Prostate cancer is among the most common malignancies in males in the United States and adenocarcinoma accounts for 95% of all malignancies of prostate. Rarely prostate cancer can also present as small cell carcinoma. Pure small cell carcinoma is rare at time of initial diagnosis (<2%) however neuroendocrine differentiation into small cell carcinoma may emerge in men who have had previous treatment with ADT for prostate adenocarcinoma. These tumors, sometimes called treatment-related neuroendocrine prostate cancers or aggressive-variant prostate cancers, are increasingly recognized in the castration-resistant phases of disease progression. They account for less than 1% of all prostate cancers. A 73-year-old otherwise male had routine health screening in May 2018. Prostate specific antigen (PSA) level was elevated at 9.53 ng/mL. He had not had a screening PSA for at least two prior years but this was a significant change from prior levels. Patient was asymptomatic however the abnormal laboratory evaluation prompted consultation with Urology. Biopsy of prostate gland confirmed prostatic adenocarcinoma with Gleason's score of 5+ 4 = 9 with bilateral gland involvement. Imaging studies including CT scan of abdomen and pelvis, a bone scan and a PET scan showed no clear evidence of metastatic disease. Patient's clinical stage was determined to be IIIC with T2c N0 M0 disease. Patient began treatment with androgen deprivation therapy and received definitive radiation treatment with external bean radiation therapy from July to September 2018. PSA was 0.08 ng/ml at the end of radiation treatment. Patient did well for about 15 months, after which he had multiple hospital admissions for dyspnea, fluid retention and lower extremity edema. He was also found to have refractory hypokalemia. Patient underwent MRI brain which revealed numerous small enhancing calvarial and skull base lesions consistent with bony metastasis in the skull. Patient also underwent PET/CT scan which showed numerous thoracic spine bony lesions, numerous to count bony metastasis throughout the lumbar spine and pelvis, as well as multiple hepatic lesions. Patient underwent biopsy of right hepatic lobe lesion and pathology was consistent with small cell carcinoma with positive neuroendocrine markers including CD56, synaptophysin and TTF-1. Interestingly patient’s PSA was only 0.09ng/dL. Given refractory hypokalemia, paraneoplastic syndrome was suspected and further work-up was initiated. Serum cortisol levels were elevated at 119.6 mcg/dL (3.7-19.4) and ACTH level was 333 pg/mL (7.2 - 63.3). Aldosterone level was <1 ng/dL (0 - 30.0). Patient was diagnosed with paraneoplastic Cushing syndrome. Given aggressive nature of this small cell transformation, patient was started on treatment with systemic chemotherapy with Carboplatin/Etoposide during the hospital stay, with stabilization of potassium levels. Prostate small cell carcinoma poses a challenge for diagnosis and treatment. In contrast to adenocarcinoma of the prostate, serum prostate-specific antigen (PSA) is not predictive of disease severity, nor is it a useful tumor marker for monitoring progression or surveillance. Patients with prostate small cell cancer presents with more diverse symptoms than any other prostate cancer since it tends to metastasize early. Also paraneoplastic syndromes are more common in prostate small cell cancers as well.

Autoimmune hemolytic anemia (AIHA) is a disease process that involves the destruction of red blood cells mediated by the humoral immune system. It can be characterized as a cold agglutinin syndrome, paroxysmal cold hemoglobinuria, and warm, mixed type, and drug-induced AIHA. Although a well-established relationship exists between the presence of AIHA and lymphoproliferative malignancy, AIHA rarely presents in association with solid malignancies. An analysis of the limited number of published cases of AIHA in association with solid malignancies performed showed that AIHA may present before the diagnosis of a solid malignancy, concurrently with the presence of a solid malignancy, or even on resolution of a solid malignancy. Few cases of solid cancers associated with AIHA have been reported. AIHA rarely presents as a paraneoplastic syndrome indicating existence of a solid cancer. We report a case of inflammatory breast cancer with AIHA.

