Complex Paraneoplastic Neuro‑Dermatological Syndrome with Gastric Involvement and Orthopedic Collapse: Systemic and Interventional Management
DOI:
https://doi.org/10.70577/asce.v5i3.1111Keywords:
Paraneoplastic syndrome; gastric cancer; paraneoplastic neuropathy; paraneoplastic dermatosis; hypertrophic osteoarthropathy; gastroparesis; multidisciplinary management.Abstract
Paraneoplastic syndromes (PNS) constitute a heterogeneous group of clinical manifestations occurring as a remote effect of a tumor, without direct relationship to metastasis, compression, or tumor invasion. They can affect multiple organ systems, including neurological, dermatological, gastrointestinal, and musculoskeletal. Their clinical presentation is often atypical and may precede the diagnosis of the underlying tumor by up to five years, representing a significant diagnostic challenge.
This review aims to synthesize current evidence on complex paraneoplastic syndromes affecting the neurological, dermatological, gastrointestinal, and musculoskeletal systems in the context of gastric neoplasms, analyzing pathophysiological mechanisms, diagnostic strategies, and systemic and interventional management.
A systematic search was conducted in PubMed, Scopus, and Web of Science up to May 2026. Original studies, systematic reviews, clinical guidelines, and case reports addressing multisystem paraneoplastic syndromes associated with gastric tumors were included.
Paraneoplastic neurological syndromes associated with gastric cancer may manifest as peripheral neuropathy (including vasculitic neuropathy and anti‑Hu neuropathy), myeloneuropathy, cerebellar degeneration (associated with anti‑Yo antibodies), autoimmune encephalitis (including anti‑LGI1 limbic encephalitis and opsoclonus‑myoclonus), and intestinal pseudo‑obstruction. Dermatological manifestations include malignant acanthosis nigricans, tripe palms, dermatomyositis, erythroderma, and paraneoplastic pemphigus. Gastrointestinal involvement manifests as gastroparesis and intestinal pseudo‑obstruction due to visceral neuropathy of the myenteric plexus. Orthopedic collapse may correspond to hypertrophic osteoarthropathy (HOA), characterized by clubbing, periostitis, and arthralgias. Management requires a multidisciplinary approach combining treatment of the underlying tumor, immunomodulation, nutritional support, and rehabilitation.
Complex paraneoplastic neuro‑dermatological syndrome with gastric involvement and orthopedic collapse constitutes a highly complex entity requiring a high index of suspicion, early diagnosis, and multidisciplinary management. Early identification of paraneoplastic manifestations may enable diagnosis of an occult neoplasm at potentially curable stages.
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Copyright (c) 2026 Sophia Beatriz Cárdenas Verdezoto, Nelson Rodrigo Figueroa Pantoja, Mishell Dayanara Vargas Saltos, María Belén Delgado González, Sindy Solange Tiban Changoluisa
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