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Miller JH, Merry P. Digital ischaemia as a presenting feature in metastatic ovarian cancer. BMJ Case Rep 2023; 16:e254701. [PMID: 38061859 PMCID: PMC10711890 DOI: 10.1136/bcr-2023-254701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
A woman in her 50s presented with acute pain and discolouration in the fingertips of both hands, without other features of connective tissue disease. The history was otherwise significant for abdominal bloating, altered bowel habit, urinary urgency and fatigue. Inflammatory markers, antinuclear antibodies, serum protein electrophoresis and complement levels were all normal. The tumour marker CA125 was significantly elevated, prompting a CT abdomen and pelvis, which revealed a large right-sided adnexal mass with multiple enhancing peritoneal and omental nodules and moderate ascites, suggestive of disseminated primary ovarian cancer.Digital ischaemia (DI) can be associated with cancer in up to 15% of cases. An underlying cancer should be suspected in patients presenting with new or worsening symptoms of DI. Prompt treatment with anticancer therapies can achieve complete resolution of DI.
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Affiliation(s)
- Jonathan Harry Miller
- Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK
- Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peter Merry
- Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK
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2
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Jud P, Raggam RB, Hafner F. Syndrome paranéoplasique vasculaire touchant les extrémités. CMAJ 2021; 193:E227-E228. [PMID: 33558414 PMCID: PMC7954543 DOI: 10.1503/cmaj.200430-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Philipp Jud
- Division d'angiologie, Département de médecine interne, Université médicale de Graz, Graz (Autriche)
| | - Reinhard B Raggam
- Division d'angiologie, Département de médecine interne, Université médicale de Graz, Graz (Autriche)
| | - Franz Hafner
- Division d'angiologie, Département de médecine interne, Université médicale de Graz, Graz (Autriche)
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AlRasbi S, Al-Badi AH, Al Alawi AM. Paraneoplastic acral vascular syndrome: case presentation and literature review. BMJ Case Rep 2021; 14:14/1/e237258. [PMID: 33452070 PMCID: PMC7813368 DOI: 10.1136/bcr-2020-237258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
A 65-year-old man, a smoker, presented to the emergency department with progressive digital ischaemia, fever and weight loss. The clinical examination revealed generalised lymphadenopathy and ischaemic changes of the right distal phalanges of the second, third and fourth fingers. He had an ultrasound-guided biopsy of the cervical lymph node, which showed histopathological findings of classic Hodgkin's lymphoma. Paraneoplastic acral vascular syndrome (PAVS) is a rare phenomenon and seen more in solid malignancies. There are very few reported cases of PAVS in haematological malignancies, including Hodgkin's lymphoma. This case highlights the idea that the presence of acral vascular syndrome-especially in older patients-should alert physicians to search for an underlying malignancy as part of the medical evaluation. Also, it shows that medical treatment may slow the progress of the digital ischaemia until the culprit tumour has been identified and treated.
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Affiliation(s)
- Sara AlRasbi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman,Oman Medical Specialty Board, Internal Medicine, Muscat, Oman
| | - Amira H Al-Badi
- Oman Medical Specialty Board, Internal Medicine, Muscat, Oman
| | - Abdullah M Al Alawi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman,Oman Medical Specialty Board, Internal Medicine, Muscat, Oman
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Matanes E, Boulus S, Lauterbach R, Matanis J, Reiss A, Amit A. Raynaud's phenomenon as a presenting manifestation of ovarian cancer: A case report. J Obstet Gynaecol Res 2020; 47:855-859. [PMID: 33325078 DOI: 10.1111/jog.14609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/19/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022]
Abstract
Raynaud's phenomenon (RP) is characterized by episodes of vasospasm affecting the hands and feet. Paraneoplastic RP, as a single presenting symptom is rarely seen in cases of ovarian cancer (OC), and thus may lead to misdiagnosis. We present a case of paraneoplastic RP in a patient with high-grade serous OC. A 66-year-old female presented with dyspnea and bilateral peripheral cyanosis involving her fingers. CA125 was elevated (423 U/mL). CT revealed a pleural effusion on the left side, suspicious omental lesions and ascites. Omental biopsy and pleural cytology demonstrated high-grade serous OC. Neoadjuvant chemotherapy (carboplatin/paclitaxel) resulted in objective improvement in finger ischemia and complete regression of vasospastic features. However, the patient's disease was refractory to post-surgical treatment and eventually she deceased of multiple organ failure. To conclude, RP may be a presenting symptom of OC. It is important to determine the underlying disease and develop an effective treatment strategy.
