A 72-year-old woman referred to our hospital because of slowly progressive (over 2 years)
muscle weakness and
paresthesias of the lower limbs. On neurological examination, weakness and
muscle atrophies were noted in the distal upper limbs as well as the proximal lower limbs. She had also
paresthesias of the legs. The level of
creatinine phosphokinase (CK) was 126 IU/l. The magnetic resonance imaging demonstrated
gadolinium enhancement of the nerve roots at the L4-S2 vertebrate levels. Nerve conduction study showed decreased compound muscle action potential and motor conduction velocity of tibial and peroneal nerves. Biopsy of the left biceps brachii muscle showed variations in fiber size, endomysial mononuclear cell infiltration and the findings like a rimmed vacuole. Although almost of her findings were in accord with clinical features of
inclusion body myositis, strong inflammatory cellular influences allowed us to administer
corticosteroid therapy. Because her weakness was well responded to
steroid therapy,
polymyositis was considered as differential diagnosis. Then, further examinations were investigated to search any occult
neoplasm, and detected the early
gastric cancer. Total
gastrectomy was performed later, and the pathological diagnosis was made as a
signet-ring cell carcinoma. To our knowledge, this is the first report of systemic
myositis and subacute sensory neuropathy concomitant with
signet-ring cell carcinoma. These symptoms might be occurred as a result of
paraneoplastic syndrome associated with satellite effects of the
signet-ring cell carcinoma.