A síndrome paraneoplásica é definida como um conjunto de sinais e sintomas que acontecem distantes do tumor primário e de suas metástases. Nos mastocitomas, os sinais sistêmicos mais comuns são os sinais gastrintestinais secundários à liberação de histamina, heparina e outras substâncias bioativas contidas no interior dos mastócitos neoplásicos. Em decorrência da ação sistêmica destas substâncias, a ulceração gastrintestinal é a principal síndrome paraneoplásica descrita. Assim, o presente trabalho avalia a ocorrência de lesões gastroduodenais em cães com mastocitoma cutâneo no momento do diagnóstico, correlacionando seu aparecimento com a apresentação clínica da doença, aparência macroscópica do tumor, diferentes marcadores prognósticos pré-estabelecidos pela literatura e valores plasmáticos de histamina. Para tal, foram utilizados 41 cães da rotina clinico/oncológica do Hospital de Clínicas Veterinárias da Universidade Federal do Rio Grande do Sul (HCV-UFRGS) com diagnóstico confirmado de mastocitoma cutâneo. Os animais foram avaliados clinicamente e, posteriormente, foram submetidos à cirurgia para exérese do tumor e exame endoscópico para avaliação do esôfago, estômago e porção proximal do duodeno. Todos os cães foram avaliados quanto a presença e a gravidade dos sinais clínicos, velocidade de crescimento tumoral, número e localização dos nódulos, tamanho tumoral, características macroscópicas do tumor, presença de metástase em linfonodo regional, classificação histopatológica, índice mitótico e valor de histamina plasmática, buscando-se estabelecer uma relação com o surgimento e a gravidade das lesões gástricas e duodenais. A análise macro e microscópica da mucosa gástrica e duodenal, não evidenciou lesões compatíveis com úlceração grave em nenhum dos cães avaliados. A ocorrência de sinais clínicos gastrintestinais foi observada em 41,5% dos casos e padrões inflamatórios, sugestivos de gastrite, foram evidenciados tanto no exame endoscópico quanto no exame histopatológico. Sendo assim, na população estudada, as lesões gastroduodenais observadas foram consideradas leves no momento do diagnóstico e não apresentaram relação estatística com as variáveis estudadas, sugerindo que a heterogenicidade da população possa ter contribuído para os resultados, ou ainda que outros fatores possam influenciar a degranulação dos mastócitos neoplásicos. / Paraneoplastic syndrome is defined as a set of signs and symptoms that are not related to the local effect of the primary tumor or its metastases. Gastrointestinal ulceration is the most common sign attributed to mast cell tumor’s paraneoplastic syndrome in dogs. In mastocytoma, release of histamine, heparin, and other bioactive substances by the neoplastic mast cells can lead to increased systemic action of these substances and induce gastrointestinal disturbances. This study aimed to evaluate the occurrence of gastroduodenal lesions in dogs with cutaneous mast cell tumor at the time of diagnosis and correlate them to the clinical presentation of the disease, tumor’s macroscopic aspects, neoplasic prognostic markers, and plasmatic histamine values. We evaluated 41 dogs with cutaneous mast cell tumor diagnosed at the oncology service of the Veterinary Hospital of the Federal University of Rio Grande do Sul (UFRGS-HCV). After clinical examination, as the animals underwent surgery to remove the tumor and endoscopy to evaluate the esophagus, stomach and proximal duodenum was performed Presence and severity of clinical signs, neoplasms macroscopic characteristics, tumor size, number and location of neoplasic masses, tumor growth rate, presence of regional lymph node metastasis, histopathological classification, mitotic index, and plasmatic histamine concentration were determined and correlated with gastrodueodenal endoscopic findings. The macro and microscopic analyses of the gastric and duodenal mucosa showed no lesions compatible with ulceration in any of the pacients. The occurrence of gastrointestinal clinical signs was observed in 41.5% of cases and inflammatory patterns, suggestive of gastritis were evidenced in both endoscopic and histopathological examination; however, its correlation with the presence of mast cell tumor could not be established. Therefore, in this population, gastroduodenal lesions observed were considered mild at diagnosis and had no relation with the variables analyzed, suggesting that the heterogeneity of the population may have contributed to the results or that other factors may influence the degranulation of mast cells neoplastic.