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Affiliation(s)
- Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Sari Boulus
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Jawad Matanis
- Department of Anesthesiology, Rambam Health Care Campus, Haifa, Israel
| | - Ari Reiss
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Amnon Amit
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Affiliation(s)
- Philipp Jud
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Reinhard B Raggam
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Franz Hafner
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Hassold N, Hu L, Michon-Pasturel U, Roscoulet D, Damiano J. [Digital necrosis revealing lung cancer: Case-report and review of the literature]. JOURNAL DE MÉDECINE VASCULAIRE 2019; 44:209-212. [PMID: 31029276 DOI: 10.1016/j.jdmv.2019.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/08/2019] [Indexed: 11/29/2022]
Abstract
We report the case of a 51-year-old patient who presented necrosis affecting all of the toes in a context of confusion and declining general health. The etiology work-up disclosed a lung mass. Biopsy and search for extension led to the diagnosis of adenocarcinoma with liver metastasis. Unfortunately, symptomatic treatment of the digital necrosis did not lead to improvement and the patient was given palliative care. Digital necrosis generally affects the fingers. Localization on the toes is atypical and few cases have been reported in the literature.
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Affiliation(s)
- N Hassold
- Service de rhumatologie, hôpital Saint-Camille, 2, rue des Pères Camilliens, 94360 Bry-sur-Marne, France.
| | - L Hu
- Service de rhumatologie, hôpital Saint-Camille, 2, rue des Pères Camilliens, 94360 Bry-sur-Marne, France
| | - U Michon-Pasturel
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - D Roscoulet
- Service de rhumatologie, hôpital Saint-Camille, 2, rue des Pères Camilliens, 94360 Bry-sur-Marne, France
| | - J Damiano
- Service de rhumatologie, hôpital Saint-Camille, 2, rue des Pères Camilliens, 94360 Bry-sur-Marne, France
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Landry GJ, Mostul CJ, Ahn DS, McLafferty BJ, Liem TK, Mitchell EL, Jung E, Abraham CZ, Azarbal AF, McLafferty RB, Moneta GL. Causes and outcomes of finger ischemia in hospitalized patients in the intensive care unit. J Vasc Surg 2019; 68:1499-1504. [PMID: 29685512 DOI: 10.1016/j.jvs.2018.01.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/22/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Vascular surgeons may be consulted to evaluate hospitalized patients with finger ischemia. We sought to characterize causes and outcomes of finger ischemia in intensive care unit (ICU) patients. METHODS All ICU patients who underwent evaluation for finger ischemia from 2008 to 2015 were reviewed. All were evaluated with finger photoplethysmography. The patients' demographics, comorbidities, ICU care (ventilator status, arterial lines, use of vasoactive medications), finger amputations, and survival were also recorded. ICU patients were compared with concurrently evaluated non-ICU inpatients with finger ischemia. RESULTS There were 98 ICU patients (55 male, 43 female) identified. The mean age was 57.1 ± 16.8 years. Of these patients, 42 (43%) were in the surgical ICU and 56 (57%) in the medical ICU. Seventy (72%) had abnormal findings on finger photoplethysmography, 40 (69%) unilateral and 30 (31%) bilateral. Thirty-six (37%) had ischemia associated with an arterial line. Twelve (13%) had concomitant toe ischemia. Eighty (82%) were receiving vasoactive medications at the time of diagnosis, with the most frequent being phenylephrine (55%), norepinephrine (47%), ephedrine (31%), epinephrine (26%), and vasopressin (24%). Treatment was with anticoagulation in 88 (90%; therapeutic, 48%; prophylactic, 42%) and antiplatelet agents in 59 (60%; aspirin, 51%; clopidogrel, 15%). Other frequently associated conditions included mechanical ventilation at time of diagnosis (37%), diabetes (34%), peripheral arterial disease (32%), dialysis dependence (31%), cancer (24%), and sepsis (20%). Only five patients (5%) ultimately required finger amputation. The 30-day, 1-year, and 3-year survival was 84%, 69%, and 59%. By Cox proportional hazards modeling, cancer (hazard ratio, 2.4; 95% confidence interval, 1.1-5.6; P = .035) was an independent predictor of mortality. There were 50 concurrent non-ICU patients with finger ischemia. Non-ICU patients were more likely to have connective tissue disorders (26% vs 13%; P = .05) and hyperlipidemia (42% vs 24%; P = .03) and to undergo finger amputations (16% vs 5%; P = .03). CONCLUSIONS Finger ischemia in the ICU is frequently associated with the presence of arterial lines and the use of vasopressor medications, of which phenylephrine and norepinephrine are most frequent. Anticoagulation or antiplatelet therapy is appropriate treatment. Whereas progression to amputation is rare, patients with finger ischemia in the ICU have a high rate of mortality, particularly in the presence of cancer. Non-ICU patients hospitalized with finger ischemia more frequently require finger amputations, probably because of more frequent connective tissue disorders.
