Paraneoplastic syndrome or metastatic sinonasal neuroendocrine carcinoma? Clinical conundrum

Panagiotis Kerezoudis, Patrick R. Maloney, Brandon Mccutcheon, Jeffrey Janus, Mark Jentoft, Timothy J Kaufmann, Daniel H Lachance, Jamie Van Gompel, Mohamad Bydon

Research output: Contribution to journalArticle

Abstract

We report a case of a middle-aged woman with a diffuse, nonenhancing, progressively atrophic T2-hyperintense lesion involving the left frontotemporal lobes and insula found to be synchronous high-grade sinonasal neuroendocrine carcinoma (SNEC) after initial endonasal resection. In 2014, a 47-year old woman underwent resection of a left-sided high-grade ethmoidal neuroendocrine carcinoma after presentation with weight gain and increased levels of serum and urine cortisol. Concurrent with the initial presentation, she was noted to have a nonenhancing, hyperintense signal change on T2-weighted images on the left frontotemporal lobes and insula thought to be paraneoplastic. Moreover, low titer antibodies to voltage-gated potassium channels were present, raising concern for limbic encephalitis. However, the patient was asymptomatic. A little more than a year after initial presentation, she noted excessive fatigue, daytime somnolence, and cognitive decline. Imaging revealed a gradually progressive, nonenhancing, T2-hyperintense signal abnormality with progressive atrophy in the left anteroinferior frontal lobe, anteromedial temporal lobe, insula bilateral cingulate gyri, and bilateral thalami. Given the progressive nature of the abnormality, stereotactic biopsy was performed, which confirmed the lesion to be metastatic, infiltrative SNEC. In summary, this is a rare case of a synchronous presentation of a high-grade SNEC with an unusual appearance that diffusely infiltrated the brain, likely directly involving the left olfactory nerve and spreading along olfactory projections. This case draws physicians' attention to the possibility that although paraneoplastic syndromes are most likely benign, dissemination of the primary cancer is a diagnostic possibility.

Original languageEnglish (US)
Pages (from-to)E15
JournalEar, Nose and Throat Journal
Volume97
Issue number10-11
StatePublished - Oct 1 2018

Fingerprint

Neuroendocrine Carcinoma
Paraneoplastic Syndromes
Limbic Encephalitis
Olfactory Nerve
Voltage-Gated Potassium Channels
Gyrus Cinguli
Frontal Lobe
Temporal Lobe
Thalamus
Weight Gain
Atrophy
Fatigue
Hydrocortisone
Urine
Physicians
Biopsy
Antibodies
Brain
Serum
Neoplasms

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Kerezoudis, P., Maloney, P. R., Mccutcheon, B., Janus, J., Jentoft, M., Kaufmann, T. J., ... Bydon, M. (2018). Paraneoplastic syndrome or metastatic sinonasal neuroendocrine carcinoma? Clinical conundrum. Ear, Nose and Throat Journal, 97(10-11), E15.

Paraneoplastic syndrome or metastatic sinonasal neuroendocrine carcinoma? Clinical conundrum. / Kerezoudis, Panagiotis; Maloney, Patrick R.; Mccutcheon, Brandon; Janus, Jeffrey; Jentoft, Mark; Kaufmann, Timothy J; Lachance, Daniel H; Van Gompel, Jamie; Bydon, Mohamad.

In: Ear, Nose and Throat Journal, Vol. 97, No. 10-11, 01.10.2018, p. E15.

Research output: Contribution to journalArticle

Kerezoudis, P, Maloney, PR, Mccutcheon, B, Janus, J, Jentoft, M, Kaufmann, TJ, Lachance, DH, Van Gompel, J & Bydon, M 2018, 'Paraneoplastic syndrome or metastatic sinonasal neuroendocrine carcinoma? Clinical conundrum', Ear, Nose and Throat Journal, vol. 97, no. 10-11, pp. E15.
Kerezoudis P, Maloney PR, Mccutcheon B, Janus J, Jentoft M, Kaufmann TJ et al. Paraneoplastic syndrome or metastatic sinonasal neuroendocrine carcinoma? Clinical conundrum. Ear, Nose and Throat Journal. 2018 Oct 1;97(10-11):E15.
Kerezoudis, Panagiotis ; Maloney, Patrick R. ; Mccutcheon, Brandon ; Janus, Jeffrey ; Jentoft, Mark ; Kaufmann, Timothy J ; Lachance, Daniel H ; Van Gompel, Jamie ; Bydon, Mohamad. / Paraneoplastic syndrome or metastatic sinonasal neuroendocrine carcinoma? Clinical conundrum. In: Ear, Nose and Throat Journal. 2018 ; Vol. 97, No. 10-11. pp. E15.
@article{0e26b7b71932447fb3d16aae15ec45cf,
title = "Paraneoplastic syndrome or metastatic sinonasal neuroendocrine carcinoma? Clinical conundrum",
abstract = "We report a case of a middle-aged woman with a diffuse, nonenhancing, progressively atrophic T2-hyperintense lesion involving the left frontotemporal lobes and insula found to be synchronous high-grade sinonasal neuroendocrine carcinoma (SNEC) after initial endonasal resection. In 2014, a 47-year old woman underwent resection of a left-sided high-grade ethmoidal neuroendocrine carcinoma after presentation with weight gain and increased levels of serum and urine cortisol. Concurrent with the initial presentation, she was noted to have a nonenhancing, hyperintense signal change on T2-weighted images on the left frontotemporal lobes and insula thought to be paraneoplastic. Moreover, low titer antibodies to voltage-gated potassium channels were present, raising concern for limbic encephalitis. However, the patient was asymptomatic. A little more than a year after initial presentation, she noted excessive fatigue, daytime somnolence, and cognitive decline. Imaging revealed a gradually progressive, nonenhancing, T2-hyperintense signal abnormality with progressive atrophy in the left anteroinferior frontal lobe, anteromedial temporal lobe, insula bilateral cingulate gyri, and bilateral thalami. Given the progressive nature of the abnormality, stereotactic biopsy was performed, which confirmed the lesion to be metastatic, infiltrative SNEC. In summary, this is a rare case of a synchronous presentation of a high-grade SNEC with an unusual appearance that diffusely infiltrated the brain, likely directly involving the left olfactory nerve and spreading along olfactory projections. This case draws physicians' attention to the possibility that although paraneoplastic syndromes are most likely benign, dissemination of the primary cancer is a diagnostic possibility.",
author = "Panagiotis Kerezoudis and Maloney, {Patrick R.} and Brandon Mccutcheon and Jeffrey Janus and Mark Jentoft and Kaufmann, {Timothy J} and Lachance, {Daniel H} and {Van Gompel}, Jamie and Mohamad Bydon",
year = "2018",
month = "10",
day = "1",
language = "English (US)",
volume = "97",
pages = "E15",
journal = "Ear, Nose and Throat Journal",
issn = "0145-5613",
publisher = "Medquest Communications LLC",
number = "10-11",

