Atypical thymic carcinoid manifesting with nephrotic-range proteinuria in a 7-year-old boy

Pediatr Nephrol. 2017 Aug;32(8):1465-1468. doi: 10.1007/s00467-017-3685-5. Epub 2017 May 5.

Abstract

Background: Nephrotic-range proteinuria as a paraneoplastic syndrome (PNS) is an exceptional presentation, especially in children. It is usually associated with hematologic malignancies. Solid tumors are very rare causes of proteinuria.

Case-diagnosis/treatment: We present the case of a 7-year-old boy with an extremely rare atypical thymic carcinoid accompanied by nephrotic-range proteinuria as PNS. The kidney biopsy was consistent with minimal change disease (MCD). Tests for a neuroendocrine tumor were performed due to symptoms of hypercortisolemia and an elevated concentration of chromogranin A in the serum. The chest computed tomography revealed a tumor in the anterior mediastinum, which was diagnosed as an atypical thymic carcinoid. A complete resolution of the nephrotic-range proteinuria was observed within 1 week after the first thoracoscopic surgery, with almost complete reduction of the tumor mass.

Conclusions: This extremely rare case shows that MCD can occur as a PNS even in children. Nephrotic-range proteinuria can be a symptom of malignant solid tumor. This case highlights the possibility of secondary causes of MCD in children.

Keywords: Carcinoid; Child; Nephrotic syndrome; Paraneoplastic syndrome.

Publication types

  • Case Reports

MeSH terms

  • Adrenocorticotropic Hormone / blood
  • Biopsy
  • Carcinoid Tumor / complications*
  • Carcinoid Tumor / diagnosis
  • Carcinoid Tumor / surgery
  • Carcinoid Tumor / urine
  • Child
  • Chromogranin A / urine
  • Cushing Syndrome / diagnosis
  • Diagnosis, Differential
  • Humans
  • Hydroxyindoleacetic Acid / urine
  • Hyperglycemia / etiology
  • Hypernatremia / etiology
  • Hypertension / etiology
  • Hypokalemia / etiology
  • Kidney / pathology
  • Kidney / ultrastructure
  • Magnetic Resonance Imaging
  • Male
  • Microscopy, Electron
  • Nephrotic Syndrome / diagnosis
  • Paraneoplastic Syndromes / diagnosis
  • Paraneoplastic Syndromes / urine*
  • Proteinuria / etiology*
  • Proteinuria / urine
  • Rare Diseases / complications*
  • Rare Diseases / diagnosis
  • Rare Diseases / surgery
  • Rare Diseases / urine
  • Thoracoscopy
  • Thymus Neoplasms / complications*
  • Thymus Neoplasms / diagnosis
  • Thymus Neoplasms / surgery
  • Thymus Neoplasms / urine
  • Tomography, X-Ray Computed

Substances

  • Chromogranin A
  • Hydroxyindoleacetic Acid
  • Adrenocorticotropic Hormone