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Gomes I, Jesus E, Sousa GM. Rare Presentation and Diagnostic Challenge of a Germ Cell Tumor of the Yolk Sac Type. Cureus 2024; 16:e53138. [PMID: 38420071 PMCID: PMC10899893 DOI: 10.7759/cureus.53138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
Opsoclonus-ataxia paraneoplastic syndrome (OAPS) is a rare neurological disorder often associated with malignancies. This case report highlights an unusual instance of OAPS linked to a yolk sac (germ cell) tumor, a correlation underrepresented in the medical literature. The patient presented with distinct neurological symptoms alongside mediastinal lymphadenopathies. The subsequent diagnostic journey revealed a yolk sac germ cell tumor. Following incisional biopsies and treatment, the patient experienced fluctuations in mental status, leading to challenges in initiating chemotherapy. Despite these complications, a multidisciplinary approach involving neurologists, oncologists, and hematologists was pivotal. The case emphasizes the complexities of managing OAPS in tandem with a germ cell tumor, underscoring the need for further research and highlighting the significance of specialized neurological evaluation in similar cases.
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Affiliation(s)
- Inês Gomes
- Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil, Coimbra, PRT
| | - Emanuel Jesus
- Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil, Coimbra, PRT
| | - Gabriela M Sousa
- Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil, Coimbra, PRT
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Brigham E, Sun C, Bronnenkant R, Kumar A, Disori K. Clinical Reasoning: An adolescent girl presenting with worsening vertigo, headache, and ataxia. Neurology 2020; 95:e1760-e1763. [DOI: 10.1212/wnl.0000000000010233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Patel A, Fischer C, Lin YC, Basu EM, Kushner BH, De Braganca K, Khakoo Y. Treatment and revaccination of children with paraneoplastic opsoclonus-myoclonus-ataxia syndrome and neuroblastoma: The Memorial Sloan Kettering experience. Pediatr Blood Cancer 2020; 67:e28319. [PMID: 32543116 PMCID: PMC8382509 DOI: 10.1002/pbc.28319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To review the treatment and revaccination of neuroblastoma-associated opsoclonus-myoclonus-ataxia syndrome (OMAS) patients at Memorial Sloan Kettering Cancer Center (MSK). PROCEDURE Institutional Review Board approval was obtained for this retrospective study of patients with neuroblastoma-associated OMAS followed at MSK from 2000 to 2016. RESULTS Fourteen patients (nine female) were 9-21 (median 17) months old at diagnosis of neuroblastoma and OMAS syndrome. They had stage 1 (n = 12), stage 2B, or intermediate-risk stage 4. Tumor histology was favorable in 11 patients, unfavorable in two, and unknown in one patient. No patient had amplified MYCN. All patients underwent tumor resection at diagnosis. Anti-neuroblastoma treatment was limited to chemotherapy in one patient. Overall survival is 100% at 3-16 (median 10) years. For OMAS, 13 patients received intravenous immune globulin (IVIg), adrenocorticotropic hormone (ACTH), and rituximab, and one received ACTH and IVIg. Seven patients experienced OMAS relapse. For these relapses, five patients received low-dose cyclophosphamide and two received rituximab. The mean total OMAS treatment was 20-96 (median 48) months. Seven patients started rituximab ≤3 months from diagnosis and did not relapse. The other six experienced OMAS relapse. To date, six patients have been revaccinated at a minimum of 2 years after completion of OMAS therapy without OMAS recurrence. CONCLUSIONS Patients with neuroblastoma-associated OMAS had excellent overall survival. Early initiation of rituximab, IVIg, and ACTH may reduce risks of OMAS relapse. Revaccination can be resumed without exacerbation of OMAS. Further investigation with a larger cohort of patients is needed.
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Affiliation(s)
- Ami Patel
- New York University School of Medicine, New York, NY, USA
| | - Cheryl Fischer
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yi-Chih Lin
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ellen M. Basu
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian H. Kushner
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin De Braganca
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yasmin Khakoo
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Department of Pediatrics, Weill Medical College of Cornell University, New York, NY USA
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Webster EM, Tymon-Rosario J, D'Addario J, Zeybek B, Ratner ES. Opsoclonus-ataxia syndrome and mature ovarian teratoma in an adolescent. Gynecol Oncol Rep 2020; 33:100601. [PMID: 32637527 PMCID: PMC7327890 DOI: 10.1016/j.gore.2020.100601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 11/17/2022] Open
Abstract
•Ovarian teratomas have been implicated in multiple paraneoplastic syndromes.•Opsoclonus-ataxia syndrome is a rare entity that may be secondary to a paraneoplastic, infectious, or idiopathic process.•Opsoclonus-ataxia syndrome may be associated with ovarian teratoma in both children and adults.•Prompt gynecologic involvement for teratoma resection is warranted.
