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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Front+Endocrinol+(Lausanne)
2018 ; 9
(ä): 170
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Dual Paraneoplastic Endocrine Syndromes Heralding Onset of Extrapulmonary Small
Cell Carcinoma: A Case Report and Narrative Review
#MMPMID29755405
Feffer JB
; Branis NM
; Albu JB
Front Endocrinol (Lausanne)
2018[]; 9
(ä): 170
PMID29755405
show ga
OBJECTIVE: Extrapulmonary small cell carcinoma (EPSCC) is rare and frequent
metastases at presentation can complicate efforts to identify a site of origin.
In particular, SCC comprises <1% of prostate cancers and has been implicated in
castration resistance. METHODS: Clinical, laboratory, imaging, and pathology data
are presented. RESULTS: A 56-year-old man with locally advanced prostate
adenocarcinoma on androgen deprivation therapy presented with a clogged
nephrostomy tube. Laboratory results included calcium 13.8?mg/dL
(8.5-10.5?mg/dL), albumin 3.6?g/dL (3.5-5?mg/dL), and potassium 2.8?mmol/L
(3.5-5.2?mmol/L). Hypercalcemia investigation revealed intact PTH 19?pg/mL
(16-87?pg/mL), 25-OH vitamin D 15.7?ng/mL (>30?ng/mL), and PTH-related peptide
(PTHrP) 63.4?pmol/L (<2.3?pmol/L). Workup for hypokalemia yielded aldosterone
5.3?ng/dL (<31?ng/dL), renin 0.6?ng/mL/h (0.5-4?ng/mL/h), and 6:00?a.m. cortisol
82?µg/dL (6.7-22.6?µg/dL) with ACTH 147?pg/mL (no ref. range). High-dose
Dexamethasone suppression testing suggested ACTH-dependent ectopic
hypercortisolism. Contrast-enhanced CT findings included masses in the liver and
right renal pelvis, a heterogeneous enlarged mass in the region of the prostate
invading the bladder, bilateral adrenal thickening, and lytic lesions in the
pelvis and spine. Liver biopsy identified epithelioid malignancy with Ki
proliferation index 98% and immunohistochemical staining positive for
synaptophysin and neuron-specific enolase, compatible with high-grade small cell
carcinoma. Staining for ACTH was negative; no stain for CRH was available. Two
weeks after chemotherapy, 6:00?a.m. cortisol normalized and CT scans showed
universal improvement. CONCLUSION: Extensive literature details paraneoplastic
syndromes associated with SCC, but we report the first case of EPSCC diagnosed
due to onset of dual paraneoplastic syndromes.