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Muacevic A, Adler JR, Bollineni VR, Þórarinsson BL, Arkink EB. Anti-CV2/Collapsin Response Mediator Protein 5 (CRMP5) Paraneoplastic Encephalitis Induced by Small Cell Lung Cancer. Cureus 2023; 15:e34323. [PMID: 36865958 PMCID: PMC9972193 DOI: 10.7759/cureus.34323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 01/30/2023] Open
Abstract
Paraneoplastic neurological syndrome (PNS) associated with anti-CV2/CRMP5 antibodies is a rare entity that can present in various clinical manifestations, from encephalitis to chorea, depending on the brain region involved. We report a case of an elderly person with small cell lung cancer who presented with PNS encephalitis associated with anti-CV2/CRMP5 antibodies which were confirmed on immunological analysis.
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Kilci F, Demirsoy U, Jones JH, Çakır Ö, Çizmecioğlu-Jones FM. Ectopic parathyroid hormone as a rare aetiology of hypercalcemia with rhabdomyosarcoma: a new treatment strategy with zoledronic acid and Denosumab. J Pediatr Endocrinol Metab 2022; 35:1107-1112. [PMID: 35534911 DOI: 10.1515/jpem-2022-0070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/19/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Ectopic parathyroid hormone (PTH) secretion is rare in children with rhabdomyosarcoma, and only a few pediatric cases have been reported to date. Reports of the use of zoledronic acid (ZA) and Denosumab are limited for the treatment of hypercalcemia of malignancy (HCM) in the pediatric population. The aim of presenting this pediatric case of rhabdomyosarcoma accompanied by HCM, secondary to ectopic PTH secretion, was to highlight the benefits of ZA as a first-choice bisphosphonate in this situation with Denosumab as an alternative therapy. CASE PRESENTATION The patient was diagnosed at 13 years with alveolar rhabdomyosarcoma. Multiple bone metastases first appeared at 15 years, but he remained normocalcemic until 17 years old when serum calcium was 15.1 mg/dL and PTH 249 pg/mL. While serum calcium responded well after ZA and Denosumab cycles, PTH remained elevated, reaching a peak value of 1851 pg/mL during treatment cycles. CONCLUSIONS We report a patient with rhabdomyosarcoma accompanied by HCM, secondary to ectopic PTH, in whom the HCM was successfully managed with ZA and Denosumab. We believe that ZA should be the bisphosphonate of choice in pediatric HCM with rhabdomyosarcoma, while Denosumab may be another option in ZA-refractory cases.
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Affiliation(s)
- Fatih Kilci
- Division of Pediatric Endocrinology, Department of Pediatrics, School of Medicine, Kocaeli University, İzmit, Kocaeli, Turkey
| | - Uğur Demirsoy
- Division of Pediatric Oncology, Department of Pediatrics, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Jeremy Huw Jones
- Department of Academic Writing, Kocaeli University, Kocaeli, Turkey
| | - Özgür Çakır
- Department of Radiology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Filiz Mine Çizmecioğlu-Jones
- Division of Pediatric Endocrinology, Department of Pediatrics, School of Medicine, Kocaeli University, İzmit, Kocaeli, Turkey
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Di Ruscio V, Del Baldo G, De Pasquale MD, De Vito R, Miele E, Colafati GS, Deodati A, De Ioris MA, Tornesello A, Milano GM, Mastronuzzi A. Ectopic ACTH Secretion in a Child With Metastatic Ewing's Sarcoma: A Case Report. Front Oncol 2020; 10:574. [PMID: 32411598 PMCID: PMC7198717 DOI: 10.3389/fonc.2020.00574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/30/2020] [Indexed: 11/17/2022] Open
Abstract
Ectopic ACTH syndrome is rare in pediatric age. Sarcomas that cause Ectopic ACTH Syndrome (EAS) are even more uncommon. Currently, only three cases of EAS caused by Ewing' sarcoma have been reported. We detail a 10-year-old boy with Cushing's syndrome symptoms caused by ectopic ACTH production by a metastatic Ewing's sarcoma of the right ischio-pubic and ileo-pubic branches. The rapid appearance of cushingoid symptoms, with significant weight gain, acne, hirsutism, and hypercortisolism were implications of ectopic ACTH production as paraneoplastic Cushing's Syndrome. The very high levels of ACTH and non-suppression at the high dose dexamethasone test confirmed the clinical suspicion. We underline the possibility EAS was caused by an ACTH-secreting tumor, including soft tissue sarcomas.
