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Lung Pathology |

Paraneoplastic Cataplexy: A Rare Presentation of Squamous Cell Lung Cancer

Basheer Tashtoush, MD; Roya Memarpour, MD; Ali Varasteh, MD; Anas Hadeh, MD; Laurence Smolley, MD
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Cleveland Clinic Florida, Weston, FL


Chest. 2015;148(4_MeetingAbstracts):602A. doi:10.1378/chest.2281548
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Abstract

SESSION TITLE: Lung Pathology Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Neurological symptoms precede the diagnosis of cancer in approximately 50% of patients with paraneoplastic syndromes. Narcolepsy - cataplexy like paraneoplastic syndrome is a CNS immune disorder that has been reported as a rare early manifestation of a few occult malignancies, such as testicular cancers, and neuroblastomas.

CASE PRESENTATION: A 77 yr old former smoker presented to the pulmonary clinic complaining of new onset mild hemoptysis for 1 day. His medical history was significant for narcolepsy with cataplexy diagnosed 5 months earlier based on a multiple sleep latency test (MSLT) that was performed in the evaluation of recurrent episodes of brief loss of postural tone with preserved consciousness. Since diagnosis the patient was started on medical treatment with little improvement in these cataplexic events. In the evaluation of his hemoptysis a left upper lobe tumor was detected on CT chest (Figure 1) and further diagnostic procedures revealed a stage IIIA Squamous cell lung cancer. Brain MRI was negative for any metastatic intracranial disease.

DISCUSSION: Hypothalamic involvement has been documented in a majority of patients with malignancies when associated with anti-Ma2 antibodies. Narcolepsy with cataplexy is a REM sleep disorder in which a cholinergic/monoaminergic imbalance accounts for the symptoms and has been linked to an absence or reduced hypothalamic hypocretin signaling.

CONCLUSIONS: Paraneoplastic CNS disorders are rare immune disorders that can present as an early manifestation of an occult malignancy where age appropriate cancer screening can potentially diagnose the underlying malignancy at an earlier stage. This case represents a very rare presentation of paraneoplastic cataplexy in a patient 5 months prior to the diagnosis of squamous cell lung cancers.

Reference #1: Joseph C. Landolfi, Mangala Nadkarni. Paraneoplastic limbic encephalitis and possible narcolepsy in a patient with testicular cancer: case study. Neuro Oncol. 2003 Jul; 5(3): 214-216.

Reference #2: Josep Dalmau, Myrna R Rosenfeld. Paraneoplastic syndromes of the CNS. Lancet Neurol. 2008 Apr; 7(4): 327-340.

Reference #3: Farid K, Jeannin S, Lambrecq V, et al. Paraneoplastic cataplexy: clinical presentation and imaging findings in a case. Mov Disord. 2009 Sep 15;24(12):1854-6.

DISCLOSURE: The following authors have nothing to disclose: Basheer Tashtoush, Roya Memarpour, Ali Varasteh, Anas Hadeh, Laurence Smolley

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