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Affiliation(s)
- Gregory J Landry
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore.
| | - Courtney J Mostul
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Daniel S Ahn
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Bryant J McLafferty
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Timothy K Liem
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Erica L Mitchell
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Enjae Jung
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Cherrie Z Abraham
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Amir F Azarbal
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Robert B McLafferty
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Gregory L Moneta
- Division of Vascular Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
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Warrier V, Ahmad A, Alshatti Y, Jafar A. Digital necrosis with squamous cell carcinoma of the tonsil. Int Med Case Rep J 2016; 9:159-62. [PMID: 27390535 PMCID: PMC4930236 DOI: 10.2147/imcrj.s106861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Digital necrosis is a rare phenomenon of paraneoplastic syndrome associated with squamous cell carcinoma of the tonsil. Since 1965, more than 70 cases have been reported worldwide in the literature. Case report A 54-year-old male smoker presented with Raynaud’s phenomenon, proceeding to frank gangrene of the fingers. Working up the case finally pointed toward carcinoma of the tonsil as the underlying cause – a rare paraneoplastic manifestation. Conclusion No definite etiology has been found to be the cause of Raynaud’s phenomenon in this case of the squamous cell carcinoma of the tonsil. A brief discussion of the literature is also presented.
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Affiliation(s)
- Vinod Warrier
- Department of Internal Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Ali Ahmad
- Department of Internal Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Yaqoub Alshatti
- Department of Internal Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Ali Jafar
- Department of Surgical and Interventional Sciences, University College London, Royal Free Hospital, London, UK
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Le Besnerais M, Miranda S, Cailleux N, Girszyn N, Marie I, Lévesque H, Benhamou Y. Digital ischemia associated with cancer: results from a cohort study. Medicine (Baltimore) 2014; 93:e47. [PMID: 25170929 PMCID: PMC4616330 DOI: 10.1097/md.0000000000000047] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Digital ischemia associated with cancer (DIAC) is increasing in frequency and recent reports have suggested the concept of paraneoplastic manifestation. The aims of this study were to characterize the clinical presentation of DIAC and identify clinical features that could lead physicians to diagnose underlying cancer.From January 2004 to December 2011, 100 patients were hospitalized in the Department of Internal Medicine at Rouen University Hospital, France for a first episode of DI. Fifteen (15%) exhibited symptomatic or asymptomatic cancer during the year preceding or following vascular episode and constituted the DIAC group. Other patients without cancer made up the digital ischemia (DI) group.Median time between diagnosis of cancer and episode of digital necrosis was 2 months [0.25-9]. Diagnosis of DI and concomitant cancer was made in 7 of the 15 patients, while DI preceded the malignant disorder in 2 cases and followed it in 6 cases. Histological types were adenocarcinoma for 7 (46.7%), squamous cell carcinoma for 4 (26.7%), and lymphoid neoplasia for 3 patients (20%). Six patients (40%) had extensive cancer. Three patients were lost to follow-up and 5 patients died <1 year after diagnosis of cancer. Cancer treatment improved vascular symptoms in 6 patients (40%). Patients with DIAC, compared to patients with DI, were significantly older (56 years [33-79] vs 46 [17-83] P =0.005), and had significantly lower hemoglobin and hematocrit levels (12.7 g/dl vs 13.9 g/dl; P =0.003 and 38% vs 42%; P =0.003, respectively). Patients with DIAC had a higher platelet rate (420 vs 300 G/L P =0.01), and 6 patients with DIAC (40%) had thrombocytosis. There was no difference between groups either in C-reactive protein level (12 mg/L vs 5 mg/L; P =0.08) or regarding cardiovascular risk factors, presence of autoimmunity, or monoclonal protein.This retrospective study suggests that DIAC may be more prevalent than previously reported. Outcomes of the 2 diseases were not strictly chronologically parallel. However, in the majority of cases, treatment of the tumor resolved vascular involvement. Our findings suggest that age >50 years and thrombocytosis should alert physicians to consider a possible occult malignancy when digital necrosis occurs.
