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Peter E, Honnorat J, Desestret V. Paraneoplastic neurologic syndrome associated with gynecologic and breast malignancies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:409-417. [PMID: 38494293 DOI: 10.1016/b978-0-12-823912-4.00014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Gynecologic and breast malignancies are the cancers most commonly associated with paraneoplastic neurologic syndromes, of which the foremost is Yo [Purkinje cell antibody, type 1 (PCA-1)] paraneoplastic cerebellar degeneration. Yo syndrome affects women in the sixth decade and manifests as a subacute severe cerebellar ataxia. The association of the typical clinical picture with the detection of Yo antibodies in a patient's serum or CSF defines the diagnosis. Yo syndrome is always associated with a cancer, and the search for the underlying tumor should focus on ovarian and breast cancers and be repeated overtime if negative. The Yo autoantibodies are directed against the Yo antigens, aberrantly overexpressed by tumor cells with frequent somatic mutations and gene amplifications. The massive infiltration of these tumors by immune cells suggests that they are the site of the immune tolerance breakdown, leading to the destruction of Purkinje cells harboring the Yo antigens. Despite a growing understanding of the immunologic mechanisms, efficient therapeutic options are still lacking. Anti-Ri and antiamphiphysin syndromes are rarer and associated with breast cancers; a wide variety of other rare paraneoplastic neurologic syndromes have been described in association with gynecologic and breast malignancies that, though sharing some similarities, may have specific immune and genetics features leading to the immune tolerance breakdown.
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Affiliation(s)
- Elise Peter
- French Reference Center for Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Lyon, France; Synaptopathies and Autoantibodies (SynatAc) Team, Institut MeLis, Inserm U1314, UMR CNRS 5284, University Claude Bernard Lyon 1, Lyon, France
| | - Jérôme Honnorat
- French Reference Center for Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Lyon, France; Synaptopathies and Autoantibodies (SynatAc) Team, Institut MeLis, Inserm U1314, UMR CNRS 5284, University Claude Bernard Lyon 1, Lyon, France.
| | - Virginie Desestret
- French Reference Center for Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Lyon, France; Synaptopathies and Autoantibodies (SynatAc) Team, Institut MeLis, Inserm U1314, UMR CNRS 5284, University Claude Bernard Lyon 1, Lyon, France
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2
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Giucca A, Morrison H, Wilson T, Cossburn M. Anti-Yo paraneoplastic cerebellar degeneration in a patient with stage IV ovarian adenocarcinoma during bevacizumab maintenance therapy. BMJ Case Rep 2023; 16:e251277. [PMID: 37137547 PMCID: PMC10163414 DOI: 10.1136/bcr-2022-251277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Anti-Yo paraneoplastic cerebellar degeneration (PCD) is a rare autoimmune neurological syndrome characterised by cerebellar symptoms and frequently associated with gynaecological malignancies. While typically preceding the diagnosis of the malignancy, rarely it may present later in the disease course, heralding a recurrence prior to biochemical or radiological confirmation. Disease management is challenging and prognosis remains poor.We present the case of a woman with stage IV ovarian adenocarcinoma who developed anti-Yo PCD 16 months post malignancy diagnosis while receiving bevacizumab maintenance therapy. We review the literature and outline the difficulties in diagnosis and the frequently refractory nature of PCD to available treatments.