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Affiliation(s)
| | | | | | | | - Elena S. Ratner
- Corresponding author at: Department of Obstetrics, Gynecology, and Reproductive Sciences, Co-Chief Gynecologic Oncology, Yale School of Medicine, 310 Cedar Street, FMB Room 328, New Haven, CT, 06520-8063, USA.
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Silverman A, Selvadurai C, Picard J, Gluck L, Fisayo A, Makhani N, Benitez V. Clinical Reasoning: A 16-year-old girl with ataxia, oscillopsia, and behavioral changes. Neurology 2020; 94:713-717. [PMID: 32234821 DOI: 10.1212/wnl.0000000000009297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Andrew Silverman
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT.
| | - Chindhuri Selvadurai
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - John Picard
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Lauren Gluck
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Adeniyi Fisayo
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Naila Makhani
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Viviana Benitez
- From the Department of Neurology, Yale University School of Medicine, New Haven, CT
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Park C, Aljabban I, Fanburg-Smith JC, Grant C, Moore M. Pediatric whole body MRI detects causative ovarian teratoma in opsoclonus myoclonus syndrome. Radiol Case Rep 2019; 15:204-209. [PMID: 31890069 PMCID: PMC6928268 DOI: 10.1016/j.radcr.2019.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/07/2019] [Accepted: 11/17/2019] [Indexed: 01/28/2023] Open
Abstract
Opsoclonus Myoclonus Syndrome (OMS, or Opsoclonus Myoclonus Ataxia) is a rare condition that presents with saccadic movements of the eyes, cerebellar ataxia, and choreiform movements of the limbs. While previous reports have described the use of ultrasound, CT, FDG-PET and traditional focused MRI for localization of OMS-associated masses, whole body MRI has not previously been reported for this purpose. Here we describe a 16-year-old patient who exhibited OMS and underwent whole body MRI to rule out the more commonly associated neuroblastoma. An ovarian mass was discovered, resected, and pathology confirmed benign teratoma - there was subsequent resolution of symptoms after complete surgical resection. Whole body MRI should be considered in pediatric cases of OMS due to the paraneoplastic nature of the disease with associated tumor, high sensitivity of disease detection, lack of ionizing radiation, excellent tissue resolution and demonstrated effectiveness in pediatric imaging.
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Affiliation(s)
- Christian Park
- Department of Radiology, Penn State Health, Hershey PA 17033, USA
- Corresponding author.
| | - Imad Aljabban
- Penn State College of Medicine, Hershey PA 17033, USA
| | - Julie C. Fanburg-Smith
- Pathology, Pediatrics, and Orthopedics, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Christa Grant
- Surgery and Pediatrics, Penn State Children's Hospital, Penn State Health, Hershey PA 17033, USA
| | - Michael Moore
- Radiology and Pediatrics, Penn State Health, Hershey PA 17033, USA
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Blomme L, Van de Velde K. Trismus as a Presenting Symptom in a Case of Progressive Encephalopathy with Rigidity and Myoclonus. Case Rep Neurol 2019; 11:132-136. [PMID: 31543794 PMCID: PMC6739699 DOI: 10.1159/000499448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 03/05/2019] [Indexed: 12/31/2022] Open
Abstract
In this report we present a clinical case of trismus. The patient in question showed symptoms of trismus for 3 days, rapidly leading to respiratory insufficiency. Afterwards she developed myoclonus and progressive encephalopathy. Neurological workup showed no relevant abnormalities. A CT of the abdomen revealed a mass in the lower abdomen, which turned out to be an ovarian teratoma. Progressive encephalopathy with rigidity and myoclonus (PERM) was diagnosed clinically. Treatment with corticosteroids, benzodiazepines, and levetiracetam did not ameliorate the patient's condition. Only after the introduction of plasmapheresis was there a spectacular improvement in her clinical state. In this case we could not detect associated antibodies. The most likely cause of PERM is paraneoplastic disease secondary to ovarian teratoma. This type of tumor has been associated with multiple paraneoplastic neurological conditions, but this is the first case associated with PERM. To date there is only one publication on trismus as a sole presenting sign, with a quite similar disease course.