A síndrome paraneoplásica é definida como um conjunto de sinais e sintomas que acontecem distantes do tumor primário e de suas metástases. Nos mastocitomas, os sinais sistêmicos mais comuns são os sinais gastrintestinais secundários à liberação de histamina, heparina e outras substâncias bioativas contidas no interior dos mastócitos neoplásicos. Em decorrência da ação sistêmica destas substâncias, a ulceração gastrintestinal é a principal síndrome paraneoplásica descrita. Assim, o presente trabalho avalia a ocorrência de lesões gastroduodenais em cães com mastocitoma cutâneo no momento do diagnóstico, correlacionando seu aparecimento com a apresentação clínica da doença, aparência macroscópica do tumor, diferentes marcadores prognósticos pré-estabelecidos pela literatura e valores plasmáticos de histamina. Para tal, foram utilizados 41 cães da rotina clinico/oncológica do Hospital de Clínicas Veterinárias da Universidade Federal do Rio Grande do Sul (HCV-UFRGS) com diagnóstico confirmado de mastocitoma cutâneo. Os animais foram avaliados clinicamente e, posteriormente, foram submetidos à cirurgia para exérese do tumor e exame endoscópico para avaliação do esôfago, estômago e porção proximal do duodeno. Todos os cães foram avaliados quanto a presença e a gravidade dos sinais clínicos, velocidade de crescimento tumoral, número e localização dos nódulos, tamanho tumoral, características macroscópicas do tumor, presença de metástase em linfonodo regional, classificação histopatológica, índice mitótico e valor de histamina plasmática, buscando-se estabelecer uma relação com o surgimento e a gravidade das lesões gástricas e duodenais. A análise macro e microscópica da mucosa gástrica e duodenal, não evidenciou lesões compatíveis com úlceração grave em nenhum dos cães avaliados. A ocorrência de sinais clínicos gastrintestinais foi observada em 41,5% dos casos e padrões inflamatórios, sugestivos de gastrite, foram evidenciados tanto no exame endoscópico quanto no exame histopatológico. Sendo assim, na população estudada, as lesões gastroduodenais observadas foram consideradas leves no momento do diagnóstico e não apresentaram relação estatística com as variáveis estudadas, sugerindo que a heterogenicidade da população possa ter contribuído para os resultados, ou ainda que outros fatores possam influenciar a degranulação dos mastócitos neoplásicos. / Paraneoplastic syndrome is defined as a set of signs and symptoms that are not related to the local effect of the primary tumor or its metastases. Gastrointestinal ulceration is the most common sign attributed to mast cell tumor’s paraneoplastic syndrome in dogs. In mastocytoma, release of histamine, heparin, and other bioactive substances by the neoplastic mast cells can lead to increased systemic action of these substances and induce gastrointestinal disturbances. This study aimed to evaluate the occurrence of gastroduodenal lesions in dogs with cutaneous mast cell tumor at the time of diagnosis and correlate them to the clinical presentation of the disease, tumor’s macroscopic aspects, neoplasic prognostic markers, and plasmatic histamine values. We evaluated 41 dogs with cutaneous mast cell tumor diagnosed at the oncology service of the Veterinary Hospital of the Federal University of Rio Grande do Sul (UFRGS-HCV). After clinical examination, as the animals underwent surgery to remove the tumor and endoscopy to evaluate the esophagus, stomach and proximal duodenum was performed Presence and severity of clinical signs, neoplasms macroscopic characteristics, tumor size, number and location of neoplasic masses, tumor growth rate, presence of regional lymph node metastasis, histopathological classification, mitotic index, and plasmatic histamine concentration were determined and correlated with gastrodueodenal endoscopic findings. The macro and microscopic analyses of the gastric and duodenal mucosa showed no lesions compatible with ulceration in any of the pacients. The occurrence of gastrointestinal clinical signs was observed in 41.5% of cases and inflammatory patterns, suggestive of gastritis were evidenced in both endoscopic and histopathological examination; however, its correlation with the presence of mast cell tumor could not be established. Therefore, in this population, gastroduodenal lesions observed were considered mild at diagnosis and had no relation with the variables analyzed, suggesting that the heterogeneity of the population may have contributed to the results or that other factors may influence the degranulation of mast cells neoplastic.