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Affiliation(s)
- Maëlle Le Besnerais
- Department of Internal Medicine (MLB, SM, NC, NG, IM, HL, YB), Rouen University Hospital, 1 Rue de Germont and Inserm (National Institute for Health and Medical Research) U1096 (HL, YB), University of Rouen, Rouen, France
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Witherspoon J, Mainwaring A, Morley O, Lewis M. Digital gangrene in an elderly patient. Br J Hosp Med (Lond) 2012; 73:288-9. [PMID: 22585330 DOI: 10.12968/hmed.2012.73.5.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Robati S, Razvi K, Madhavan K, Gajjar K. Paraneoplastic vasculitis with digital necrosis: a rare presentation of advanced ovarian cancer. Arch Gynecol Obstet 2012; 286:813-4. [PMID: 22526450 DOI: 10.1007/s00404-012-2326-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Accepted: 04/05/2012] [Indexed: 11/28/2022]
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Staff S, Lagerstedt E, Seppänen J, Mäenpää J. Acute digital ischemia complicating gemcitabine and carboplatin combination chemotherapy for ovarian cancer. Acta Obstet Gynecol Scand 2011; 90:1296-7. [PMID: 21880022 DOI: 10.1111/j.1600-0412.2011.01259.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Poiraud C, Durant C, Saint-Jean M, Connault J, Barbarot S, Planchon B. Une cause rare de nécroses digitales : la maladie de Hodgkin. Presse Med 2011; 40:432-5. [DOI: 10.1016/j.lpm.2010.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 10/04/2010] [Accepted: 10/07/2010] [Indexed: 02/08/2023] Open
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Raimondo L, Cella CA, Moretto R, Matano E, Carlomagno C. Digital Ischemia in Patients with Solid Tumors: a Case Report and Review of the Literature. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/jct.2011.22036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Behne MJ, Hauswirth U, Menz A, Brüllke N, Müllerleile U, Moll I. [Acral necrosis in metastatic ovarian carcinoma. A single episode of Moschowitz syndrome during gemcitabine chemotherapy]. Hautarzt 2008; 59:917-21. [PMID: 18368377 DOI: 10.1007/s00105-008-1494-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
For some time now, there have been reports of acral necrosis as a paraneoplasia that may occur in association with a number of different malignant tumours. There have also been a series of reports about acral necrosis associated with chemotherapy with various cytostatics. The treatment of choice if these lesions occur is plasmapheresis. Ultimately, the occurrence of thrombotic microangiopathy (TMA) can only be prevented by close monitoring through regular laboratory controls before each new cycle of chemotherapy. In the differential diagnosis, Raynaud's syndrome should be considered as a premonitory paraneoplasia, a risk factor for the occurrence of acral necrosis in patients with a malignant tumour undergoing chemotherapy, particularly patients with ovarian carcinoma receiving gemcitabine treatment.
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Affiliation(s)
- M J Behne
- Klinik für Dermatologie und Venerologie, Universitätskrankenhaus Eppendorf, Martinistrasse 52, 20246 Hamburg, Deutschland.
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Affiliation(s)
- Safvet Ors
- Department of Plastic and Reconstructive Surgery, Gunes Public Hospital, Yildirim Beyazit mah., M. Simsek Cad. Manolya Apt. No. 119/9 38030, Kayseri, Turkey.
