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• W4387248514 abstract "SESSION TITLE: Paraneoplastic Syndromes and Immunotherapy Complications SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/11/2023 09:40 am - 10:25 am INTRODUCTION: Primary pulmonary mucoepidermoid carcinoma (MEC) is a rare, often low-grade, tumor of glandular origin1. Because of the usual polypoid structure and endobronchial location, patients typically present with recurrent post-obstructive pneumonia2. Presentation with symptoms due to definitive paraneoplastic syndromes (PNS) has never been reported in primary pulmonary MEC. In the following report, we describe a suspected case of PNS due to endobronchial MEC wherein the patient presented with diplopia which resolved after tumor resection. CASE PRESENTATION: A 67-year-old healthy man presented to the emergency department at the advice of his ophthalmologist after developing bilateral horizontal diplopia three days prior. His vision changes were preceded by a two-week febrile illness with cough and pharyngitis that had resolved prior to presentation after treatment with amoxicillin. Physical examination demonstrated multiple cranial nerve palsies, most notable in the bilateral abducens nerves. Magnetic resonance imaging of the brain and orbits was unremarkable. Preliminary cerebrospinal fluid analysis showed non-specific elevated protein and immunoglobulin G levels. Concurrently, his recent respiratory symptoms prompted chest radiograph followed by computed tomography of the chest which revealed an endobronchial lesion in the right bronchus intermedius with distal obstructive atelectasis of the middle and lower lobes. The patient underwent flexible and rigid bronchoscopy with tumor biopsy, transbronchial nodal aspiration, and multimodal tumor debridement. Pathologic evaluation showed low-grade mucoepidermoid carcinoma without nodal involvement. The patient was discharged to await further treatment recommendations. During this time, additional CSF studies returned which detected an elevated level of AChR ganglionic neuronal antibodies (0.05nmol/L; ref <0.02nmol/L) supporting a paraneoplastic neurologic process as the cause of his cranial nerve deficits. After multidisciplinary discussion, right pneumonectomy was recommended to ensure complete resection. The day following uncomplicated pneumonectomy, the patient reported significant improvement in diplopia, and it completely resolved over the subsequent month. DISCUSSION: Although various primary lung cancers have been associated with antibody-mediated paraneoplastic syndromes affecting the nervous system, this association has never been reported with pulmonary mucoepidermoid carcinoma. It has been hypothesized that infection may trigger paraneoplastic syndromes, which may have been a factor in this case. Pulmonary MEC is typically low-grade and localized at the time of presentation and prompt diagnosis and surgical resection can be curative for both the malignancy and any associated paraneoplastic syndrome. CONCLUSIONS: This is the first reported case of antibody-mediated paraneoplastic syndrome affecting the nervous system associated with pulmonary mucoepidermoid carcinoma. Surgical resection of the tumor resulted in complete resolution of the associated cranial nerve deficits. REFERENCE #1: Yousem SA, Hochholzer L. Mucoepidermoid tumors of the lung. Cancer. 1987;60(6):1346-1352. doi:10.1002/1097-142(19870915)60:6<_x0031_346:_x003a_AID-CNCR2820600631>3.0.CO;2-0 REFERENCE #2: Shilo K, Foss RD, Franks TJ, DePeralta-Venturina M, Travis WD. Pulmonary Mucoepidermoid Carcinoma With Prominent Tumor-Associated Lymphoid Proliferation. The American Journal of Surgical Pathology. 2005;29(3):407. doi:10.1097/01.pas.0000151616.14598.e7 DISCLOSURES: No relevant relationships by Jessica Channick No relevant relationships by Colleen Channick No relevant relationships by Gregory Fishbein No relevant relationships by Miki Ueoka Owner/Founder relationship with ICONA Please note: 2021 to present Added 04/07/2023 by Jane Yanagawa, source=Web Response, value=Ownership interest Speaker/Speaker's Bureau relationship with IDEO Oncology Please note: 3/3/2022 Added 04/07/2023 by Jane Yanagawa, source=Web Response, value=Honoraria" @default.
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• W4387248514 date "2023-10-01" @default.
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• W4387248514 title "A LUNG FOR AN EYE: RESOLUTION OF DIPLOPIA AFTER PNEUMONECTOMY FOR MUCOEPIDERMOID CARCINOMA" @default.
• W4387248514 doi "https://doi.org/10.1016/j.chest.2023.07.2783" @default.
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