ABSTRACT
BACKGROUND: Paraneoplastic syndromes precede the dia-gnosis of malignancy. Early detection of paraneoplastic syndrome may lead to detection of malignancy in its early and potentially curable stage. Differential diagnostic process of rare paraneoplastic vasculitis requires multidisciplinary cooperation between rheumatologists, radiologists and oncologists. CASE: 41 yearâold female patient with cervical cancer in stage IVB (paraaortic lymphadenopathy) and clinical symptoms of acute vasculitis was admitted to our ward for oncological treatment. Chemoradiotheraphy was initiated concurrently with corticotherapy. During the treatment we observed alleviation of vasculitis related symptoms. Ongoing followup, however, brought no further improvement in vasculitis related symptoms. This lead us to suspicion of recurrence, confirmed on CT scan. Palliative chemotherapy was without any effect and due to worsening performance status was terminated. CONCLUSION: The activity of vasculitis was closely associated with the activity of primary malignant disease. Early recognition of paraneoplastic syndrome may contribute not only to dia-gnosis of malignancy, but is helpful during followup of these patients.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Chemoradiotherapy , Neoplasm Recurrence, Local , Paraneoplastic Syndromes/therapy , Uterine Cervical Neoplasms/therapy , Vasculitis/therapy , Adult , Female , Humans , Neoplasm Recurrence, Local/diagnosis , Paraneoplastic Syndromes/diagnosis , Uterine Cervical Neoplasms/diagnosis , Vasculitis/diagnosisABSTRACT
BACKGROUND: Superior vena cava syndrome (SVCO) is caused by compression of superior vena cava and restriction of blood flow to the heart. The most common underlying condition in cancer patients is lung cancer or other malignancy expanding in the upper mediastinum. SVCO belongs to oncological emergencies and requires a prompt dia-gnostic workâup and treatment. CASE 1: A 79yearâold man with a history of rightâsided stage IIIB nonsmall cell lung cancer, after two cycles of chemotherapy, was admitted to hospital with clinical signs of SVCO. The initial radiotherapy brought no relief of symptoms and due to deterioration of patients status during the treatment we proceeded to selfâexpanding caval stent insertion. This was followed by immediate resolution of SVCO symptoms. CASE 2: In the second case we describe a 56yearâold female with a newly dia-gnosed diffuse large B cell lymphoma who presented with SVCO symptoms when referred to our outpatient chemotherapy department. She had no history of previous treatment and she complained of a rapid face and eyelid edema and intractable cough in the last two days. CT scan revealed mediastinal mass compressing the superior vena cava. Urgent antilymphoma chemotherapy (RCHOP schedule) was commenced and yielded quick resolution of her symp-toms. CONCLUSION: Superior vena cava syndrome is a medical emergency in oncological patients usually caused by external compression of cava by lung cancer, lymphoma, other tumors, less frequently, from a thrombosis of indwelling central venous catheter. Multidiscip-linary cooperation among radiation and medical oncologists and interventional radiologists is needed in order to provide an early treatment without an undue delay.
