Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Colorectal carcinoma and chronic inflammatory demyelinating polyneuropathy: is there a possible paraneoplastic association?

  • Adnan Malik (Loyola University Medical Center) ;
  • Faisal Inayat (Allama Iqbal Medical College) ;
  • Muhammad Hassan Naeem Goraya (Services Institute of Medical Sciences) ;
  • Gul Nawaz (Marshfield Clinic) ;
  • Ahmad Mehran (Allama Iqbal Medical College) ;
  • Atif Aziz (Islamic International Medical College) ;
  • Saad Saleem (Sunrise Hospital and Medical Center)
  • Received : 2021.02.06
  • Accepted : 2021.04.05
  • Published : 2023.03.30
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Abstract

A plethora of paraneoplastic syndromes have been reported as remote effects of colorectal carcinoma (CRC). However, there is a dearth of data pertaining to the association of this cancer with demyelinating neuropathies. Herein, we describe the case of a young woman diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP). Treatment with intravenous immunoglobulins and prednisone did not improve her condition, and her neurological symptoms worsened. Subsequently, she was readmitted with exertional dyspnea, lightheadedness, malaise, and black stools. Colonoscopy revealed a necrotic mass in the ascending colon, which directly invaded the second part of the duodenum. Pathologic results confirmed the diagnosis of locally advanced CRC. Upon surgical resection of the cancer, her CIDP showed dramatic resolution without any additional therapy. Patients with CRC may develop CIDP as a type of paraneoplastic syndrome. Clinicians should remain cognizant of this potential association, as it is of paramount importance for the necessary holistic clinical management.

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References

  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424. 
  2. Dyck PJ, Lais AC, Ohta M, et al. Chronic inflammatory polyradiculoneuropathy. Mayo Clin Proc 1975;50:621-637. 
  3. Broers MC, Bunschoten C, Nieboer D, et al. Incidence and prevalence of chronic inflammatory demyelinating polyradiculoneuropathy: a systematic review and meta-analysis. Neuroepidemiology 2019;52:161-172. 
  4. Malik A, Berry R, Fung BM, et al. Association between chronic inflammatory demyelinating polyneuropathy and gastrointestinal malignancies. Clin J Gastroenterol 2021;14:1-13. 
  5. Rajabally YA, Attarian S. Chronic inflammatory demyelinating polyneuropathy and malignancy: a systematic review. Muscle Nerve 2018;57:875-883. 
  6. Antoine JC, Mosnier JF, Lapras J, et al. Chronic inflammatory demyelinating polyneuropathy associated with carcinoma. J Neurol Neurosurg Psychiatry 1996;60:188-190. 
  7. Ayyappan S, Day T, Kiers L. Distal acquired demyelinating symmetric (DADS) neuropathy associated with colorectal adenocarcinoma. Muscle Nerve 2015;51:928-931. 
  8. Galassi G, Luppi G. Distal acquired demyelinating symmetric neuropathy associated with colorectal adenocarcinoma: should it be termed paraneoplastic? Muscle Nerve 2016;53:658-659. 
  9. Bell CE, Seetharam S. Identification of the Schwann cell as a peripheral nervous system cell possessing a differentiation antigen expressed by a human lung tumor. J Immunol 1977;118:826-831. 
  10. Kudo M, Noguchi T. Immunoreactive myelin basic protein in tumor cells associated with carcinomatous neuropathy. Am J Clin Pathol 1985;84:741-743. 
  11. Altermatt HJ, Rodriguez M, Scheithauer BW, et al. Paraneoplastic anti-Purkinje and type I anti-neuronal nuclear autoantibodies bind selectively to central, peripheral, and autonomic nervous system cells. Lab Invest 1991;65:412-420. 
  12. Fuller GN, Spies JM, Pollard JD, et al. Demyelinating neuropathies triggered by melanoma immunotherapy. Neurology 1994;44:2404-2405. 
  13. Henry K. Paraneoplastic syndromes: definitions, classification, pathophysiology and principles of treatment. Semin Diagn Pathol 2019;36:204-210. 
  14. Jameson JL, Longo DL. Paraneoplastic syndromes: endocrinologic/hematologic. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. Harrison's Principles of Internal Medicine 20th ed. McGraw-Hill Education; 2018. 
  15. Bunschoten C, Jacobs BC, Van den Bergh PYK, et al. Progress in diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy. Lancet Neurol 2019;18:784-794. 
  16. Van den Bergh PYK, Hadden RDM, Bouche P, et al. European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society-first revision. Eur J Neurol 2010;17:356-363. 
  17. Breiner A, Brannagan TH. Comparison of sensitivity and specificity among 15 criteria for chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2014;50:40-46. 
  18. Kuwabara S, Misawa S. Chronic inflammatory demyelinating polyneuropathy. Adv Exp Med Biol 2019;1190:333-343. 
  19. Benson AB, Venook AP, Al-Hawary MM, et al. NCCN guidelines insights: colon cancer, version 2.2018. J Natl Compr Canc Netw 2018;16:359-369. 
  20. Kakushadze Z, Raghubanshi R, Yu W. Estimating cost savings from early cancer diagnosis. Data 2017;2:30.