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Affiliation(s)
- Alice Giucca
- Department of Oncology, Bristol Haematology and Oncology Centre, Bristol, UK
| | - Hamish Morrison
- Department of Neurology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Thomas Wilson
- Department of Oncology, Bristol Haematology and Oncology Centre, Bristol, UK
| | - Mark Cossburn
- Department of Neurology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
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Venkatraman A, Opal P. Paraneoplastic cerebellar degeneration with anti-Yo antibodies - a review. Ann Clin Transl Neurol 2016; 3:655-63. [PMID: 27606347 PMCID: PMC4999597 DOI: 10.1002/acn3.328] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/25/2016] [Accepted: 06/04/2016] [Indexed: 12/30/2022] Open
Abstract
The ataxic syndrome associated with Anti-Yo antibody, or Purkinje cell cytoplasmic antibody type 1 (PCA1), is the most common variant of paraneoplastic cerebellar degeneration (PCD). The typical presentation involves the subacute development of pancerebellar deficits with a clinical plateau within 6 months. The vast majority of cases have been reported in women with pelvic or breast tumors. Magnetic resonance imaging of the brain is often normal in the early stages, with cerebellar atrophy seen later. The underlying mechanism is believed to be an immunological reaction to cerebellar degeneration-related protein 2 (CDR2), a protein usually found in the cerebellum that is ectopically produced by tumor cells. Although both B- and T-cell abnormalities are seen, there is debate about the relative importance of the autoantibodies and cytotoxic T lymphocytes in the neuronal loss. Cerebrospinal fluid abnormalities, primarily elevated protein, lymphocytic pleocytosis, and oligoclonal bands, are common in the early stages. The low prevalence of this condition has not allowed for large-scale randomized controlled trials. Immunotherapies, such as steroids, intravenous immune globulins, and plasma exchange, have been extensively used in managing this condition, with limited success. Although some reports indicate benefit from antitumor therapies like surgery and chemotherapy, this has not been consistently observed. The prognosis for anti-Yo PCD is almost uniformly poor, with most patients left bedridden. Further studies are required to clarify the pathophysiology and provide evidence-based treatment options.
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Affiliation(s)
- Anand Venkatraman
- Department of Neurology University of Alabama at Birmingham Birmingham Alabama
| | - Puneet Opal
- Davee department of Neurology Northwestern University Feinberg School of Medicine Chicago Illinois; Department of Cell and Molecular Biology Northwestern University Feinberg School of Medicine Chicago Illinois
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Maas E, Skoberne T, Werner A, Braun S, Jackisch C. Paraneoplastic Neurological Syndrome in Fallopian Tube Cancer. Geburtshilfe Frauenheilkd 2014; 74:950-953. [PMID: 25364036 DOI: 10.1055/s-0034-1383041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/07/2014] [Accepted: 07/28/2014] [Indexed: 10/24/2022] Open
Abstract
We report on a rare case of paraneoplastic syndrome (PS) that was discovered on completion of diagnostic work-up to be an undifferentiated fallopian tube carcinoma. A 49-year-old Caucasian woman was admitted to neurology with vertigo, gait ataxia and dysarthria, transient ischaemic attack (TIA) and stroke were quickly excluded. Indicative for the further diagnosis of a paraneoplastic syndrome was the identification of onconeuronal antibodies the detection of which can be associated with certain tumour entities. The strongly positive anti-Yo antibody that is formed above all by breast and lung cancers as well as ovarian cancer led to a corresponding staging. The tumour markers CEA, CA 125 and CA 15-3 were in the normal ranges. Mammography and thorax CT were also unremarkable; on transvaginal sonography the internal genitals were inconspicuous except for a follicular cyst on the left. On abdominal CT the only conspicuous finding was a 1.5 cm ovarian cyst. After consensual agreement a bilateral laparoscopic adenexectomy was performed but with unremarkable abdominal findings. The histological examination confirmed a right-sided undifferentiated tubal carcinoma with the provisional classification FIGO IIA. After a stage-related staging operation, the final classification was found to be the FIGO-IIIC stage on account of positive retroperitoneal lymph nodes. Thus adjuvant chemotherapy with 6 cycles of carboplatin and paclitaxel was performed. By means of a timely, guideline-conform therapy for tubal carcinoma, the neurological symptoms and, above all, the dysarthria could be improved after 10 months.
