SYMPATHETIC PARALYSIS DUE TO METASTASIS AS INITIAL SIGN OF GASTRIC CARCINOMA

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Abstract
A 53yr.-old white male formerly addicted to morphine complained of boring pain in the region of the right nipple. General physical examination was negative except for arterial hypertension. Neurologic studies disclosed dysesthesia in D-4,to D-6 dermatomes, anhidrosis of the right half of the face and neck, the right upper extremity and the right half of the chest down to D-4. Intracut. histamine phosphate elicited wheal, flare, and pseudopod formation below D-4 but only local wheal within the D-4 dermatome. Roentgenograms of the dorsal spine were negative as were cerebrospinal fluid studies. Posterior rhizotomy was performed for relief of pain. Two yrs. later he began to complain of abdominal discomfort, and shortly afterward a nodular mass was palpated in the left rectus muscle. Biopsy revealed adenocarcinoma, source unknown. X-ray of the chest revealed evidence of bone destruction and cyst formation in the 4th rib near the spine. A gastrointestinal series showed deformities which were interpreted as due to a retroperitoneal mass. The patient died 26 mos. after the onset of his illness. At autopsy a large adenocarcinoma of the stomach was found, with metastases to the right prevertebral sympathetic chain, invasion of the 4th thoracic vertebral body and adjacent rib and involvement of the 4th intercostal nerve. It was noteworthy that 2 yrs. elapsed between the onset of neurologic signs and symptoms referable to the stomach.