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©2014 Baishideng Publishing Group Inc.
World J Clin Oncol. Aug 10, 2014; 5(3): 197-223
Published online Aug 10, 2014. doi: 10.5306/wjco.v5.i3.197
Published online Aug 10, 2014. doi: 10.5306/wjco.v5.i3.197
Table 1 Criteria for the diagnosis of paraneoplastic endocrine syndromes
Abnormal endocrine function without physiologic feedback regulation |
The absence of metastasis in the respective endocrine gland |
Deterioration with increasing tumor burden |
Improvement in endocrine function with the treatment of the tumor |
Evidence of the presence of hormones in the tumor or hormone synthesis by the tumor |
Table 2 Paraneoplastic endocrine syndromes and causes of hypercalcemia associated with lung cancer
Paraneoplastic endocrine syndromes associated with lung cancer |
Humoral hypercalcemia of malignancy |
Syndrome of inappropriate antidiuretic hormone production |
Cushing’s syndrome |
Hypoglycemia |
Acromegaly |
Carcinoid syndrome |
Gynecomastia |
Hyperthyroidism |
Causes of hypercalcemia associated with lung cancer |
Humoral hypercalcemia of malignancy |
(1) Parathyroid hormone-related protein |
(2) Parathyroid hormone |
(3) 1,25-dihydroxyvitamin D |
(4) Granulocyte colony-stimulating factor |
Osteolytic activity at the sites of skeletal metastases |
Table 3 Syndrome of inappropriate antidiuretic hormone secretion
Hyponatremia (serum sodium < 134 mEq/L) |
Hypoosmolality (plasma osmolality < 275 mOsm/kg) |
Inappropriately high urine osmolality ( > 500 mOsm/kg) |
Inappropriately high urinary sodium concentration ( > 20 mEq/L) |
Absence of hypothyroidism |
Absence of adrenal insufficiency |
Absence of volume depletion |
Table 4 Classical and non-classical paraneoplastic neurological syndromes[93]
Syndromes of the central nervous system |
Encephalomyelitis1 |
Limbic encephalitis1 |
Brainstem encephalitis |
Subacute cerebellar degeneration1 |
Opsoclonus-myoclonus1 |
Optic neuritis |
Cancer-associated retinopathy |
Melanoma-associated retinopathy |
Stiff person syndrome |
Necrotizing myelopathy |
Motor neuron diseases |
Syndromes of the peripheral nervous system |
Subacute sensory neuropathy1 |
Acute sensorimotor neuropathy |
Guillain-Barre syndrome |
Brachial neuritis |
Subacute/chronic sensorimotor neuropathies |
Neuropathy and paraproteinaemia |
Neuropathy with vasculitis |
Autonomic neuropathies |
Chronic gastrointestinal pseudo-obstruction1 |
Acute pandysautonomia |
Syndromes of the neuromuscular junction and muscle |
Myasthenia gravis |
Lambert-Eaton myasthenic syndrome1 |
Acquired neuromyotonia |
Dermatomyositisa |
Acute necrotizing myopathy |
Table 5 Onconeural antibodies
Well-characterized onconeural antibodies |
Anti-Hu (ANNA1) |
Anti-Yo (PCA1) |
Anti-CV2 (CRMP5) |
Anti-Ri (ANNA2) |
Anti-Ma2 (Ta) |
Anti-amphiphysin |
Partially characterized onconeural antibodies |
Anti-Tr (PCA-Tr) |
ANNA3 |
PCA2 |
Anti-Zic4 |
Anti-mGluR1 |
Other antibodies |
Anti-acetylcholine receptor |
Anti-nicotinic AchR |
Anti-voltage-gated calcium channel |
Anti-voltage-gated potassium channel |
Anti-NR1/NR2 of N-methyl-D-aspartate |
Anti-glutamic acid decarboxylase |
Table 6 Criteria for the diagnosis of paraneoplastic neurological syndromes[93]
Definite PNS |
A classical syndrome and cancer that develops within five years of the diagnosis of the neurological disorder |
A non-classical syndrome that resolves or improves significantly after cancer treatment without concomitant immunotherapy, provided that the syndrome is not susceptible to spontaneous remission |
A non-classical syndrome with onconeural antibodies (well characterized or not) and cancer that develops within five years of the diagnosis of the neurological disorder |
A neurological syndrome (classical or not) with well-characterized onconeural antibodies and no cancer |
Possible PNS |
A classical syndrome, no onconeural antibodies, and no cancer, but a high risk of an underlying tumor |
A neurological syndrome (classical or not) with partially characterized onconeural antibodies and no cancer |
A non-classical syndrome, no onconeural antibodies, and cancer present within five years of the diagnosis |
Table 7 Criteria for the diagnosis of Lambert-Eaton myasthenic syndrome
Clinical features |
(1) Proximal muscle weakness |
(2) Autonomic symptoms |
(3) Reduced tendon reflexes |
Anti-voltage-gated calcium channel antibodies |
Repetitive nerve stimulation abnormalities |
(1) Low compound muscle action potential |
(2) Decrease > 10% at low frequency (1-5 Hz) |
(3) Increase > 100% after maximum voluntary contraction or at high frequency (50 Hz) |
Table 8 Paraneoplastic dermatologic syndromes and paraneoplastic rheumatologic syndromes associated with lung cancer
Paraneoplastic dermatologic syndromes associated with lung cancer |
Polymyositis/dermatomyositis |
Acrokeratosis paraneoplastica (Bazex syndrome) |
Acanthosis nigricans |
Tripe palms |
The sign of Leser-Trélat |
Erythema gyratum repens |
Cutaneous leukocytoclastic vasculitis |
Pityriasis rubra pilaris |
Rhinophyma |
Eosinophilic cellulitis |
Herperiformis pemphigus |
Hypertrichosis lanuginose acquisita |
Erythema elevatum diutinum |
Paraneoplastic rheumatologic syndromes associated with lung cancer |
Polymyositis/dermatomyositis |
Vasculitis |
Cutaneous leukocytoclastic vasculitis |
Henoch-Schönlein purpura |
Hypertrophic pulmonary osteoarthropathy |
Remitting seronegative symmetrical synovitis with pitting edema |
Polymyalgia rheumatica |
Table 9 Criteria for the diagnosis of paraneoplastic glomerulopathy
No obvious alternative etiology other than malignancy |
Existence of a time relationship between the diagnosis of glomerulopathy and malignancy |
Clinical improvement after the complete surgical removal of the tumor or complete remission achieved by chemotherapy/radiotherapy |
Deterioration of glomerulopathy associated with recurrence of the malignancy |
- Citation: Kanaji N, Watanabe N, Kita N, Bandoh S, Tadokoro A, Ishii T, Dobashi H, Matsunaga T. Paraneoplastic syndromes associated with lung cancer. World J Clin Oncol 2014; 5(3): 197-223
- URL: https://www.wjgnet.com/2218-4333/full/v5/i3/197.htm
- DOI: https://dx.doi.org/10.5306/wjco.v5.i3.197