}

TY - JOUR

T1 - Paraneoplastic syndrome or metastatic sinonasal neuroendocrine carcinoma? Clinical conundrum

AU - Kerezoudis, Panagiotis

AU - Maloney, Patrick R.

AU - Mccutcheon, Brandon

AU - Janus, Jeffrey

AU - Jentoft, Mark

AU - Kaufmann, Timothy J

AU - Lachance, Daniel H

AU - Van Gompel, Jamie

AU - Bydon, Mohamad

PY - 2018/10/1

Y1 - 2018/10/1

N2 - We report a case of a middle-aged woman with a diffuse, nonenhancing, progressively atrophic T2-hyperintense lesion involving the left frontotemporal lobes and insula found to be synchronous high-grade sinonasal neuroendocrine carcinoma (SNEC) after initial endonasal resection. In 2014, a 47-year old woman underwent resection of a left-sided high-grade ethmoidal neuroendocrine carcinoma after presentation with weight gain and increased levels of serum and urine cortisol. Concurrent with the initial presentation, she was noted to have a nonenhancing, hyperintense signal change on T2-weighted images on the left frontotemporal lobes and insula thought to be paraneoplastic. Moreover, low titer antibodies to voltage-gated potassium channels were present, raising concern for limbic encephalitis. However, the patient was asymptomatic. A little more than a year after initial presentation, she noted excessive fatigue, daytime somnolence, and cognitive decline. Imaging revealed a gradually progressive, nonenhancing, T2-hyperintense signal abnormality with progressive atrophy in the left anteroinferior frontal lobe, anteromedial temporal lobe, insula bilateral cingulate gyri, and bilateral thalami. Given the progressive nature of the abnormality, stereotactic biopsy was performed, which confirmed the lesion to be metastatic, infiltrative SNEC. In summary, this is a rare case of a synchronous presentation of a high-grade SNEC with an unusual appearance that diffusely infiltrated the brain, likely directly involving the left olfactory nerve and spreading along olfactory projections. This case draws physicians' attention to the possibility that although paraneoplastic syndromes are most likely benign, dissemination of the primary cancer is a diagnostic possibility.

AB - We report a case of a middle-aged woman with a diffuse, nonenhancing, progressively atrophic T2-hyperintense lesion involving the left frontotemporal lobes and insula found to be synchronous high-grade sinonasal neuroendocrine carcinoma (SNEC) after initial endonasal resection. In 2014, a 47-year old woman underwent resection of a left-sided high-grade ethmoidal neuroendocrine carcinoma after presentation with weight gain and increased levels of serum and urine cortisol. Concurrent with the initial presentation, she was noted to have a nonenhancing, hyperintense signal change on T2-weighted images on the left frontotemporal lobes and insula thought to be paraneoplastic. Moreover, low titer antibodies to voltage-gated potassium channels were present, raising concern for limbic encephalitis. However, the patient was asymptomatic. A little more than a year after initial presentation, she noted excessive fatigue, daytime somnolence, and cognitive decline. Imaging revealed a gradually progressive, nonenhancing, T2-hyperintense signal abnormality with progressive atrophy in the left anteroinferior frontal lobe, anteromedial temporal lobe, insula bilateral cingulate gyri, and bilateral thalami. Given the progressive nature of the abnormality, stereotactic biopsy was performed, which confirmed the lesion to be metastatic, infiltrative SNEC. In summary, this is a rare case of a synchronous presentation of a high-grade SNEC with an unusual appearance that diffusely infiltrated the brain, likely directly involving the left olfactory nerve and spreading along olfactory projections. This case draws physicians' attention to the possibility that although paraneoplastic syndromes are most likely benign, dissemination of the primary cancer is a diagnostic possibility.

UR - http://www.scopus.com/inward/record.url?scp=85056823839&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056823839&partnerID=8YFLogxK

M3 - Article

C2 - 30481850

AN - SCOPUS:85056823839

VL - 97

SP - E15

JO - Ear, Nose and Throat Journal

JF - Ear, Nose and Throat Journal

SN - 0145-5613

IS - 10-11

ER -