Paraneoplastic syndromes

Question: Which of the following paraneoplastic syndromes has a relationship to hepatocellular carcinoma?

A. polycythemia

B. Trousseau sign

C. Cushing syndrome

D. acanthosis nigricans


Answer: Paraneoplastic syndromes are not frequently attributed to primary cancers of the liver, like hepatocellular carcinoma.  Perhaps the most common is hypoglycemia, caused by an elaboration of insulin-like substance or IGF-II (this is not one of the answer choices).  Of the answer choices above, polycythemia is also associated with HCC.  This is due elaboration of erythropoietin.  It can result in hypercoagulability. 

Trousseau’s sign is associated with pancreatic carcinoma and bronchogenic carcinoma, and is thought to be related to mucins that activate clotting factors.  It may present as a migratory thrombophlebitis. 

Cushing syndrome is also associated with pancreatic and lung cancers, as well as neural tumors and thymomas.  Acanthosis nigricans is associated with gastric, uterine and lung cancers, and is thought to be related to the secretion of EGF (epidermal growth factor). 

*Reference: Robbins Basic Pathology. Philadelphia: Saunders. ISBN 1-4160-2973-7.  8th edition.

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