Paraneoplastic syndromes

Question 1

Clubbing

Answer 1

Sign of malignancy - can be anywhere

Question 2

Pigmented lesion: Acanthosis nigricans

Answer 2

Adenocarcinoma, predominantly gastric

Question 3

Pigmented lesion: Paget’s disease of nipple

Answer 3

Breast cancer

Question 4

Red lesions: Erythema annulare centrifugum

Answer 4

Prostate cancer, myeloma and others

Question 5

Red lesions: Erythema gyratum repens

Answer 5

Lung, breast uterine and GI cancers

Question 6

Red lesions: Necrolytic migratory erythema

Answer 6

Islet cell tumour of pancreas

Question 7

Red lesions: Systemic nodular panniculities

Answer 7

Adenocarcinoma of pancreas

Question 8

Blistering lesions: Bullous pemphigoid

Answer 8

Lymphoma and others

Question 9

Blistering lesions: Dermatitis herpetiformis

Answer 9

Lymphoma and others

Question 10

Misc: Acquired ichthyosis

Answer 10

Hodgkin’s disease, lymphomas, myelomas

Question 11

Misc: Dermatomyositis

Answer 11

Miscellaneous tumours

Question 12

Endocrine paraneoplastic syndromes

Answer 12

Cushing’s syndrome;

Syndrome of inappropriate ADH

Question 13

Malignant cause of SIADH

Answer 13

SCLC

Question 14

Entero-pancreatic hormone syndromes

Answer 14

Carcinoid syndrome

• due to serotonin and kinin secretion
• flushing, diarrhoea, abdominal pain, boborgymi
• assess by 24hr urinary 5HIAA (serotonin metabolite)

Phaeochromocytoma

• dysregulated chromaffin cell activity
• intermittent/ sustained HTN, tremor, palpirations
• assess by 24hr urinary free catecholamines (NA/A)

Question 15

Neurological paraneoplastic syndromes

Answer 15

Antibody directed at ion channels:

• pre-synaptic P-type voltage gated calcium channel –> Lambert Eaton myasthenic syndrome
• nACh receptor –> myasthenia gravis

Antibody binding intracellular protein

• Hu, neuronal nuclear RNA binding protein
• Yo, cytoplasmic protein in purkinje cells in cerebellum