levoleucovorin and Paraneoplastic-Syndromes

We describe the case of a 65-year-old woman, known with ulcerative colitis, who presented with progressive headaches, haematomas and rectal bleeding which turned out to be the initial manifestation of disseminated intravascular coagulation (DIC) associated with colorectal cancer. The presentation posed as a general medicine case but turned out to be a rare oncological complication. The patient revealed possible carcinocythaemia and bone marrow infiltration with signet ring-like cells, as indicators of advanced adenocarcinoma. Treatment of the underlying disease resolved the DIC and contributed to prolonged survival. Subsequently, we reviewed the English literature since 1990 on similar cases and demonstrated that this association is extremely rare and is associated with a poor prognosis. Prompt recognition and treatment of the underlying disease is confirmed to be of utmost importance to prolong (progression-free) survival.

Topics: Adenocarcinoma; Aged; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Capecitabine; Deoxycytidine; Disseminated Intravascular Coagulation; Fatal Outcome; Female; Fluorouracil; Humans; Leucovorin; Lymphatic Metastasis; Oxaloacetates; Paraneoplastic Syndromes; Sigmoid Neoplasms

Hypertrichosis lanuginosa acquisita is regarded as an obligatory cutaneous paraneoplasm and is defined as the sudden and excessive appearance of lanugo hairs on the entire integument associated with malignant neoplasm of internal organs. We observed such a case of hypertrichosis in a 30-year-old man with a long history of ulcerative colitis who developed carcinoma of the caecum with lymph node metastasis.

Topics: Adenocarcinoma; Adult; Biopsy; Cecal Neoplasms; Chemotherapy, Adjuvant; Colectomy; Colitis, Ulcerative; Colonic Polyps; Combined Modality Therapy; Fluorouracil; Humans; Hypertrichosis; Intestinal Mucosa; Leucovorin; Male; Paraneoplastic Syndromes

Few studies have incorporated high-dose methotrexate (MTX) with leucovorin rescue in the treatment of small cell lung cancer (SCLC). Potentially therapeutic levels of MTX can be achieved in the central nervous system (CNS) by systemic administration of high doses of this drug. Utilizing a combination chemotherapy program of Adriamycin, vincristine, cyclophosphamide, and methotrexate, 31 patients were sequentially assigned to receive either low-dose MTX (40 mg/m2), or high-dose MTX (500 mg/m2) with leucovorin rescue. Radiation therapy to the primary site was also administered. At these dosage levels there were no statistically significant differences in response rate or survival between the two groups. High-dose MTX did not prevent the appearance of CNS disease; there being 2/15 and 3/15 CNS relapses in the HD MTX and LD MTX treated groups, respectively. The occurrence of CNS disease did not significantly affect overall survival as compared to patients not similarly affected.

Topics: Aged; Carcinoma, Small Cell; Drug Therapy, Combination; Female; Humans; Leucovorin; Leukopenia; Lung Neoplasms; Male; Methotrexate; Middle Aged; Neoplasm Recurrence, Local; Nervous System Neoplasms; Paraneoplastic Syndromes; Smoking; Thrombocytopenia