Madrid A, Casado J L, Pérez-Errazquin F, Vázquez A, Garzón F, Gil-Peralta A
Servicios de Neurología, Hospital Universitario Virgen del Rocío, Sevilla.
Rev Neurol. 1997 Jul;25(143):1098-101.
Subacute combined degeneration of the spinal cord associated with vitamin B12 deficit is well known. However a paraneoplastic induced cyanocobalamin malabsorption responsible for either subacute combined degeneration of the spinal cord, has not been reported. Moreover, the possibility of either subacute combined degeneration of the spinal cord may be manifestation of a cancer, it's unknown.
We present the case of a 73-year-old woman with cutaneous paleness and clinical manifestations of a subacute combined degeneration of the spinal cord. Laboratory analysis showed a megaloblastic anemia and Schilling test showed cyanocobalamin malabsorption corrected by intrinsic factor. Anti-intrinsic factor antibodies were positive. Chronic atrophic gastritis and immunological diseases associated with pernicious anemia or with anti-intrinsic factor positive, were excluded. A hidden esophageal squamous cell carcinoma was discovered. Necropsy confirmed both, subacute combined degeneration of the spinal cord and esophageal carcinoma in the absence of chronic atrophic gastritis.
Anti-intrinsic factor antibodies were the only found factor which could explain cyanocobalamin malabsorption. A esophageal squamous cel carcinoma was discovered. In our case, vitamin B12 malabsorption had a paraneoplastic origin mediated by anti-intrinsic factor antibodies. Subacute combined degeneration of the spinal cord may be the manifestation of a hidden esophageal squamous cell carcinoma.
与维生素B12缺乏相关的脊髓亚急性联合变性是众所周知的。然而，由副肿瘤引起的钴胺素吸收不良导致脊髓亚急性联合变性的情况尚未见报道。此外，脊髓亚急性联合变性是否可能是癌症的表现也尚不清楚。
我们报告了一名73岁女性的病例，她有皮肤苍白以及脊髓亚急性联合变性的临床表现。实验室分析显示巨幼细胞贫血，希林试验显示钴胺素吸收不良可通过内因子纠正。抗内因子抗体呈阳性。排除了与恶性贫血或抗内因子阳性相关的慢性萎缩性胃炎和免疫性疾病。发现了一例隐匿性食管鳞状细胞癌。尸检证实存在脊髓亚急性联合变性和食管癌，且无慢性萎缩性胃炎。
抗内因子抗体是唯一能解释钴胺素吸收不良的因素。发现了一例食管鳞状细胞癌。在我们的病例中，维生素B12吸收不良是由抗内因子抗体介导的副肿瘤性病因。脊髓亚急性联合变性可能是隐匿性食管鳞状细胞癌的表现。