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Affiliation(s)
- Valentina Di Ruscio
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.,Department of Paediatric, Sapienza University of Rome, Rome, Italy
| | - Giada Del Baldo
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Maria Debora De Pasquale
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Rita De Vito
- Department of Pathology, Bambino Gesù Children Hospital (IRCCS), Rome, Italy
| | - Evelina Miele
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Annalisa Deodati
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | | | - Giuseppe Maria Milano
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Angela Mastronuzzi
- Department of Paediatric Haematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
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4
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Ibrahim Ismail I, K John J, Ibrahim M, Al-Hashel JY. Paraneoplastic Limbic Encephalitis Associated with Anti-CV2/CRMP5 Antibodies Secondary to Thymoma in an Adolescent. Case Rep Neurol 2020; 12:50-55. [PMID: 32110228 PMCID: PMC7036575 DOI: 10.1159/000505232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/03/2019] [Indexed: 11/19/2022] Open
Abstract
Paraneoplastic neurological syndromes (PNS) associated with anti-CV2/CRMP5 antibodies are rare in the literature. Various clinical manifestations can occur including paraneoplastic limbic encephalitis (PLE). Thymoma is one of the rare causes that can be associated with this syndrome. It has not been reported in the literature in children or adolescents to the best of our knowledge. We report a case of PLE in a 19-year-old male patient secondary to thymoma that was diagnosed after 5 years of onset. Anti-CV2/CRMP5 antibodies were positive in the serum and became negative after thymectomy. Diagnosis of PNS should be evoked in cases with atypical neurological manifestation and can be confirmed by the presence of onconeuronal antibodies. We report the first pediatric PLE secondary to thymoma associated with anti-CV2/CRMP5 antibodies.
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Affiliation(s)
| | - John K John
- Department of Neurology, Ibn Sina Hospital, Safat, Kuwait
| | | | - Jasem Yousef Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Safat, Kuwait.,Department of Medicine, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait
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5
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Brooks R, Lord C, Davies JH, Gray JC. Hypercalcaemia secondary to ectopic parathyroid hormone expression in an adolescent with metastatic alveolar rhabdomyosarcoma. Pediatr Blood Cancer 2018; 65. [PMID: 28843052 DOI: 10.1002/pbc.26778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 07/27/2017] [Accepted: 07/31/2017] [Indexed: 11/06/2022]
Abstract
We report the case of a 14-year-old male with metastatic alveolar rhabdomyosarcoma, presenting with hypercalcaemia (3.89 mmol/l) and elevated parathyroid hormone (PTH) level (10.2 pmol/l). Imaging demonstrated extensive bony lytic damage, with "floating teeth" in the mandible. Normalisation of calcium levels and bony reformation of the mandible occurred following chemotherapy; PTH levels decreased initially but remained above normal levels. Imaging did not demonstrate any evidence of parathyroid abnormality. Tumour ectopic PTH secretion is a very rare cause of hypercalcaemia of malignancy in children. Hypercalcaemia with an elevated PTH, in the absence of parathyroid-related cause, should prompt investigation for underlying malignancy.