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Affiliation(s)
- E Maas
- Gynäkologie und Geburtshilfe, SanaKlinikum Offenbach, Offenbach
| | - T Skoberne
- Neurologie, SanaKlinikum Offenbach, Offenbach
| | - A Werner
- Gynäkologie und Geburtshilfe, SanaKlinikum Offenbach, Offenbach
| | - S Braun
- Pathologie, SanaKlinikum Offenbach, Offenbach
| | - C Jackisch
- Gynäkologie und Geburtshilfe, SanaKlinikum Offenbach, Offenbach
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Bhargava A, Bhushan B, Kasundra GM, Shubhakaran K, Pujar GS, Banakar B. Response to abdominal hysterectomy with bilateral salpingo-oophorectomy in postmenopausal woman with anti-yo antibody mediated paraneoplastic cerebellar degeneration. Ann Indian Acad Neurol 2014; 17:355-7. [PMID: 25221413 PMCID: PMC4162030 DOI: 10.4103/0972-2327.138528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/01/2014] [Accepted: 06/06/2014] [Indexed: 11/25/2022] Open
Abstract
Paraneoplastic cerebellar degeneration (PCD) is a rare neurological disorder characterized by a widespread loss of Purkinje cells associated with a progressive pancerebellar dysfunction. PCD often precedes the cancer diagnosis by months to years. Here, we report a case of 44-year old postmenopausal woman who presented with PCD symptoms and high levels of anti-Yo antibodies titer since 8 months. We failed to conclude any neoplastic focus after thorough laboratory and imaging study. She minimally responded to methylprednisolone and immunoglobulin therapies. Despite therapy she was severely disabled. Planned abdominal hysterectomy with bilateral salpingo-oophorectomy (AHBSO) was done, histology revealed grade IIA borderline serous papillary carcinoma of ovary. Her neurological deficit responded dramatically to AHBSO. It is first case report who emphasize the response of AHBSO with presentation of anti-Yo antibody-mediated PCD and hidden nidus in post menopausal women.
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Affiliation(s)
- Amita Bhargava
- Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Bharat Bhushan
- Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Gaurav M Kasundra
- Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Khichar Shubhakaran
- Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Guruprasad S Pujar
- Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Basavaraj Banakar
- Department of Neurology, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
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Paraneoplastic neurological syndromes associated with ovarian tumors. J Cancer Res Clin Oncol 2014; 141:99-108. [PMID: 24965744 PMCID: PMC4282879 DOI: 10.1007/s00432-014-1745-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/10/2014] [Indexed: 01/10/2023]
Abstract
Introduction Paraneoplastic neurological syndromes (PNS) are neurologic deficits triggered by an underlying remote tumor. PNS can antedate clinical manifestation of ovarian malignancy and enable its diagnosis at an early stage. Interestingly, neoplasms associated with PNS are less advanced and metastasize less commonly than those without PNS. This suggests that PNS may be associated with a naturally occurring antitumor response. Methods We review the literature on the diagnosis, pathogenesis and management of PNS associated with ovarian tumors: paraneoplastic cerebellar degeneration (PCD) and anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis. An approach to the diagnostic workup of underlying tumors is discussed. Results PCD can precede the manifestation of ovarian carcinoma. Anti-NMDAR encephalitis in young women appears often as a result of ovarian teratoma. Since ovarian tumors and nervous tissue share common antigens (e.g., cdr2, NMDAR), autoimmune etiology is a probable mechanism of these neurologic disorders. The concept of cross-presentation, however, seems insufficient to explain entirely the emergence of PNS. Early resection of ovarian tumors is a significant part of PNS management and improves the outcome. Conclusions The diagnosis of PNS potentially associated with ovarian tumor indicates a need for a thorough diagnostic procedure in search of the neoplasm. In some patients, explorative laparoscopy/laparotomy can be considered.
