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Título

PARANEOPLASTIC FEVER ASSOCIATED WITH LOCALIZED SOFT TISSUE SARCOMA: CASE REPORT

Apresentação do caso

A 19-year-old, female, presented amenorrhea, fever and ocasional low back pain. Laboratory tests detected microcytic and hypochromic anemia and elevated ferritin, c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The patient was referred to the hematologist and clinical oncologist who decided to investigate as anemia of chronic disease, ruling out rheumatologic and infectous diseases, drug abuse, besides myelogram suggesting a reactional picture. Magnetic resonance imaging of the lumbosacral spine showed liquid colections with thickened walls and lobulated contours with impregnation by paramagnetic contrast, located in the gluteus maximus muscle, measuring 4.9x3.6 cm and 2.1x1.6 cm. Due to the possibility of an abscess, the patient was referred to a surgical procedure. The patient continued to have fever and elevated ESR and CRP despite the use of antibiotics. During surgery, it was noticed that the lesion had the appearance of a malignant tumor due to its high infiltration to adjacent structures. The anatomopathological result showed liposarcoma measuring 6 cm, low grade, resected with free margins. Immunohistochemistry demonstrated positivity for Vimentin and CD99 and negativity for S100, CD34, AE1/AE3 and desmin which is consistent with myxoid liposarcoma. After surgery, there was resolution of symptons, including fever, amenorrhea, and reduction in CRP and ESR levels to normal.

Discussão

Fever, elevated ferritin, CRP and ESR is a common and physiological response to an underlying medical disease, mostly infection. Accordingly, many patients are at risk to be misdiagnosed as having infectious, autoimmune or hematological diseases and the underlying neoplasm might be only detected incidentally upon further clinical workup causing significant diagnostic delay. Although paraneoplastic fever is mostly observed in patients with advanced cancer, it is related to the production of inflammatory cytokines, so it is not specific. Sarcomas are rare and heterogeneous cancers and are uncommonly associated with paraneoplastic syndromes. This is the first documented case of paraneoplastic fever in a patient with a low grade localized myxed liposarcoma.

Comentários finais

Liposarcoma may be associated with systemic clinical conditions besides a muscle mass, as described in the literature. No data were found about the variability of symptoms caused by myxoid liposarcoma neither about associated paraneoplastic syndromes, which makes this case report of great relevance.

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Área

Oncologia - Tumores cutâneos e Sarcomas