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Paraneoplastic syndromes > Paraneoplastic syndromes > Flashcards

Paraneoplastic syndromes Flashcards

1
Q

How many dog and cats with hypercalemia are diagnosed with cancer?

A

60% and 30%

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2
Q

Which neoplasia is the most common cause for hypercalcemia in dogs?

A

T-cell lymphoma (35-55%) followed by ASAC (25%)

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3
Q

Name 8 other neoplastic processes known to cause hypercalcemia?

A 
DOG:
Epithelial- 
Nasal
Thyroid
Thymoma
Pulmonary
Mammary
Hepatocellular
Adrenal
Renal 
Clitoral
ASAC

Round cell;
Lymphoma - T cell
Leukemia - chronic lymphocytic, acute lymphoblastic
Multiple myeloma

Mesenchymal:
Melanoma
Osteosarcoma
Achantomatous ameloblastoma

CAT:
Epithelial 
SCC
Thyroid
Pulmonary
Renal

ROUND CELL:
Acute leukemia
Lymphoma
MM

Mesenchymal:
OSA
FSA
Undifferentiated SA

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4
Q

What is the most common cause for hypercalcemia of malignancy in cats?

A

Lymphoma, SCC and multiple myeloma

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5
Q

Name 5 other neoplasia which have caused hypercalcemia in cats?

A 
Epithelial:
Pulmonary
Thyroid
Renal 
SCC

Mesenchymal
OSA
FSA

Rounds:
LSA
Acute leukemia

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6
Q

What are the main differentials to hypercalcemia?

A 
D- vitaminosis D
R - Renal disease
A - ddisons
G- granulomatous
O - Osteolysis
N - Neoplasia
S - spurious
H - hyperparathyroidism
I - idiopathic 
T- Total protein elevation
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7
Q

What is the MOA of bisphosphanates?

A

They inhibit the enzyme Farnesyl dephosphate synthase (FPPS) in the mevalonate pathway, inhibit formation of farnesyl-PP result in accumulation of cytotoxic intermediate substrates causing reduced osteoclast function and possible apoptosis.

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8
Q

Which AE have been associated with bisphosphanates?

A 
Osteonecrosis of the jaw (rare)
Human AE:
Nephrotoxicity
Electrolyte imbalances
acute phase reactions
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9
Q

What is the MAO of paraneoplastic fever?

A

Immune reaction to tumour antigens or tumour necrosis resulting in IL-1, IL-6 and TNF-alpha release- This will activate the arachidonic acid cascade which produce prostaglandin E2 which work on the hypothalamus

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10
Q

Which type of malignancy is most commonly found as the cause of paraneoplastic fever?

A

Haematological neoplasia

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11
Q

Which neoplastic process is most likely to be the cause of myastenia gravis?

A

Thymoma

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12
Q

Which other neoplastic diseases than thymoma may cause MG?

A

Oral sarcoma, non-epitheliotrophic lsa, cholangiocellular carcinoma, osteosarcoma

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13
Q

DDX paraneoplastic erythrocytosis

A
  • renal tumour (adenocarcinoma, LSA, FSA)
  • nasal fibrosarcoma
  • caecal leiomyosarcoma
  • spinal cord swannoma
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14
Q

DDX non-neoplastic causes erythropoietin

A

non-neoplastic renal disease
heart disease with right to left shunting
chronic respiratory disease

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15
Q

What is the suspected mechanisms of paraneoplastic erythrocytosis?

A

Increased production EPO by tumour cells
OR
Chronic reduced renal perfusion

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16
Q

By which mechanisms can paraneoplastic hypogycemia occur?

A 
Production of insulin
Production of IGF-1 or IGF-2
Hypermetabolism of glucose
production of substances stimulating insulin release
production stomatomedins
insulin binding by monoclonal immunoglobulin (plasma cell tumour)
insulin receptor proliferation
ectopic insulin production
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17
Q

Which tumours are associated with paraneoplastic hypoglycaemia

A 
Primary hepatic tumours (HCC, or adenoma)
Smooth muscle tumours - leiomyom and leiomyosarcoma. 
Case reports for:
HSA
LSA
LL
mammary carcinoma
melanoma
Plasmacell tumour
renal adenocarcinoma
salivary adenocarcinoma
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18
Q

HSA has been associated with the following PNS?

A

Anemia
DIC
Neutrophilic leukocytsosis
Hypoglycemia

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19
Q

How many dogs and diagnosed with LSA have anaemia?

A

30-60%

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20
Q

Which neoplastic process does most commonly cause paraneoplastic IMHA?

A

Lymphoma

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21
Q

What is microangiopathic hemolytic anaemia?

A

Non-immune mediated destruction of RBCs secondary to microangiopahty, tumor cell erythrophagocytosis, oxidative damage to erythrocytes.