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O'Riordan A, Ong C, Pavlakis N, Veitch P. Blue fingers. Intern Med J 2003; 33:620-1. [PMID: 14656243 DOI: 10.1111/j.1445-5994.2003.00489.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pronk WG, Baars JP, De Jong PC, Westermann AM. Some unusual paraneoplastic syndromes. Case 2. Digital ulceration as a paraneoplastic syndrome in ovarian cancer. J Clin Oncol 2003; 21:2620-2. [PMID: 12829684 DOI: 10.1200/jco.2003.07.099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
The relation between rheumatic syndromes and an underlying malignancy is a complex one. As a result of autoimmunity, an aberrant immune response, or the use of immunomodulatory drugs, many of the rheumatic diseases appear to pose an increased risk for the development of malignancy. Unfortunately, for many of the same reasons, the presence of an underlying malignancy can result in the development of features of rheumatic disease. Awareness of the associations between rheumatic syndromes and malignancy will aid the clinician in the accurate diagnosis of underlying pathology, more effective treatment of both the symptoms and underlying disease, and appropriate surveillance for the development of later complications.
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Wright JR, Gudelis S. Digital necrosis associated with squamous cell carcinoma of the tonsil. Head Neck 2002; 24:1019-21. [PMID: 12410538 DOI: 10.1002/hed.10155] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Digital necrosis is an uncommon paraneoplastic syndrome. Fewer than 50 cases have been sporadically reported through the literature over the last 30 years. CASE REPORT We describe the unfortunate case of a 62-year-old woman with a locally advanced squamous cell carcinoma of the tonsil. She was admitted to the hospital for symptomatic hypercalcemia and was found to have metastatic disease. She subsequently had digital necrosis develop. Despite numerous attempts to control the rapidly progressive ischemia, little objective evidence of response was noted. Her primary disease did not respond to palliative radiation, and her general condition rapidly deteriorated. CONCLUSIONS A review of the literature provided some insight into the possible etiology of this unique complication of malignancy. Unfortunately, the treatment options suggested were of limited value, because there was no discernible benefit with any directed treatment. A brief summary and discussion of the literature follows.
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Affiliation(s)
- Jim R Wright
- Department of Radiation Oncology, Hamilton Regional Cancer Centre, Cancer Care Ontario, 699 Concession St, Hamilton, Ontario, Canada L8V 5C2.
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Poszepczynska-Guigné E, Viguier M, Chosidow O, Orcel B, Emmerich J, Dubertret L. Paraneoplastic acral vascular syndrome: epidemiologic features, clinical manifestations, and disease sequelae. J Am Acad Dermatol 2002; 47:47-52. [PMID: 12077580 DOI: 10.1067/mjd.2002.120474] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Acral vascular syndromes associated with malignancy have rarely been reported. OBJECTIVE Our purpose was to assess the clinical and evolving features of paraneoplastic acral vascular syndromes. PATIENTS AND METHODS Two cases of paraneoplastic gangrene are described and analyzed together with previously reported cases identified by a MEDLINE search. RESULTS Among the 68 patients identified, 40 had gangrene, 16 had acrocyanosis, and 12 had Raynaud's phenomenon. The male to female ratio was 0.89; median age was 59 years. Fingers were affected in 94%. Adenocarcinomas were the predominant associated malignancies (41%), and metastases were observed in 41%. The acral vascular syndromes in 48% of the patients definitively regressed after tumor treatment. Forty-four percent of the patients died within 2 years. A favorable cutaneous outcome was obtained with prostacyclin infusions in 6 patients. CONCLUSION A neoplastic origin of acral vascular syndrome should be considered in elderly patients, especially men, in the absence of usual causative conditions.
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Affiliation(s)
- Ewa Poszepczynska-Guigné
- Department of Dermatology, Hôpital Saint-Louis, 1 avenue Claude-Vellefaux, 75475 Paris Cedex 10, France
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Affiliation(s)
- S Brenner
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Reproductive Health LiteratureWatch. J Womens Health (Larchmt) 1996. [DOI: 10.1089/jwh.1996.5.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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