[Non-obstructive jaundice as paraneoplastic syndrome of prostate carcinoma: Systematic review of published cases]

Stauffer syndrome is a paraneoplastic syndrome (PS) that involves liver disorders; it has been often related to renal tumors, but also to others such as adenocarcinoma of the prostate (ACP). Our objective was to carry out a systematic review of published cases associated with ACP. A total of 357 articles were accessed, 25 of which met the study's inclusion criteria. All published cases of Stauffer syndrome in patients diagnoses with ACP were in the metastatic stage. The PS resolved in 3 out of 4 patients when ACP-targeted therapy was implemented. The following were identified as poor prognosis factors: the diagnosis of ACP prior to that of SP, non-elevated levels of total bilirubin, and the non-resolution of SP at the start of treatment.

Autoimmune retinopathy with onconeuronal antibodies: Case report

We present a case of autoimmune retinopathy in a patient with unknown small cell lung cáncer (SCLC), which was diagnosed after ophthalmological examination. Serology was positive for CV2/CRMP5 onconeuronal antibodies. Autoimmune retinopathy is a rare entity that can be missed and underdiagnosed. It is produced by an immune-mediated reaction against retinal antigens. The importance of its early diagnosis lies in the fact that in many of the patients, ocular symptoms appear before the diagnosis of the primary cancer, so its early identification and referral for an extension study may lead to the diagnosis of a hidden primary neoplasm.

[Multiple insufficiency fractures (metatarsial, calcaneal and sacral) as the first manifestation of lung adenocarcinoma. A case report and literature review]

Insufficiency fractures, or pathological fractures, are produced after minimal trauma or no prior trauma and normally affect weakened bone. Their presence should be suspected in fractures showing abnormal patterns, when several fractures occur in a short period of time and in those with no apparent or only minimal trauma. On confirmation of an insufficiency fracture, a differential diagnosis should be made between tumoral and metastatic fractures if there is a history of underlying primary malignancy. The epidemiology of lung cancer has changed due to women's adoption of smoking. In women, the most frequent type of lung cancer is adenocarcinoma, which is less aggressive and has lower mortality, with 5-year survival of 9.5%. Consequently, in Spain, 44% of pulmonary nodules are due to adenocarcinomas. Therefore, all solitary pulmonary nodules should be followed-up for at least 5 years. A history of solitary pulmonary nodule is found in one out of every 1,000 x-rays. However, in patients younger than 35 years, only 1% is malignant. In persons with a history of malignancy and age older than 35 years, this percentage increases to 68%. Size larger than 3cm increases the percentage of malignancy to up to 93%. Therefore, in female smokers older than 50 years with a history of solitary pulmonary nodule, the nodule should be considered malignant until demonstrated otherwise. We report for the first time in Spain the case of a woman with risk factors (smoking, age older than 50 years, with a 3-cm solitary pulmonary nodule that showed no significant growth in 3 years) who had multiple insufficiency fractures in a short period of time. Rehabilitation therapy was unsuccessful and the patient underwent investigation for malignancy. Unfortunately, histopathological study confirmed that the fractures were the initial manifestation of lung adenocarcinoma.

Polyarthritis and membranoproliferative glomerulonephritis as paraneoplastic manifestation of Hodgkin's lymphoma: A case report and literature review

Paraneoplastic syndromes can be presented in multiple ways, which include endocrinological, hematologic, rheumatologic and nephrologic manifestations. While most of the publications described solid tumors as responsible for these manifestations, hematologic neoplasms are important cause to consider as part of the differential diagnosis. We report the case of a 46 year-old man with seronegative symmetric polyarthritis of large and small joints associated with membranoproliferative glomerulonephritis with deposits of immune complexes and acute impairment of renal function, as part of a paraneoplastic syndrome secondary of a classical Hodgkin lymphoma with bone marrow invasion, which reversed completely with chemotherapy treatment.

Glomeruloid hemangioma and POEMS syndrome

POEMS syndrome is a paraneoplastic manifestation associated with hematopoietic disorders such as multiple myeloma and Castleman disease. POEMS is an acronym for the main clinical features of the syndrome, namely, Polyneuropathy, Organomegaly, Endocrinopathy, M protein, and Skin abnormalities. Glomeruloid hemangiomas are considered to be a specific clinical marker of POEMS syndrome. However, while they are not pathognomonic, their presence should raise suspicion of this syndrome or alert clinicians to its possible future development, as these lesions can appear years before the onset of the syndrome. We report the cases of 2 women with plasma cell dyscrasias and sudden onset of lesions with a vascular appearance and histologic findings consistent with glomeruloid hemangioma. Recognition of this vascular tumor is important for the early diagnosis of POEMS syndrome.

[Ocular paraneoplastic syndrome: cancer-associated retinopathy]

CASE REPORT

We review a patient with ocular manifestations of a paraneoplastic syndrome. It was a cancer-associated retinopathy (CAR) in a woman with visual loss, and attenuated and sheathed retinal arterioles. The electroretinography (ERG) showed severe abnormalities of the a and b-waves. The tumour process was not discovered until 6 months later, when a squamous neoplasia that invaded the uterus and vagina was observed.

DISCUSSION

Paraneoplastic syndromes are a group of manifestations produced as a remote effect of cancer cells. CAR syndrome is caused by autoimmune reactions to retinal antigens induced by aberrant expression of recoverin in cancer tissues. Ophthalmologists must be aware of ocular paraneoplastic signs as they can be the first manifestations of a malignant tumour.

[Renal cell carcinoma producing erythrocytosis due to inappropriate production of erythropoietin]

Erythrocytosis, or polycythaemia, is an increase, in absolute terms, of the erythrocyte mass. The most common solid tumour related to this phenomenon is renal cell carcinoma, which can produce erythrocytosis by increasing erythropoietin production. About 30% of symptomatic renal cell carcinomas are diagnosed due to the appearance of a paraneoplastic syndrome. Polycythaemia is one of these. Surgery, (radical or partial nephrectomy), is the treatment of choice in renal cell carcinoma and helps to keep the erythrocytosis situation under control.