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22
Q

Which tumours are most commonly associated with paraneoplastic anaemia?

A

Lymphoma, leukemia, HSA, HS, disseminated MCT

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23
Q

Which other clinicopathological abnormalities can be seen with dogs with hemophagocytic HS?

A

Thrombocytopenia, regenerative anaemia, negative direct agglutination, hypoalbuminemia, hypocholesterolemia

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24
Q

Erythrocytosis have been documented in which neoplastic processes?

A 
HS
Plasma cell tumour
Lymphoma
acute megacaryopblastic leukemia
Cats with LSA and MCT
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25
Q

What is the most common pathogenesis of anaemia in pets with cancer?

A

Anaemia of inflammatory disease: Mild to moderate, non regenerative, normocytic normochromic anaemia
TNF-alpha
INF-gamma
IL1, IL-6, Il-19 reduce EPO production and suppress erythroid progenitor response

IL-6 increase hepcidine production in the liver, causing internalisation and degradation of ferroportin, reducing available iron and decreased availability of iron for erythropoiesis.

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26
Q

Which factors are responsible for inducing cachexia?

A

IL-1, IL-6, TNF-alpha, myostatin, NF-kappa beta activating ubiquitin proteasome pathway, GH and IGF-1
Result in anorexia, energy metabolism and loss of lean body mass

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27
Q

Which tumours may cause GI ulceration?

A
  1. MCT

2. Gastrinoma

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28
Q

What is the effect of hypehistaminemia?

A
  1. Increased HCl secretion
  2. Increased vascular permeability of gastric mucosa
  3. localised protein exudation
  4. increased mucosal blood flow
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29
Q

What is Zollinger Ellison-syndrome?

A

Hypergastrinemia, GI ulceration and a no-neta cell neuroendocrine tumour in the pancrease

30
Q

What is the most common cause of paraneoplastic hypoglycaemia?

A

Insulinoma - due to production of insulin

31
Q

What is the most common cause for paraneoplastic hypoglycemia in non-islet cell tumour?

A

Production of IGF-2

32
Q

Which 5 tumours have been reported to cause hypoglycemia?

A 
Primary liver tumour
Leiomyom
Leiomyosarcoma
HSA
LSA
Lymphocytic leukemia
MC
Melanoma
Plasma cell tumour
Renal carcinoma
Salivary gland adenocarcinoma
33
Q

By which mehcanisms can tumours potentially cause hypoglycemia?

A
  1. insulin
  2. IGF-1 or IGF-2
  3. Glucose metabolism
  4. Proliferation of insulin receptors
  5. Ectopic insulin production
  6. Produce substances stimulating insulin release
  7. Produce hepatic glucose inhibitor
  8. Insulin binding to monoconal AB - plasma cell tumour
34
Q

which tumours may cause hyperestrogenism

A

1, Sertoli

less likely - seminoma, leydig cell or ovarian granulosa cell tumour

35
Q

What are the clinical signs associated with hyperestrogenism

A

Bilateral symmetric alopecia, hyperpigmentation, epidermal thinning, gynecomastia, galactorrhea, pendulous prepuce penile atrophy, atrophy contralateral testicel, attraction other males

BONEMARROW TOXICOSIS

36
Q

What are the findings associated with hyperestrogenims on a CBC?

A

Initial granulocytosis- normally neutrophilic, followed by progressive bone marrow hypo-plasia leading to aplastic anaemia

37
Q

What is the mechanism behind canine acromegaly?

A

Progesin-induced GH secretion from a mammary ductal epithelium - has been reported in 2 mammary tumours

38
Q

What is the MAO for acromegaly in cats?

A

Hypersomatrophism due to a pituitary adenoma

39
Q

What is the result of prolonged exposure to excessive amounts of GH?

A

Reduced insulin sensitivity and DM
Overgrowth of connective tissue, bone and viscera - broad facia features, diffuse thickening oropharyngeal tissue, organomegaly, HCM, clubbing of the paws

40
Q

How do we diagnose acromegaly?

A

Measure IGF-1

41
Q

What is the cause of ectopic ACTH production documented in people with small cell carcinoma of the lungs?

A

The tumour express proopiomelanocortin gene

42
Q

How can M components interfere with coagulation?

A
  1. coat the platelets
  2. inhibit platelet aggregation to damages surface
  3. inhibit release platelet factor 3
43
Q

How does BJ proteins cause renal damage?

A

They can form tubular casts which result in interstitial nephritis and possible renal failure

44
Q

What are the possible neoplastic causes for hyperviscosity syndrome?

A

.Increased globulins- ie myeloma related disorders
PV
Paraneoplastic erythrocytosis- TVT, caecal leiomyosarcoma, renal tumour, nasal fibrosarcoma, spinal cord schwannoma

45
Q

Which Ig is most likely to cause hyperviscosity+

A

IgM or IgA

46
Q

What are the clinical signs associated with hyperviscosity syndrome?