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Affiliation(s)
- Rachael Brooks
- Department of Paediatric Oncology, University Hospital Southampton Foundation Trust, Southampton, UK
| | - Christopher Lord
- Department of Paediatric Radiology, University Hospital Southampton Foundation Trust, Southampton, UK
| | - Justin H Davies
- Department of Paediatric Endocrinology, University Hospital Southampton Foundation Trust, Southampton, UK
| | - Juliet C Gray
- Department of Paediatric Oncology, University Hospital Southampton Foundation Trust, Southampton, UK.,Cancer Sciences Unit, University of Southampton, Southampton, UK
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Alsaied T, Mohameden M, Lee L, Lawson SA, Mantell BS, Saqr AH, Nagarajan R. Abdominal Pain, Fatigue, and Constipation in a Teenager Female: Is It Worth Further Investigations? Clin Pediatr (Phila) 2016; 55:986-9. [PMID: 26581356 DOI: 10.1177/0009922815616071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tarek Alsaied
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Lynn Lee
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sarah A Lawson
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Ahmad H Saqr
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Fisher MM, Misurac JM, Leiser JD, Walvoord EC. Extreme Hypercalcemia of Malignancy in a Pediatric Patient: Therapeutic Considerations. AACE Clin Case Rep 2015. [DOI: 10.4158/ep14308.cr] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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8
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Wendt S, Shelso J, Wright K, Furman W. Neoplastic causes of abnormal puberty. Pediatr Blood Cancer 2014; 61:664-71. [PMID: 24155044 PMCID: PMC4693637 DOI: 10.1002/pbc.24825] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/24/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Neoplasm-related precocious puberty (PP) is a rare presenting feature of childhood cancer. Moreover, evaluation of suspected PP in a child is complex, and cancer is often not considered. We characterized the clinicopathologic features of patients presenting with PP at a large pediatric cancer center, reviewed the relevant literature, and developed an algorithm for the diagnostic work-up of these patients. METHODS We examined the records of all patients with a neoplasm and concomitant PP treated at St. Jude Children's Research Hospital from January 1975 through October 2011, reviewed the available literature, and analyzed the demographic, clinical, endocrine, and neoplasm-related features. RESULTS Twenty-four of 13,615 children and adolescents (0.18%) were diagnosed with PP within 60 days of presentation. Primary diagnoses included brain tumor (12), adrenocortical carcinoma (5), hepatoblastoma (4), and others (3). PP was observed 0-48 months before diagnosis of neoplasm; 17 patients had peripheral PP and 7 had central PP. CONCLUSIONS Neoplasm-related PP is rare and takes the form of a paraneoplastic syndrome caused by tumor production of hormones or by alteration of physiologic gonadotropin production. PP can precede diagnosis of malignancy by months or years, and neoplastic causes should be considered early to avoid delayed cancer diagnosis. Treatment of the primary malignancy resolved or diminished PP in surviving patients with an intact hypothalamic-pituitary-gonadal axis.
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Affiliation(s)
- Susanne Wendt
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee,Correspondence to: Susanne Wendt, Department of Oncology, St. Jude Children’s Research Hospital, 260 Danny Thomas Place, MS 260, Memphis, TN 38105.
| | - John Shelso
- Sanford Children’s Specialty Clinic, Sioux Falls, South Dakota
| | - Karen Wright
- Department of Neuro-Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Wayne Furman
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
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Tristán JU, Castelló CH, Picó RB, Ramírez RVS, Melwani KM. Síndrome opsoclono-mioclono y neuroblastoma. Clin Transl Oncol 2004. [DOI: 10.1007/bf02710119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Florell SR, Bruggers CS, Matlak M, Young RH, Lowichik A. Ovarian small cell carcinoma of the hypercalcemic type in a 14 month old: the youngest reported case. MEDICAL AND PEDIATRIC ONCOLOGY 1999; 32:304-7. [PMID: 10102028 DOI: 10.1002/(sici)1096-911x(199904)32:4<304::aid-mpo13>3.0.co;2-m] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S R Florell
- Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, USA
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11
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Shuper A, Gilai AN, Stark B, Zeevi O, Cohen IJ, Zaizov R. Myopathic changes as a paraneoplastic sign in childhood acute lymphoblastic leukemia. Clin Pediatr (Phila) 1998; 37:565-7. [PMID: 9773241 DOI: 10.1177/000992289803700908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A Shuper
- National Center of Hematology/Oncology, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
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