Neurological cancer clinical pathological features of the myopathy

Cancer of nerve myopathy is the emergence of non-malignant tumor patients directly caused by the cancer infringement of neuromuscular disease and dysfunction of the disease. Cancer of nerve myopathy is the emergence of non-malignant tumor patients directly caused by the cancer infringement of neuromuscular disease and dysfunction of the disease. Clinically rare, the disease can affect the brain, the cerebellum, spinal cord and peripheral nerve, and other nervous system As well as parts of the muscle, or a number of sites involved at the same time, the variety of clinical manifestations, which mainly depend on the diagnosis of muscle, nerve biopsy. Since 1948, Denny-Brown for the first time the report of 2 cases of lung cancer associated with peripheral neuromuscular disease, and scholars Have been reported, we collected 2, in conjunction with the literature on cancer and nerve disease pathology, clinical features. Case 1 Summary Example 1: male, 58 years old, the main cause pain malaise in January, both lower extremities numb unable to 3 days in February 17, 1984 admission. Patients in January before the malaise began to pain, chest to the back and lower limbs as the most important thing, in 3 days before the double no incentive to lower limb weakness and numbness in the activities of obstacles. Checkup: temperature 36.8 ℃, pulse 80 beats / min, respiration 21 times / min, blood pressure, 15.6 / 10.5 Kpa. Sclera without skin yellow dye , The body does not touch on superficial lymph nodes. Inspection of the nervous system: the neck without resistance, the cranial nerves are not unusual, two-level Ⅱ lower limb muscle strength, acid wall, the cremaster reflex, reflex did not lead to pathology. X-ray film spinal bone No change in clinical spinal cord lesions in order to check to be hospitalized. Admission by the support of the symptomatic treatment of poor growing conditions, chest, lower limb pain increased and a high fever, and Suanzhang urine retention, occasional cough, but no blood Disease, lower limbs muscle strength down to 0, tendon reflexes disappear. Lung film that under the right leaf shadow of the massive corporation, liver B see a number of super-size abnormal echo area. The end result of extreme failure patients hospitalized 23 days of death . Autopsy findings: Ye under the right lung cancer cells (oat cell), with lung infection, a small amount of fluid on the right side of the chest, some of pleural thickening, mild coronary atherosclerosis, significantly lower limbs muscle atrophy, the brain , Cerebellum and spinal cord tumors has not violated, spinal motor neuron degeneration cell swelling, decrease in the number of cells, some of Marconi's body inside the disappearance of peripheral nerve can be seen clearly axonal swelling and rupture, Lax01 solid blue - a purple dye phenol Mild demyelination. Gastrocnemius muscle atrophy, degeneration, the band disappeared, the formation of vacuoles inside the muscle fibers, arranged in clusters nuclear muscle. Intrahepatic see more than 0.1 to 3.5 size of the cancer nodules, under the same form of lung cancer. Mediastinum, lymph nodes under the bulge can be seen the transfer of cancer. Pathology: (1) small-cell lung cancer (oat cell), liver and the mediastinum, lymph node under the bulge. (2), cancer of nerve myopathy. Example 2: male, 49 years old, on October 21, 1991 as a result of an inability to both lower extremities and numbness, difficulty walking with heavier 1 week admitted to hospital. Checkup: temperature 37 ℃, pulse 84 beats / min, blood pressure 16/11 5Kpa. Two-weakened lower limb muscle strength, the left side of the class Ⅱ, the right side of the class Ⅰ, tendon reflexes weakened, the depth of feeling the loss of basic, spinal X-chip, the head CT lesion was found, no abnormal cranial nerve examination, pathological reflex did not lead to. Epigastric pain than Obviously, fecal occult blood (+), a history of questioning, the patient has in the past history of stomach trouble, six months ago to do gastroscopy clinic for chronic gastritis, biopsy done, Bank gastroscopy admitted to hospital again, taking antrum mucous membrane lesions send seized disease, Confirmed to be poorly differentiated adenocarcinoma, after which they will take gastrocnemius muscle biopsy, for the performance of the degeneration of muscle fiber atrophy, ranging from thick, muscle-like nucleus beaded arranged basophilic muscle fiber, showing the phenomenon of regeneration. Pathology: poorly differentiated adenocarcinoma of the stomach with cancer Neural myopathy. 