Aplastic anaemia as a paraneoplastic syndrome in lung cancer

MALIGNANT lung tumours can be associated with haematological syndromes, such as leucocytosis, erythrocytosis and thromboeytosis [ 1). Pancytopenia without bone marrow metastasis is rare [2, 33. We report a patient with aplastic anaemia associated with epidermoid lung cancer. A 62-year-old man was admitted because of progressive weakness and pancytopenia. His previous history included chronic bronchitis with 30 years of smoking. Rheumatoid arthritis had been diagnosed 10 years earlier. 6 months before admission he had been investigated elsewhere because of rightsided pleural effusion, which subsided spontaneously and was considered to be associated with his rheumatoid arthritis. His previous medication consisted of D-penicilhunine for 24 months, which was discontinued 1 month before admission because of mild anaemia and leukopenia. On admission, the only findings were coarse bilateral basal inspiratory crackles. Haemoglobin (Hb) value was 88 g/l, white cell count 2 x 109/1 with 11% neutrophils and platelet count 36 x 109/1. Bone marrow biopsy revealed severe marrow hypoplasia. Aplastic anaemia was diagnosed and treated with regular transfusion support with leucocyte-depleted, packed red cells and thrombocytes. Over the next 6 months, chest radiography was used to observe the right upper lobe infiltrate. Fibreoptic bronchoscopy revealed tumour in the right upper lobe and histology confirmed a squamous cell carcinoma. No mediaa mild pancytopenia also developed. 4 months after the removal of the brain metastasis, pancytopenia worsened, bone marrow hypoplasia recurred and the patient also had multiple liver metastases and hypercalcaemia. 15 months after the lung operation he died without any cytotoxic chemotherapy. At necropsy, metastases were found in mediastinal lymph nodes and liver, but not in lungs, brain or bone marrow. Haematological abnormalities in lung cancer are common, but nearly always associated with metastasized disease. In our patient no signs of metastases were observed at thoracotomy. Although the pleural effusion may have been due to malignancy, it cleared spontaneously and repeated cytological examination of the fluid was normal. Rheumatoid arthritis can itself cause pleural effusions and the specimens of pleural fluid from our patient were similar to those seen in rheumatoid pleuritis.