title: A coin-like peripheral small cell lung carcinoma associated with acute paraneoplastic axonal Guillain-Barre-like syndrome.
abstract: A 65-year-old previously healthy male heavy smoker was hospitalized with a 2-week history of progressive muscle weakness in the lower and upper extremities. After 10 days of hospitalization, urinary sphincter incompetence and fecal incontinence were added and tetraparesis was established. The computer-tomography scan examination revealed a massive right hydrothorax and multifocal solid acinar structures with peripheral localization in the left lung, which suggested pulmonary cancer. Bone marrow metastases were also suspected. Based on the examination results, the final diagnosis was acute paraneoplastic axonal Guillain-Barre-like syndrome. The patient died 3 weeks after hospitalization. At autopsy, bronchopneumonia and a right hydrothorax were confirmed. Several 4 to 5-mm-sized round peripherally located white nodules were identified in the left lung, without any central tumor mass. Under microscope, a coin-shaped peripheral/subpleural small cell carcinoma was diagnosed, with generalized bone metastases. A huge thrombus in the abdominal aorta and acute pancreatitis was also seen at autopsy. This case highlights the difficulty of diagnosis of lung carcinomas and the necessity of a complex differential diagnosis of severe progressive ascending neuropathies. This is the 6th reported case of small cell lung cancer-associated acute Guillain-Barre-like syndrome and the first report about an association with a coin-like peripheral pattern.
authors.affiliation: From the Department of Pathology (IJ, SG, AOC, SP); Department of Neurology (RB, AM); and Department of Radiology, University of Medicine and Pharmacy of Tirgu-Mures, Tirgu-Mures, Romania (IH, IS).
authors.forename: Ioan
authors.initials: I
authors.lastname: Jung
authors.forename: Simona
authors.initials: S
authors.lastname: Gurzu
authors.forename: Rodica
authors.initials: R
authors.lastname: Balasa
authors.forename: Anca
authors.initials: A
authors.lastname: Motataianu
authors.forename: Anca Otilia
authors.initials: AO
authors.lastname: Contac
authors.forename: Ioana
authors.initials: I
authors.lastname: Halmaciu
authors.forename: Septimiu
authors.initials: S
authors.lastname: Popescu
authors.forename: Iunius
authors.initials: I
authors.lastname: Simu
mesh_terms: D000368:Aged; D017809:Fatal Outcome; D020275:Guillain-Barre Syndrome / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000473:pathology*; D008297:Male; D020361:Paraneoplastic Syndromes, Nervous System / Q000209:etiology* / Q000473:pathology; D055752:Small Cell Lung Carcinoma / Q000150:complications* / Q000473:pathology*