SENSORIMOTOR POLYNEUROPATHY AND SYSTEMIC AMYLOIDOSIS AS PARANEOPLASTIC SIGNS OF A CARCINOID-LIKE WELL-DIFFERENTIATED CARCINOMA OF THE BREAST

History and admission findings: A 75-year-old woman was admitted becau se of weakness and paraesthesias in both legs. 15 years earlier a ches t radiogram had shown numerous round foci of uncertain cause. Physical examination confirmed muscular weakness in all limbs, especially the legs, as well as abnormal superficial and deep sensory perception. Inv estigations: Electromyography registered a patchy pattern of intention al muscular activity and marked denervation activity but largely norma l nerve conduction. There was no evidence of inflammatory disease in t he laboratory tests, including the CNS. Diagnosis, course and treatmen t: The neurological findings indicated progressive axonal sensorimotor polyneuropathy. A paraneoplastic cause was suspected, but search for a primary tumour was unsuccessfull. The patient developed a urinary in fection from which she died in septic shock. A carcinoid-like well-dif ferentiated carcinoma of the breast with haematogenous metastases to l iver, spleen and lung was discovered at autopsy. It also revealed seve re systemic AA-type amyloidosis. involving liver, spleen heart and kid neys. In addition there was a severe progressive axonal neuropathy and marked neurogenic atrophy of the peripheral skeletal musculature. No amyloid deposition was seen. Conclusion: In case of amyloidosis and po lyneuropathy of uncertain cause a paraneoplastic pathogenesis should b e considered in the differential diagnosis, even in the absence of pro ven malignancy.