2 discussion (1) the incidence of: cancer of the incidence of neural myopathy accounted for 6.6 percent of the tumors, most of them found in lung cancer and ovarian cancer, others see breast cancer, gastric cancer, colorectal cancer, uterine cancer, pancreatic cancer and malignant lymphoma, fine The original tumor, osteosarcoma .1965, and other years, Croft report of 33 cases of cancer of nerve myopathy, of which 16 cases of lung cancer, accounting for 48% of Sino-Japanese Friendship Hospital reported 4 cases of lung cancer, malignant lymphoma, esophagus, lymph node cancer 1 case, we collected 2 cases of lung cancer and 1 case of gastric cancer. These data indicate that a variety of malignant tumors in the body may be associated with cancer of nerve myopathy. (2) the incidence and cause: cancer of nerve myopathy, and the cause of the pathogenesis is still unclear, the following two statements. Poisoning theory: Some scholars believe that cancer is generated by toxic metabolic effects of nerve, or cancer have some kind of material with the nerve of the main metabolites compete. It was also suggested that there may be a toxin at the same time cause cancerous tumors and nervous Myopathy. And some scholars have negative tumors caused by the toxin on the grounds that the cancer incidence rate of neural myopathy low, the tumor only 6 to 8%, but the size of the tumor and has nothing to do with the course, a lot of cases the symptoms appear In the tumor was found before. Immunity doctrine: Qugerhoer in 1983 of cancer observed in nerve biopsy specimens of myopathy in immunoglobulin IgM and complement C3, C4 deposition, so that its incidence may be related to immune-related effects. According to clinical observation, or to remove the tumor in hormone And immunosuppressant treatment, often get a certain effect can be further immune dysfunction and Benbingfasheng. Pathological changes: cancer of nerve myopathy of the main pathological changes involving the nervous system and muscle. Demyelination of the central nervous mainly, the original nerve and blood vessels surrounding the disappearance of infiltrating lymphocytes, and so on. Myelin sheath surrounding nerve to the axonal degeneration and change Mainly. Striated muscle diseases as the main muscle cell contraction, necrosis, irregular muscle fiber size, muscle cell proliferation, muscle fiber regeneration. (3) and the type of diagnosis: cancer of nerve myopathy, while mainly relying on the diagnosis of nerve, muscle disease of the seizure, but the pathological changes are not specific, and all the nerve and muscle systems of nutrition, metabolism and the damage is similar to poisoning, the diagnosis Should be: (1) combined with clinical, with the exception of nutrition, metabolism disorders, as well as toxic. (2) must be found evidence of malignancy. (3) rule out the possibility of direct tumor invasion and metastasis neuromuscular caused by the damage. Cancerous The type of nerve myopathy: (1) myopathy cancer: major changes to the muscle degeneration, and polymyositis similar. (2), cancer of myasthenia gravis: the neuromuscular junction dysfunction, and similar to myasthenia gravis. (3), cancer of peripheral neuropathy: peripheral nerve disease is demyelination, the major clinical manifestation is the physical obstacles to the remote feel, there are often obstacles to the movement and reflection, and a similar multiple neuritis. (4), cancer of the spinal cord disease: For the performance of the sense of movement and reflection barriers. (5) acute atrophy: for the disease and cerebellar Purkinje cells shrink, clinical performance, such as ataxia. (6) encephalopathy cancer: the main diseases of the brain is gray matter of nerve Cells shrink away, for a variety of clinical manifestations of neuropsychiatric symptoms. (4) tips for the future: Neurosis cancer of the neuromuscular disease with symptoms of cancer at the same time or one after another, many patients with symptoms of peripheral neuropathy as the first symptom, easy-to-clinically misdiagnosed, it appeared for the progressive neuromuscular symptoms Patients should expect the incidence of tumors and, if necessary, to do the muscle biopsy.