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We identified four patients with paraneoplastic necrotizing myopathy from muscle biopsies done at Washington University over a 10-year period.The patients(aged 38 to 76 years)presented with subacutely evolving,symmetric, proximal weakness.Tumor types included gastrointestinal adenocarcinoma(2 of 4),transitional cell carcinoma,prostatic carcinoma and non-small cell lung carcinoma.Two patients died.Two others improved after treatment that include corticosteroids and tumor resection.Muscle pathology showed numerous necrotic fibers(8 to 100%)and intense alkaline phosphatase staining of the muscle connective tissue,but little inflammation. Paraneoplastic necrotizing myopathy is characterized by a rapidly progressive,symmetric,predominantly proximal weakness that produces severe disability.Muscle pathology demonstrates prominent necrosis with alkaline phosphatase staining of connective tissue and little inflammation. Evaluation for cancer is indicated in patients with these clinical and pathologic findings. |
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carcinoma
creatine phosphokinase(CPK)elevated
muscle biopsy
muscle weakness
muscle weakness,proximal
myopathy
myopathy,necrotizing
neurologic complications of,systemic cancer
old age,neurology of
remote effect of cancer on the nervous system
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