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Negishi Y, Sakai K, Noguchi Y, Iwasaki N, Kawai N. Paraneoplastic cerebellar degeneration caused by ovarian clear-cell carcinoma. J Obstet Gynaecol Res 2013; 40:614-7. [PMID: 24148073 DOI: 10.1111/jog.12212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 06/15/2013] [Indexed: 11/29/2022]
Abstract
Paraneoplastic cerebellar degeneration is a paraneoplastic neurological syndrome caused by the remote effect of certain systemic cancers and is characterized by subacute cerebellar symptoms. A 62-year-old woman suffering from unidentified cerebellar symptoms was admitted to our hospital. Paraneoplastic cerebellar degeneration was suspected and ovarian cancer was detected after the systemic examination for malignancy. The symptoms of vertigo and dysarthria were improved a little after surgical operation and treatments of γ-globulin, steroid pulse and tacrolimus hydrate. The cerebellar symptoms of paraneoplastic cerebellar degeneration are often evident prior to detection of malignancy. It is important to perform systemic examination for malignancy in case of unidentified cerebellar symptoms.
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Affiliation(s)
- Y Negishi
- Department of Microbiology and Immunology, Nippon Medical School, Tokyo, Japan; Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan; Department of Obstetrics and Gynecology, Tokyo Rinkai Hospital, Tokyo, Japan
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Russo AE, Scalone S, Leonardi GC, Scalisi A, Giorda G, Sorio R. Paraneoplastic cerebellar degeneration associated with ovarian cancer. Oncol Lett 2012; 5:681-683. [PMID: 23420048 PMCID: PMC3572954 DOI: 10.3892/ol.2012.1016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 08/03/2012] [Indexed: 11/06/2022] Open
Abstract
Paraneoplastic cerebellar degeneration (PCD) is a rare neurological disorder characterized by a widespread loss of Purkinje cells associated with a progressive pancerebellar dysfunction. PCD often precedes the cancer diagnosis by months to years. Here, we report the case of a 64-year-old woman who developed PCD symptoms, associated with high levels of anti-Yo antibodies, one year after a previous diagnosis of ovarian cancer. Clinical features, pathogenesis and treatment of PCD associated with cancer are discussed according to previous studies.
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Affiliation(s)
- Alessia Erika Russo
- Department of Biomedical Sciences, Section of Pathology and Oncology, Laboratory of Translational Oncology and Functional Genomics, University of Catania, Catania 95124; ; Department of Medical Oncology C, National Cancer Institute, IRCCS, Aviano 33081
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Saloustros E, Zaganas I, Mavridis M, Vamvakas L, Plaitakis A, Georgoulias V, Mavroudis D. Anti-CV2 associated cerebellar degeneration after complete response to chemoradiation of head and neck carcinoma. J Neurooncol 2009; 97:291-4. [PMID: 19798470 DOI: 10.1007/s11060-009-0022-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 09/21/2009] [Indexed: 12/11/2022]
Abstract
Paraneoplastic cerebellar degeneration is a rare neurological disorder that frequently precedes the detection of malignancy. Here, we report the case of a 60 year-old woman with locally advanced squamous cell carcinoma of the tongue who developed a subacute cerebellar syndrome associated with the presence of anti-CV2/CRMP5 antibodies in the cerebrospinal fluid, after achieving complete remission of the primary tumor and the involved cervical lymph nodes by chemoradiation. The patient's symptoms on presentation were dizziness and gait unsteadiness. On examination she showed dysarthria, nystagmus and limb and gait ataxia. The diagnosis of paraneoplastic cerebellar syndrome was made on the basis of the clinical findings and immunological testing that revealed the presence of anti-CV2/CRMP5 antibodies in the patient's cerebrospinal fluid. This syndrome, which is very rare in association with head and neck cancer, commonly precedes the detection of malignancy by a year or more and has been documented in only a few cases after completion of anticancer treatment.
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Affiliation(s)
- Emmanouel Saloustros
- Department of Medical Oncology, University Hospital of Heraklion, Voutes, 71110, Heraklion, Crete, Greece
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