From the Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (M.B., D.M.G., B.R.K., A.C.M., S.J., K.M.E.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (N.C.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (M.S.); Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, Tex (J.C.H.); and Department of Radiology, University of Missouri School of Medicine, Columbia, Mo (A.H.G.).
Radiographics. 2023 Mar;43(3):e220085. doi: 10.1148/rg.220085.
Patients often have symptoms due to the mass effect of a neoplasm on surrounding tissues or the development of distant metastases. However, some patients may present with clinical symptoms that are not attributable to direct tumor invasion. In particular, certain tumors may release substances such as hormones or cytokines or trigger an immune cross-reactivity between malignant and normal body cells, resulting in characteristic clinical features that are broadly referred to as paraneoplastic syndromes (PNSs). Recent advances in medicine have improved the understanding of the pathogenesis of PNSs and enhanced their diagnosis and treatment. It is estimated that 8% of patients with cancer develop a PNS. Diverse organ systems may be involved, most notably the neurologic, musculoskeletal, endocrinologic, dermatologic, gastrointestinal, and cardiovascular systems. Knowledge of various PNSs is necessary, as these syndromes may precede tumor development, complicate the patient's clinical presentation, indicate tumor prognosis, or be mistaken for metastatic spread. Radiologists should be familiar with the clinical presentations of common PNSs and the selection of appropriate imaging examinations. Many of these PNSs have imaging features that can assist with arriving at the correct diagnosis. Therefore, the key radiographic findings associated with these PNSs and the diagnostic pitfalls that can be encountered during imaging are important, as their detection can facilitate early identification of the underlying tumor, reveal early recurrence, and enable monitoring of the patient's response to therapy. RSNA, 2023 Quiz questions for this article are available in the supplemental material.
患者常因肿瘤对周围组织的压迫效应或远处转移而出现症状。然而，有些患者可能出现无法归因于直接肿瘤侵袭的临床症状。特别是，某些肿瘤可能释放激素或细胞因子等物质，或引发恶性和正常体细胞之间的免疫交叉反应，导致具有特征性的临床特征，通常被称为副肿瘤综合征（PNS）。医学的最新进展提高了对 PNS 发病机制的理解，并增强了其诊断和治疗能力。据估计，8%的癌症患者会发生 PNS。涉及的器官系统多种多样，最常见的是神经、肌肉骨骼、内分泌、皮肤、胃肠道和心血管系统。了解各种 PNS 是必要的，因为这些综合征可能先于肿瘤发生，使患者的临床表现复杂化，提示肿瘤预后，或被误诊为转移扩散。放射科医生应熟悉常见 PNS 的临床表现和适当的影像学检查选择。许多 PNS 都有影像学特征，有助于做出正确诊断。因此，这些 PNS 相关的关键影像学表现和影像学检查中可能遇到的诊断陷阱非常重要，因为这些表现的检测有助于早期识别潜在肿瘤、发现早期复发，并能监测患者对治疗的反应。RSNA，2023 本文的补充材料中提供了相关测验题。
