. Bone marrow metastases were also suspected. Based on the examination results, the final diagnosis was acute paraneoplastic axonal Guillain-Barre-like syndrome. The patient died 3 weeks after hospitalization. At autopsy, bronchopneumonia and a right hydrothorax were confirmed. Several 4 to 5-mm-sized round peripherally located white nodules were identified in the left lung, without any central tumor mass. Under microscope, a coin-shaped peripheral/subpleural small cell carcinoma was diagnosed, with generalized bone metastases. A huge thrombus in the abdominal aorta and acute pancreatitis was also seen at autopsy. This case highlights the difficulty of diagnosis of lung carcinomas and the necessity of a complex differential diagnosis of severe progressive ascending neuropathies. This is the 6th reported case of small cell lung cancer-associated acute Guillain-Barre-like syndrome and the first report about an association with a coin-like peripheral pattern.

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Electromyographic examination. (A) Left ulnar motor study, recording on abductor digiti minimi, C8 T1; (B) right peroneus motor study, recording on Extensor digitorum brevis; (C) right ulnaris sensory study.
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Figure 1: Electromyographic examination. (A) Left ulnar motor study, recording on abductor digiti minimi, C8 T1; (B) right peroneus motor study, recording on Extensor digitorum brevis; (C) right ulnaris sensory study.

Mentions: At the electromyography examination, nerve conduction studies show completely normal sensory studies in upper and lower extremities. The motor studies were consistent with axonal loss (more severe in lower limbs): lLow amplitude, and slightly decreased velocities and altencies. The median and ulnar F responses were slightly prolonged. On needle electromyography there was evidence of distal denervation in the legs and arms, with fibrillation potentials and large, long, polyphasic motor unit action potentials with reduced recruitment. Comparing 2 controlateral muscles, the tibialis anterior and extensor digitorum, the findings were symmetric. There was electrophysiologic evidence of an active pure motor distal axonal polyneuropathy (Figure 1 and Table 2).


A coin-like peripheral small cell lung carcinoma associated with acute paraneoplastic axonal Guillain-Barre-like syndrome.

Jung I, Gurzu S, Balasa R, Motataianu A, Contac AO, Halmaciu I, Popescu S, Simu I - Medicine (Baltimore) (2015)

Electromyographic examination. (A) Left ulnar motor study, recording on abductor digiti minimi, C8 T1; (B) right peroneus motor study, recording on Extensor digitorum brevis; (C) right ulnaris sensory study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4616354&req=5

Figure 1: Electromyographic examination. (A) Left ulnar motor study, recording on abductor digiti minimi, C8 T1; (B) right peroneus motor study, recording on Extensor digitorum brevis; (C) right ulnaris sensory study.
Mentions: At the electromyography examination, nerve conduction studies show completely normal sensory studies in upper and lower extremities. The motor studies were consistent with axonal loss (more severe in lower limbs): lLow amplitude, and slightly decreased velocities and altencies. The median and ulnar F responses were slightly prolonged. On needle electromyography there was evidence of distal denervation in the legs and arms, with fibrillation potentials and large, long, polyphasic motor unit action potentials with reduced recruitment. Comparing 2 controlateral muscles, the tibialis anterior and extensor digitorum, the findings were symmetric. There was electrophysiologic evidence of an active pure motor distal axonal polyneuropathy (Figure 1 and Table 2).

Bottom Line: Based on the examination results, the final diagnosis was acute paraneoplastic axonal Guillain-Barre-like syndrome.At autopsy, bronchopneumonia and a right hydrothorax were confirmed.This is the 6th reported case of small cell lung cancer-associated acute Guillain-Barre-like syndrome and the first report about an association with a coin-like peripheral pattern.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Pathology (IJ, SG, AOC, SP); Department of Neurology (RB, AM); and Department of Radiology, University of Medicine and Pharmacy of Tirgu-Mures, Tirgu-Mures, Romania (IH, IS).

ABSTRACT
A 65-year-old previously healthy male heavy smoker was hospitalized with a 2-week history of progressive muscle weakness in the lower and upper extremities. After 10 days of hospitalization, urinary sphincter incompetence and fecal incontinence were added and tetraparesis was established. The computer-tomography scan examination revealed a massive right hydrothorax and multifocal solid acinar structures with peripheral localization in the left lung, which suggested pulmonary cancer. Bone marrow metastases were also suspected. Based on the examination results, the final diagnosis was acute paraneoplastic axonal Guillain-Barre-like syndrome. The patient died 3 weeks after hospitalization. At autopsy, bronchopneumonia and a right hydrothorax were confirmed. Several 4 to 5-mm-sized round peripherally located white nodules were identified in the left lung, without any central tumor mass. Under microscope, a coin-shaped peripheral/subpleural small cell carcinoma was diagnosed, with generalized bone metastases. A huge thrombus in the abdominal aorta and acute pancreatitis was also seen at autopsy. This case highlights the difficulty of diagnosis of lung carcinomas and the necessity of a complex differential diagnosis of severe progressive ascending neuropathies. This is the 6th reported case of small cell lung cancer-associated acute Guillain-Barre-like syndrome and the first report about an association with a coin-like peripheral pattern.

Show MeSH
Related in: MedlinePlus