[Neurologic disorder complicating a cervical cancer]. / Troubles neurologiques compliquant une néoplasie du col utérin.

A 47-year-old patient is admitted to the hospital for visual disorders and paresthesia on her left hemiface and her superior left limb. Symptoms appeared about a month before. The patient is currently under treatment for a non metastatic cervical adenocarcinoma, of stage IIIb according to FIGO. Further exams show bilateral hypodense cerebral lesions of unknown origin despite many complementary tests, among which a transthoracic and transoesophageal echocardiography, autoimmune and infectious testings. During her hospitalisation, the patient's condition worsens on the neurologic and cardiac levels in spite of a wide-spectrum empirical antibiotherapy initiated with the presumed diagnosis of infectious endocarditis. The repetition of cardiac echocardiographies ends up showing a nodule on the mitral valve. The context of neoplasia, negative hemocultures and serologies, lead us to evoke the diagnostic of marantic endocarditis even though this kind of complication was rarely described in cases of cervical neoplasia. An anticoagulant treatment is therefore initiated and the patient's state will progressively improve, at least at first.

Increased Dickkopf-1 expression in breast cancer bone metastases.

The aim of this study was to determine whether Dickkopf-1 (Dkk-1) expression in breast cancer was associated with bone metastases. We first analysed Dkk-1 expression by human breast cancer cell lines that induce osteolytic or osteoblastic lesions in animals. Dickkopf-1 levels were then measured in the bone marrow aspirates of hind limbs from eight NMRI mice inoculated with breast cancer cells that induced bone metastases and 11 age-matched non-inoculated control animals. Finally, Dkk-1 was measured in the serum of 17 women with breast cancer in complete remission, 19 women with breast cancer and bone metastases, 16 women with breast cancer and metastases at non-bone sites and 16 healthy women. Only breast cancer cells that induce osteolytic lesions in animals produced Dkk-1. There was a six-fold increase in Dkk-1 levels in the bone marrow from animals inoculated with MDA-B02 cells when compared with that of control non-inoculated animals (P=0.003). Median Dkk-1 levels in the serum of patients with breast cancer and bone metastases were significantly higher than levels of patients in complete remission (P=0.016), patients with breast cancer having metastases at non-bone sites (P<0.0001) and healthy women (P=0.047), although there was a large overlap in individual levels between the different groups. In conclusion, Dkk-1 is secreted by osteolytic human breast cancer cells lines and increased circulating levels are associated with the presence of bone metastases in patients with breast cancer. Measurements of circulating Dkk-1 levels may be useful for the clinical investigation of patients with breast cancer and bone metastases.

Acute confusion in patients with systemic cancer.

OBJECTIVE: To determine the incidence, the causes and the prognostic value for survival of acute confusion (delirium) in patients admitted to a general cancer hospital. PATIENTS: Hundred consecutive patients with confusion were examined; 78 had a metastatic disease, 11 had local tumor and 11 had no sign of tumor recurrence at admission. Patients with confusion represented 11.8% (95%CI: 9.7-14.2%) of admissions. Follow-up period lasted 18 months from the inclusion of the last patient. RESULTS: Structural brain lesions (SBL) were mostly metastatic and caused confusion in 36 patients. 57 patients had a toxic or metabolic encephalopathy (TME). The cause remained unexplained in 6 cases, and in one patient the final diagnosis was psychotic state. Most patients with TME had more than one abnormality which could cause confusion. Confusion was reversible in 34 patients, and the odds for its regression was 3-fold higher in patients with TME (P = 0.02). Survival was significantly shorter (P = 0.02) in patients with SBL (median: 3 weeks) than in patients with TME (median: 8 weeks). However, the survival was significantly longer (P = 0.007) in patients with only one toxic or metabolic disorder (median: 20.5 weeks) than in patients with multiple changes (median: 5 weeks). CONCLUSION: Confusion is common in general cancer population. TME is the leading etiology and it is due to multiple causes in most patients. SBL causes confusion in one third of the patients. Patients with TME have a greater chance to recover, and survive longer especially if they have only one toxic or metabolic change.