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Affiliation(s)
- Lies Blomme
- Neurology Department, ZNA Middelheim Antwerp, Antwerp, Belgium
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Pranzatelli MR, Tate ED, McGee NR. Multifactorial analysis of opsoclonus-myoclonus syndrome etiology ("Tumor" vs. "No tumor") in a cohort of 356 US children. Pediatr Blood Cancer 2018; 65:e27097. [PMID: 29727049 DOI: 10.1002/pbc.27097] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/14/2018] [Accepted: 03/17/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pediatric opsoclonus-myoclonus syndrome (OMS) presents a paradox of etiopathogenesis: A neuroblastic tumor (NB) is found in only one half of the cases, the others are ascribed to infections or designated as idiopathic. METHOD From an IRB-approved observational study of 356 US children with OMS, secondary analysis of "etiology" and related factors was performed on a well-characterized cohort. The "Tumor" (n = 173) and "No Tumor" groups (n = 183), as defined radiologically, were compared according to multiple factors considered potentially differentiating. Data were analyzed retrospectively using parametric and nonparametric tests as indicated. RESULTS Patients with NB were not distinguishable by prodromal symptoms, OMS onset age, gender, race/ethnicity, OMS severity, rank order of neurological sign appearance, or geographic distribution. Various CSF immunologic biomarker abnormalities of OMS did not vary in the presence or absence of a detectable tumor: frequency of six lymphocyte subsets, or concentrations of 18 cytokines/chemokines, cytokine antagonists, chemokine receptors, cell adhesion molecules, or neuronal/glial markers. Prior responsiveness to conventional immunotherapy was not contingent on tumor/no tumor designation. CONCLUSIONS Multiple convergent factors provide compelling empirical evidence and rationalize the concept that OMS is one neurological disorder, regardless of apparent etiology. Limitations to the current clinical etiologic classifications as paraneoplastic, parainfectious/post-infectious, and idiopathic etiology require antigen-based biological solutions to tease out the molecular pathophysiology of viral/tumoral mechanisms. Systematic studies, regardless of presumed etiology, will be necessary to find the highest-yield combination of imaging approaches, screening for infectious agents, and new biomarkers. Two testable hypotheses for future research are presented.
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Affiliation(s)
- Michael R Pranzatelli
- National Pediatric Myoclonus Center, National Pediatric Neuroinflammation Organization, Inc., Orlando, Florida, USA
| | - Elizabeth D Tate
- National Pediatric Myoclonus Center, National Pediatric Neuroinflammation Organization, Inc., Orlando, Florida, USA
| | - Nathan R McGee
- National Pediatric Myoclonus Center, National Pediatric Neuroinflammation Organization, Inc., Orlando, Florida, USA
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Yau WY, Fabis-Pedrini MJ, Kermode AG. Acute reversible seronegative cerebellar ataxia in a young woman with ovarian teratoma. J Neurol Sci 2016; 369:227-228. [PMID: 27653894 DOI: 10.1016/j.jns.2016.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/10/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Wai Yan Yau
- Sir Charles Gairdner Hospital, Neurology Department, 1st Floor, E Block, Hospital Avenue, Nedlands, WA, Australia.
| | - Marzena J Fabis-Pedrini
- Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, The University of Western Australia, QEII Medical Centre, Nedlands, WA 6009, Australia
| | - Allan G Kermode
- Sir Charles Gairdner Hospital, Neurology Department, 1st Floor, E Block, Hospital Avenue, Nedlands, WA, Australia; Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, The University of Western Australia, QEII Medical Centre, Nedlands, WA 6009, Australia; Murdoch University, Building 390, Discovery Way, Murdoch, WA, Australia; University of Western Australia, 35 Stirling Highway, Crawley WA, Australia
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Blaes F, Dharmalingam B. Childhood opsoclonus-myoclonus syndrome: diagnosis and treatment. Expert Rev Neurother 2016; 16:641-8. [DOI: 10.1080/14737175.2016.1176914] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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