Detection of primary tumor in paraneoplastic cerebellar degeneration by FDG-PET

Paraneoplastic neurological syndromes associated with renal or bladder cancer: case series and PRISMA-IPD systematic review

BACKGROUND

The link between paraneoplastic neurological syndromes (PNS) and renal cell and bladder cancer (RCC/BC) is rare and uncertain. Our aim was to clinically evaluate, in light of the updated PNS criteria, these uncommon associations.

METHODS

Retrospective nationwide cohort chart review study and systematic review of the literature.

RESULTS

After excluding 5 patients due to the diagnosis of another co-occurrent malignancy, 10/18 patients with RCC and 8/18 patients with BC were identified. A total of 31 cases were previously published, yielding an overall series of 27/49 RCC and 22/49 BC patients. There was a predominance of cerebellar syndromes in both cancers (10/27, 37% for RCC; 9/22, 41% for BC), followed by encephalitis in 9/27 (33%) patients with RCC and encephalomyelitis/sensory neuronopathy in 5/22 (23%) patients with BC. The detection of high-risk Abs was more frequent among BC patients (16/19, 84% vs. 3/13, 23% in RCC, p = 0.0009), Ri antibodies being the most frequent thereof. After applying the updated PNS criteria, patients with BC met highest degrees (possible, probable, and definite) of certainty for PNS diagnosis (20/22, 91% vs. 16/27, 59% in RCC, p = 0.021).

CONCLUSION

A second neoplasm should always be ruled out before establishing the diagnosis of PNS in patients with RCC or BC. However, while this association remains dubious for most patients with RCC, a casual role is more probable in patients with BC and high-risk antibodies presenting with cerebellar ataxia, brainstem encephalitis or encephalomyelitis/sensory neuronopathy.

Michel Dumas and Pierre-Marie Preux: promoting tropical neurology silently--the gist of their contributions

This article presents the contribution by two senior French Neurologists over the past three decades in building, developing and promoting 'tropical neurology' in a number of neglected countries of Asia, Africa and Latin America. It talks about the 'human, dedicational and contributive value' of these two experts who do not come from an English-speaking world. It highlights meaningful changes that have been achieved in different tropical countries as a result of their direct contribution. This overview may likely be a cause for learning and motivation to others to really work in and for tropical countries, where a large proportion of global health burden is to be found.

Anti-yo associated paraneoplastic cerebellar degeneration in a man with large cell cancer of the lung

Purkinje cell cytoplasmic antibody type 1 (PCA-1), or anti-Yo, is the most frequently detected autoantibody in paraneoplastic cerebellar degeneration (PCD). The vast majority of cases of anti-Yo PCD, however, occur in females over 60 years old and are associated with gynecologic tumors. Only 10 cases have been reported in males, and only 2 were associated with cancer of the lung. Here we describe the youngest known case of PCA-1 positive PCD in a male, whose lung tumor was undetectable even on FDG-PET.

Paraneoplastic Cerebellar Degeneration as Initial Presentation of Papillary Carcinoma of the Fallopian Tube: Evaluation and Usefulness of (18)F-FDG PET-CT. Case Report and Literature Review

The acquisition of an (18)F-FDG PET-CT scan in patients with suspected paraneoplastic cerebellar syndrome can be helpful in determining the origin of a neoplasm because of its high sensitivity and also helps guide the neurological development course depending on the degree of incorporation of (18)F-FDG to the cerebellar parenchyma when compared with the rest of the brain.

A rare gynecological case of paraneoplastic cerebellar degeneration discovered by FDG-PET

BACKGROUND

PET/CT may be particularly useful to detect the primary cancer in paraneoplastic cerebellar degeneration (PCD) with anti-Yo which is most commonly associated with breast, ovarian and other gynecological cancers.

CASE

A 60-year-old woman developed a PCD associated with anti-Yo antibodies in serum and cerebrospinal fluid. Conventional imaging was negative. FDG-PET showed an abnormal hot spot in the right ovarian area associated with lombo aortic lymph nodes. The diagnosis was confirmed by surgery as an ovarian adenocarcinoma.

CONCLUSION

In this case report, FDG-PET played a crucial role in detecting the unknown primary tumor in a patient with PCD.

Quantitative PET cerebral glucose metabolism estimates using a single non-arterialized venous-blood sample

The purpose of this study is to develop a method of quantitating the cerebral metabolic rate of glucose (CMRglc) by positron emission tomography using a population-based heated venous curve and one-point sampling from a non-heated vein, i.e. that can avoid arterial puncture.

