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• W4387248915 abstract "SESSION TITLE: Lung Cancer Case Report Posters 6 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Paraneoplastic syndromes are disorders that have various manifestations and are associated with numerous malignancies. Paraneoplastic glomerulopathies have been established in many solid organ malignancies including the lung, with membranous glomerulopathy being the leading manifestation. Rarely an association of IgA nephropathy paraneoplastic syndrome has been documented in both non-small cell and small cell lung carcinoma. We present a unique case of metastatic poorly differentiated carcinoma of unknown origin. That was later diagnosed as adenocarcinoma of the lung, and initially manifested as IgA nephropathy. CASE PRESENTATION: A 58-year-old male smoker, with a past medical history of hypertension and chronic kidney (CKD) disease, was transferred from an outside continuity clinic for worsening acute kidney injury (AKI) on CKD. Upon arrival, the patients WBC count was 16.2, creatinine was 5.97 and urinalysis displayed no bacteria, large blood and >600 protein. Further investigation unveiled a nephrotic range proteinuria to 16.1 and renal biopsy was performed. Kidney biopsy revealed crescentic IgA nephropathy. A Computed Topography (CT) scan demonstrated several enlarged lymph nodes in the neck, mediastinum, and abdomen with a large retropharyngeal fluid collection near the vocal cords which was most consistent with malignant impaired lymphatic drainage. Imaging did not reveal any masses or lesions, but an endobronchial ultrasound (EBUS) was performed to biopsy the mediastinal lymph nodes. During the procedure an obstructing mass in the medial segment of the right middle lobe bronchus was identified. Biopsies of the mass and mediastinal lymph node were obtained. The final pathology report of the mass tissue was benign endobronchial mucosa. However, the lymph node sample displayed poorly differentiated, metastatic carcinoma of unknown origin. Next Generation Sequencing was required to discover the origin of the malignancy. The mediastinal lymph node tissue favored adenocarcinoma of the lung with 93% confidence. DISCUSSION: Paraneoplastic syndromes have a range of manifestations depending on the primary tumor. Hypercalcemia and syndrome of inappropriate antidiuretic hormone secretion (SIADH) are the most ordinary paraneoplastic syndromes in pulmonary malignancies. Secondary IgA nephropathy has been associated with relatively few malignancies, most commonly renal cell carcinoma and hematological cancers. However, a few associations with pulmonary malignancies have been reported. CONCLUSIONS: Pulmonary malignancy should be included as a differential diagnosis in patients with strong smoking history, nephrotic range proteinuria, and no obvious mass noted on imaging. Our patient's initial presentation with IgA nephropathy, ultimately led to his diagnosis of poorly differentiated metastatic adenocarcinoma of the lung. REFERENCE #1: Bacchetta J, Juillard L, Cochat P, Droz JP. Paraneoplastic glomerular diseases and malignancies. Critical Reviews in Oncology/Hematology. 2009;70(1):39-58. doi:10.1016/j.critrevonc.2008.08.003 REFERENCE #2: Kanaji N, Watanabe N, Kita N, Bandoh S, Tadokoro A, Ishii T, Dobashi H, Matsunaga T. Paraneoplastic syndromes associated with lung cancer. World J Clin Oncol. 2014 Aug 10;5(3):197-223. doi: 10.5306/wjco.v5.i3.197. PMID: 25114839; PMCID: PMC4127595. REFERENCE #3: Wang J, Liu Y, Liu N, Gao M, Yuan H. Paraneoplastic immunoglobulin A nephropathy in a patient with lung adenocarcinoma: A case report and literature review. J Int Med Res. 2021 Apr;49(4):300060521996868. doi: 10.1177/0300060521996868. PMID: 33926295; PMCID: PMC8113932 DISCLOSURES: No relevant relationships by Joshua Fowler No relevant relationships by Stanley Hoy Consultant relationship with COOK Medical Please note: June 2022 Added 03/30/2023 by Shaheen Islam, source=Web Response, value=Consulting fee No relevant relationships by Alexandra Medeiros" @default.
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• W4387248915 date "2023-10-01" @default.
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• W4387248915 title "POORLY DIFFERENTIATED METASTATIC ADENOCARCINOMA OF THE LUNG PRESENTING AS IGA NEPHROPATHY" @default.
• W4387248915 doi "https://doi.org/10.1016/j.chest.2023.07.2943" @default.
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