Pulmonary Research and Respiratory Medicine · Vol. 4, No. 2 · 2017 · pp. e6–e8 · e-ISSN 2377-1658

Paraneoplastic Syndrome: What should Pulmonologists know?

Takeshi Saraya

Assistant Professor Department of Respiratory Medicine Kyorin University School of Medicine Takeshi Saraya, MD, PhD 6-20-2 Shinkawa, Mitaka City Tokyo 181-8611, JapanJapan

DOI: https://doi.org/10.17140/prrmoj-4-e009 · Published 2017-09-21 · Licence: https://creativecommons.org/licenses/by/4.0 · © 2017 The Author(s)

Also available as PDF (figures and tables appear in the PDF).

Abstract

Pulmonologists often encounter patients with oncologic emergencies such as metabolic syndrome (tumor lysis syndrome), hypercalcemia, syndrome of inappropriate secretion of antidiuretic hormone (SIADH), hematologic (febrile neutropenia and hyperviscosity syndrome) and structural disorders (superior vena cava syndrome, spinal cord compression syndrome, malignant pericardial effusion, and malignant airway obstruction), along with drug-related adverse events in already-known malignancies including liver5 or pulmonary toxicity and renal disease.

PULMONARY RESEARCH AND RESPIRATORY MEDICINE Editorial Paraneoplastic Syndrome: What should * *Corresponding author Pulmonologists know?

Takeshi Saraya, MD, PhD Assistant Professor Department of Respiratory Medicine * Kyorin University School of Medicine Takeshi Saraya, MD, PhD* 6-20-2 Shinkawa, Mitaka City Tokyo 181-8611, Japan Tel. +81 (0)422 44 0671 Department of Respiratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Fax: +81 (0)422 44 0671 Mitaka City, Tokyo 181-8611, Japan E-mail: sara@yd5.so-net.ne.jp Pulmonologists often encounter patients with oncologic emergencies (Figure 1) such Volume 4 : Issue 2 as metabolic syndrome (tumor lysis syndrome),1 hypercalcemia, syndrome of inappropriate Article Ref. #: 1000PRRMOJ4e009 secretion of antidiuretic hormone (SIADH), hematologic (febrile neutropenia and hyperviscos- ity syndrome) and structural disorders (superior vena cava syndrome,2 spinal cord compres- 3 4 Article History sion syndrome, malignant pericardial effusion,3 and malignant airway obstruction4), alongwith th 5 Received: September 20th, 2017 drug-related adverse eventsin already-known malignancies including liver5 or pulmonary tox- st 6,7 8,9 Accepted: September 21 , 2017 icity and renal disease. Additionally, pulmonologists occasionally encounter paraneoplastic st Published: September 21st, 2017 syndrome (PNS), which partially overlaps with oncologic emergencies (Figure 1). In this re- gard, pulmonologists should be aware of PNS, involving organ-based classification (Figure 2).

Citation Saraya T. Paraneoplastic syn- drome: What should pulmonolo-

gists know? Pulm Res Respir Med Open J. 2017; 4(2): e6-e8.

doi: 10.17140/PRRMOJ-4-e009 SIADH: Syndrome of Inappropriate Secretion of Antidiuretic Hormone; SVC: Superior Vena Cava Syndrome.

Copyright ©2017 Saraya T. This is an open access article distributed under the Creative Commons Attribution 4.0 ACTH: Adrenocorticotropic Hormone; ANNA1: Type I Anti-Neuronal Nuclear Antibody; Anti-SOX1: Anti-Sry-related HMG; Anti- International License (CC BY 4.0), TIF1: Anti-transcriptional intermediary factor 1-gamma; Anti-VGCC: Anti-Voltage-Gated Calcium Channel; Anti-VGKC: Anti- which permits unrestricted use, VoltAge-Gated Potassium Channel, G-CSF: Granulocyte-Colony Stimulating Factor, GHRH/GH: Growth Hormone Releasing Hormone/Glucose Hormone, PTH: Parathyroid Hormone, SCLC: Small Cell Lung Cancer.

distribution, and reproduction in any medium, provided the original work is properly cited.

10,11 10 12 13 PNS has diverse symptoms and signs in neurologic, muscle/neuromuscular junction/skeletal, hematological, eye, 14 1 15,16 17 renal, metabolic, skin, and endocrine systems, which often present as antecedent problems of lung cancer or other malignan- cies. In some cases, physicians might have difficulty in discriminating PNS from malignant independent conditions due to clinical 18 19 similarity but they are pathologically different.18 PNS occurs in approximately 10% of patients with lung cancer,19 and the histology of lung cancer influences the type of associated PNS. The most common forms of PNS are hypercalcemia fromsquamous carcinoma and SIADH in small cell lung cancer.

Nowadays, various onconeural antibodies have been detected, and well-characterized autoantibodies such as anti-Hu (ANNA1), anti-Yo (PCA1), anti-CV2 (CRMP5), anti-Ri, anti-Ma2 (Ta), and anti-amphiphysin have been described. Other partially characterized onconeural antibodies and other antibodies were also identified.17 These antibodies seem to be directly involved in cell surface or synaptic proteins or disrupt function of receptors by cross-linking and internalization, which leads to PNS.20 Of note, a high frequency of anti-Hu antibody has been reported in PNS such as limbic encephalitis, cerebellar degen- eration, and peripheral neuropathy (Figure 2), which resulted in “anti-Hu syndrome” being considered an independent entity.21 Moreover, although identification of onconeural antibodies can be a useful marker for early diagnosis of PNS and/or malignancies, multidisciplinary assessment for PNS is needed along with long-term observation.

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