| Popis: |
Introduction:We report the case of a patient who had a paraneoplastic syndrome as the first manifestation of a head and neck squamous cell carcinoma. Materials and methods:A 57-year-old man was admitted to the pulmonology department due to long-standing dyspnea along with bilateral pleural effusion and arthritis in knees, carpus and metacarpae of recent appearance. During his hospitalization he presents erythema and desquamation in the hands, auricular pavilions, knees and thighs; A minimal pericardial effusion was also observed. The autoimmunity analysis revealed positive antinuclear antibodies and Anti Ro positive, being the rest of the tests normal. The skin lesions are diagnosed as Acrokeratosis Paraneoplastica (Basex síndrome). The physical examination of the patient revealed the presence of a hard and adherent right cervical mass, not showing pharyngolaryngeal lesions or in other locations. A puncture with thick needle of cervical mass is performed, being the result of anatomopathological analysis squamous cell carcinoma. The mass is classified as cervical metastasis of unknown origin. Discussion:The systemic clinical manifestations by the metabolites of tumors are called paraneoplastic syndromes. The different metabolites produced can cause a wide range of symptoms, usually mediated by the toxic action of substances released by the tumor. They usually affect several organs and systems: endocrine, dermatological, ocular and osteoarticular. Paraneoplastic syndromes occur in 1 to 7.4% of all cancer patients, with presentation in infrequent head and neck neoplasms. Squamous cell carcinoma is the variant most frequently associated with this type of syndromes, also frequently occurring in neuroendocrine tumors, with a lower incidence in other types of tumors such as adenocarcinoma, adenoid cystic carcinoma, lymphomas and sarcomas. Basex Acrokeratosis Paraneoplastica was first described in 1965, being associated with carcinoma of the piriformis sinus. Clinically, it is characterized by erythematous desquamative skin patches with a predilection in the extremities and is the paraneoplastic syndrome that occurs most frequently in tumors of the larynx and hypopharynx. Conclusion:Physicians treating cancer patients should be able to differentiate paraneoplastic syndromes from other benign disorders; These syndromes can dominate the clinical picture of the patient leading to a diagnostic delay since this symptom eclipses the underlying oncological pathology. The paraneoplastic syndromes are important because they allow an early diagnosis and an adequate treatment of the patient's tumor |