A síndrome paraneoplásica é definida como um conjunto de sinais e sintomas que acontecem distantes do tumor primário e de suas metástases. Nos mastocitomas, os sinais sistêmicos mais comuns são os sinais gastrintestinais secundários à liberação de histamina, heparina e outras substâncias bioativas contidas no interior dos mastócitos neoplásicos. Em decorrência da ação sistêmica destas substâncias, a ulceração gastrintestinal é a principal síndrome paraneoplásica descrita. Assim, o presente trabalho avalia a ocorrência de lesões gastroduodenais em cães com mastocitoma cutâneo no momento do diagnóstico, correlacionando seu aparecimento com a apresentação clínica da doença, aparência macroscópica do tumor, diferentes marcadores prognósticos pré-estabelecidos pela literatura e valores plasmáticos de histamina. Para tal, foram utilizados 41 cães da rotina clinico/oncológica do Hospital de Clínicas Veterinárias da Universidade Federal do Rio Grande do Sul (HCV-UFRGS) com diagnóstico confirmado de mastocitoma cutâneo. Os animais foram avaliados clinicamente e, posteriormente, foram submetidos à cirurgia para exérese do tumor e exame endoscópico para avaliação do esôfago, estômago e porção proximal do duodeno. Todos os cães foram avaliados quanto a presença e a gravidade dos sinais clínicos, velocidade de crescimento tumoral, número e localização dos nódulos, tamanho tumoral, características macroscópicas do tumor, presença de metástase em linfonodo regional, classificação histopatológica, índice mitótico e valor de histamina plasmática, buscando-se estabelecer uma relação com o surgimento e a gravidade das lesões gástricas e duodenais. A análise macro e microscópica da mucosa gástrica e duodenal, não evidenciou lesões compatíveis com úlceração grave em nenhum dos cães avaliados. A ocorrência de sinais clínicos gastrintestinais foi observada em 41,5% dos casos e padrões inflamatórios, sugestivos de gastrite, foram evidenciados tanto no exame endoscópico quanto no exame histopatológico. Sendo assim, na população estudada, as lesões gastroduodenais observadas foram consideradas leves no momento do diagnóstico e não apresentaram relação estatística com as variáveis estudadas, sugerindo que a heterogenicidade da população possa ter contribuído para os resultados, ou ainda que outros fatores possam influenciar a degranulação dos mastócitos neoplásicos. / Paraneoplastic syndrome is defined as a set of signs and symptoms that are not related to the local effect of the primary tumor or its metastases. Gastrointestinal ulceration is the most common sign attributed to mast cell tumor’s paraneoplastic syndrome in dogs. In mastocytoma, release of histamine, heparin, and other bioactive substances by the neoplastic mast cells can lead to increased systemic action of these substances and induce gastrointestinal disturbances. This study aimed to evaluate the occurrence of gastroduodenal lesions in dogs with cutaneous mast cell tumor at the time of diagnosis and correlate them to the clinical presentation of the disease, tumor’s macroscopic aspects, neoplasic prognostic markers, and plasmatic histamine values. We evaluated 41 dogs with cutaneous mast cell tumor diagnosed at the oncology service of the Veterinary Hospital of the Federal University of Rio Grande do Sul (UFRGS-HCV). After clinical examination, as the animals underwent surgery to remove the tumor and endoscopy to evaluate the esophagus, stomach and proximal duodenum was performed Presence and severity of clinical signs, neoplasms macroscopic characteristics, tumor size, number and location of neoplasic masses, tumor growth rate, presence of regional lymph node metastasis, histopathological classification, mitotic index, and plasmatic histamine concentration were determined and correlated with gastrodueodenal endoscopic findings. The macro and microscopic analyses of the gastric and duodenal mucosa showed no lesions compatible with ulceration in any of the pacients. The occurrence of gastrointestinal clinical signs was observed in 41.5% of cases and inflammatory patterns, suggestive of gastritis were evidenced in both endoscopic and histopathological examination; however, its correlation with the presence of mast cell tumor could not be established. Therefore, in this population, gastroduodenal lesions observed were considered mild at diagnosis and had no relation with the variables analyzed, suggesting that the heterogeneity of the population may have contributed to the results or that other factors may influence the degranulation of mast cells neoplastic.