A

Neurological: seizure, abnormal mentation, ataxia
Ocular: Retinal bleeding, tortuous vessels, retinal detachment
Bleeding diathesis
Cardiomyopathy

47
Q

What would be a treatment option for severe hyperviscosity syndrome?

A

Plasmapheresis

Phlebotomy and IV-fluids if due to erythrocytosis

48
Q

What are possible ddx for agglutination?

A
  • IMHA

- EDTA-agglutination - spurious

49
Q

What is the possible causes of Rouleaux formation?

A
  • Hyperglobulinemia - fibrinogen og immunoglobulin
50
Q

How does anaemia of inflammatory disease cause anemia?

A

It is caused by increase in inflammatory cytokines - TNF-alpha, IFN-gamma, IL1, IL6, IL-10 reduce the production of EPPO in the face of hypoxemia and suppress the erythroid progenitor response. and IL-6 produce more hepcidin, which degrade ferroportine reducing availability of iron . decreased iron for erythropoiesis.

51
Q

Paraneoplastic neutrophilic leukocytosis has been documented with :

A

Dog: Renal tumours, pulmonary carcinoma, interstitial t-cell lymphoma, fibrosarcoma, rectal polyos

Cat: Pulmonary carcinoma, dermal adeocarcinoma

52
Q

What is the suspected cause for neutrophilic leukocytosis?

A

Tumor production of G-CSF

53
Q

What are possible causes of paraneoplastic eosinophilia?

A

IL-5 production -

54
Q

What is the cause of paraneoplastic eosinophilia?

A

IL-5

55
Q

Which tumours have been documented to cause hypereosinopilia?

A

MCT, T-cell lymphoma most common, others include FSA, MC, leiomyosarcoma in dogs

Oral SCC and TCC in cats

56
Q

How many dogs with neoplasia present with thrombocytopenia?

A

10-35%

57
Q

T/F The cause of paraneoplastic thrombocytopenia is not identified in up to 60% of cases

A

T

58
Q

Which neoplastic disease most commonly cause immune mediated thrombocytopenia?

A
  1. lymphoma
  2. MM
  3. HS

Other:
Mammary carcinoma
Nasal adenocarcinoma

MCT

HSA
FSA

59
Q

Which tumours can cause thrombocytopenia by increased splenic sequestration?

A

LSA
Feline MCT
Hemangioma
HSA

60
Q

Which canine tumour most commonly cause hypogoaulability by causing clotting factor dysfunction? AND what is the mechanism?

A

MCT - cofactor for antithrombin 3 - inactivate clotting facto 12, 11, 10 and 9

61
Q

What is most common in cancer patients - hyper or hypo coagulability?

A

Hyper

62
Q

Which tumours most commonly cause DIC?

A

HSA
Mammary carcinoma - inflammatory especially
Pulmonary adenocarcinoma

63
Q

What are the mechanisms of DIC in neoplasia?

A
  1. Abnormal vasculature cause rearrangement of the haemodynamics triggering coagulation
  2. Hyperviscosity reduced efficacy of the PLT and slugging of blood
  3. Inflammation cause cross-talk with coags- tissue factor complex with factor 7a and activate the extrinsic pathway - main source of thrombin in neoplasia
  4. Cytokines TNF-alpha, IL-1 and IL6 can activate the extrinsic clotting cascade, and down regulate C-thrombomodulin
64
Q

Which tumours are commonly found in dogs with nodular fibrosis in addition to the renal cyst adenomas and carcinomas?

A

Uterine leyomyoma

65
Q

Superficial necrolytic dermatitis is seen with which tumour?

A

Glucagonma in Pancras or liver

66
Q

Give ddx for a dog presenting with hyperkeratosis man fissuring uf the foot pads and ulceration and crusting of mucocutaneous junctions

A

Paraneoplastic superficial necrolytic dermatitis - glucagonoma in liver or pancreas

67
Q

What is the MAO causing hypoaminoacidemia

A

Elevated glucagon sustain glyconeogenesis and amino acid catabolism . causing low AA resulting in epidermal protein depletion and keratinocyte necrolysis

68
Q

Which tumours have been known to cause paraneoplastic alopecia in cats?

A

Pancreatic carcinoma

Biliary carcinoma

69
Q

What is the difference between feline paraneoplastic alopecia and feline thymoma associated exofoliative dermatitis?

A

Alopecia is at the venture and medial aspect of limb, skin is shiny and thin

Exofoliative dermatitis affect the head and pinna, and progress, cause scaling and mild erythema

70
Q

What is the most common PNP glomerular disorder

A

Membranous nephropathy caused by immuncomplex formation

71
Q

T/F HS can cause hypercalcemia

A

True

Paraneoplastic syndromes (1 decks)

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