Paraneoplastic encephalomyelitis: Is it an oropharyngeal or a lung cancer complication?

Abstract

This case report describes a patient with a locally advanced oropharyngeal cancer with a simultaneous paraneoplastic encephalomyelitis. To the best of our knowledge, a paraneoplastic neurological syndrome is a rare complication in head and neck cancer, and has previously not been reported in the literature. One year later, following initial treatment, a small cell lung cancer developed, a tumor frequently associated with this type of paraneoplastic syndrome. The dilemma, therefore, is whether this paraneoplastic symdrome was a secondary complication of the tonsilar concurrent cancer or a metachronous paraneoplastic syndrome prior to small cell lung cancer.

Figure 1

The CT showed a heterogeneous mass located on the right tonsilar area involving pterygoideus medial muscle and the pre-styloid parapharingeus space. This mass grew inside the back wall of the oropharynx, and presumably involved the right long neck muscle. Certain cervical lymph nodes were present in the IIA and IIB spaces, the largest diameter being ~2.5 cm.

Figure 2

MRI showed a (A) small lesion in the right protuberance (arrow) with (B and C) subtle changes in the DW sequence that were enhanced following contrast infusion, and (D) another lesion in the cervical spinal cord.

Figure 3

Small subcortical lesions.

Figure 4

Chest CT scan; a 3-cm nodule in the upper right lobe.