METHODS

We conducted this study on 17 subjects with a mean age of 61 +/- 9 years. A time-concentration curve as an input function was obtained by sampling 24 blood samples, from the heated left hand vein, one before and the others after intravenous injection of 259 MBq of F-18-fluorodeoxyglucose into the right cubital vein. A non-heated venous sample was also obtained from the right cubital vein.

RESULTS

The population-based input function was calculated by averaging time-concentration curves from the first 7 subjects. A single sample obtained from 10 other subjects from 7.5 to 20 minutes and 35 and 40 minutes after injection predicted input function well with an error of less than 4.5%. The radioactivity in the non-heated 40 minutes' sample was 1.7 +/- 2.9% higher than in the heated vein. When we calibrated the population-based curve using the non-heated venous samples at 40 minutes in 10 subjects, the calculated CMRglc values were 1.3 +/- 5.4% lower than the actual values.

CONCLUSIONS

Non-heated venous one-point sampling and the population-based curve can decrease the complexity of the procedures and the manpower required, and also make the FDG study less invasive, without a significant increase in measurement error.

Strategies in detection of the primary tumour in anti-Yo associated paraneoplastic cerebellar degeneration

In patients with anti-Yo associated paraneoplastic cerebellar degeneration (PCD) neurological symptoms precede the diagnosis of the underlying cancer in about 60%. Ovarian carcinoma, breast cancer and other gynaecological malignancies are most frequently found as causative malignancies. Antitumour treatment should be applied in an early stage of disease. The identification of the tumour is a diagnostic challenge in many of these patients. In the first of two patients reported here a pelvic tumour was suggested after detection of a pathological lymph node and elevated tumour markers. The intraoperative findings appeared macroscopically normal during ovariectomy with adnexectomy. Not until microscopic examination of the resected tissue was performed was a tubal adenocarcinoma found. If intrapelvic gynaecological tumours are suspected a deliberate surgical exploration seems to be justified, but only after an intensive diagnostic investigation. To search for the underlying cancer in patients with paraneoplastic neurological disorders successive CT and [18F]-FDG-PET are widely recommended. Instead of this in the second reported patient whole-body dual-modality PET/CT was performed revealing enhanced uptake in three regions of the left thorax. By combining function and anatomy PET/CT was able to localise the lesions and characterise them as lymph node metastases of breast cancer. Diagnosis could be confirmed by subsequently executed needle biopsy. PET/CT seems to be highly applicable in the investigation of paraneoplastic disorders with unknown primary cancer. It may help in guidance of needle biopsy or to optimise the results of deliberate surgery and it provides whole-body tumour staging in a single session with higher diagnostic accuracy than PET alone.

Paraneoplastic cerebellar degeneration as the first manifestation of cancer

Paraneoplastic cerebellar degeneration (PCD) is a type of paraneoplastic syndrome that primarily affects women with gynecological cancers. Patients typically experience pancerebellar symptoms, including gait ataxia, dysarthria, nystagmus, and truncal and appendicular ataxia. We present the case of a 50-year-old woman with PCD and presumed ovarian cancer who initially complained of ataxia and dysarthria. PCD was diagnosed on the basis of her symptoms, diagnostic imaging, and laboratory work. PCD symptoms may precede the diagnosis of malignancy by months or years. Early diagnosis and treatment of these syndromes, including rehabilitation, may result in improvements in quality of life for this population of patients.

FDG-PET imaging in patients with paraneoplastic syndromes and suspected small cell lung cancer

Paraneoplastic syndromes may be the presenting clinical manifestation of small cell lung cancer. In some cases, however, confirming the diagnosis can be difficult because findings on conventional imaging studies can be subtle or nonspecific. This study examined the utility of fluoro-2-deoxy-glucose positron emission tomography (FDG-PET) in identifying clinically suspected small cell lung cancer in patients with paraneoplastic syndromes. FDG-PET appears to be very useful in localizing suspected small cell lung cancer in patients presenting with paraneoplastic syndromes.

Paraneoplastic syndromes

Paraneoplastic neurological syndromes cause severe neurological dysfunction and may lead to the diagnosis of a potentially curable cancer. The range of clinical presentations of these syndromes continues to grow and new antibody associations are constantly being described. Conventional immunosuppressive therapy is rarely helpful and the prognosis of these conditions remains poor.