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French AV, Grossmann L. Early diagnosis and treatment improve outcomes for premenarchal patients with anti-NMDA receptor encephalitis and ovarian teratoma. J Pediatr Adolesc Gynecol 2022; 35:516-517. [PMID: 35358707 DOI: 10.1016/j.jpag.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/18/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Amanda V French
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Tufts Children's Hospital and Tufts Medical Center, 800 Washington Street, Boston, MA, United States.
| | - Lily Grossmann
- Division of Pediatric Neurology, Department of Pediatrics, Tufts Children's Hospital and Tufts Medical Center, Boston, MA, United States
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Hwang JH, Kim BW. Mature Cystic Teratoma Combined With Autoimmune Limbic Encephalitis Mimicking Functional Ovarian Cyst. Cureus 2022; 14:e26812. [PMID: 35971364 PMCID: PMC9374113 DOI: 10.7759/cureus.26812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Abstract
Autoimmune limbic encephalitis (ALE) associated with an anti-N-methyl-D-aspartate receptor (NMDAR) is a rare but occasionally fatal condition that could be accompanied by ovarian teratoma. We report a case of a 27-year-old woman with ALE combined with a mature cystic teratoma that looks like a functional cyst in imaging studies. A single port access laparoscopic left oophorectomy was performed. On the 154th postoperative day, symptoms were fully recovered. Teratoma detection and tumor removal are critical for the management of patients diagnosed with or suspected of ALE.
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Begum J, Aziz Z, Sahoo SK, Majumder R, Sable MN. Anti-N-Methyl-D-Aspartate Receptor Encephalitis Associated with Mature Ovarian Teratoma in a Young Adolescent: A Case Report. J Pediatr Adolesc Gynecol 2022; 35:400-403. [PMID: 34863950 DOI: 10.1016/j.jpag.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/19/2021] [Accepted: 11/15/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Ovarian teratoma has an uncommon association with anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis. This is a life-threatening condition, and here, we describe a case of an adolescent girl with anti-NMDAR encephalitis caused by an ovarian teratoma. CASE A 14-year-old girl presented with acute features of fever, severe headache, altered behavioral changes, delirium, autonomic instability, episodes of seizure, and involuntary movement over a period of 1 month. Upon investigation, electroencephalogram (EEG), computed tomography (CT), and magnetic resonance imaging (MRI) of her brain showed normal findings. Her serum and cerebrospinal fluid were positive for anti-NMDARs, and a diagnosis of anti-NMDAR encephalitis was made, so she received a course of intravenous methyl prednisolone and immunoglobulin and was discharged after her neurological status improved. Upon further workup, she was suspected to have a left ovarian dermoid cyst on transabdominal ultrasonogram, which was an incidental finding. Her tumor marker panel showed normal serum lactate dehydrogenase, beta human chorionic gonadotropin, inhibin, alpha-fetoprotein, and carcinoembryonic antigen and a cancer antigen 125 level of 71.5 U/L. She eventually underwent laparoscopic left ovarian cystectomy and received immunotherapy in the postoperative period. She was discharged in stable condition on postoperative day 4. On histopathological examination, the specimen revealed a mature cystic teratoma with glial component. One year after surgery, the patient has recovered completely and has no residual psychiatric or neurological symptoms. CONCLUSION Complete recovery after surgery in cases of anti-NMDAR encephalitis with ovarian teratoma emphasizes the need for early recognition of the entity, search for underlying tumor, and tumor removal to improve the prognosis.
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Affiliation(s)
- Jasmina Begum
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India, 751019.
| | - Zaheda Aziz
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India, 751019
| | - Subrat Kumar Sahoo
- Department of Pediatrics Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India, 751019
| | - Rishila Majumder
- Department of Pathology with Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India, 751019
| | - Mukund Namdev Sable
- Department of Pathology with Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India, 751019
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Santi AD, Emamian A, Appu M, Tcheng W, Fernandez KS. When Agitation, Hallucination, and Paranoia Mean More Than Psychosis. Pediatr Rev 2022; 43:288-290. [PMID: 35490200 DOI: 10.1542/pir.2020-004887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Krsman A, Baturan B, Vlahovic D, Grujic Z, Petrovic D, Radovanovic B. Mature ovarian teratoma-associated encephalitis. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh201203004k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Autoimmune encephalitis associated with ovarian teratoma is a
serious and potentially fatal pathology. While this clinical entity is known
to neurologists, the available literature rarely mentions the role of a
gynecologist in diagnostic imagining and treatment. Although several months
have passed from the appearance of the symptoms to surgical treatment, this
case shows that even then a complete recovery is possible. Case
presentation. The patient was a 28-year-old female, brought to the hospital
because a sudden onset of unusual behavior - an acute psychosis with
suicidal thoughts and auditory hallucinations. Soon after the admission she
became delirious, uncooperative and agitated. Blood check, neurological
assessment and cranial computed tomography yielded normal results.
Therefore, a psychiatric disorder was suspected. Electroencephalogram
revealed a diffuse encephalitic insufficiency. As cerebrospinal fluid was
negative for infections, the autoimmune etiology of the disease was
suspected. Abdominal computer tomography showed a complex right ovarian mass
measuring 50 x 40 x 30 mm, confirmed by vaginal ultrasound. Laparoscopy with
right adnexectomy was performed. The pathohistological finding showed a
mature teratoma. In the meantime, the result of the cerebrospinal fluid test
came positive for anti NMDAR antibodies. Six months after surgery, the
patient was in a good mental and neurological status without symptoms.
Conclusion. Gynecologists should be aware of the presence of ovarian tumors
in encephalitis cases. A timely diagnosis of the underlying gynecological
cause of a neurological condition, allows for prompt treatment and can
remarkably improve clinical conditions and, thus, be lifesaving.
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Schiavi MC, Manganelli F, Morgani C, Cignini P, Yacoub V, Carletti V, Grilli D, Di Pinto A, Bisogni F, Ligato A, Galanti F, Valensise HCC, Palazzetti PL. Mature Ovarian Teratoma: Neurological Implications in a Young Woman. Case Rep Obstet Gynecol 2021; 2021:3085559. [PMID: 34777887 DOI: 10.1155/2021/3085559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/18/2021] [Accepted: 10/11/2021] [Indexed: 12/05/2022] Open
Abstract
Anti-NMDAR encephalitis is an autoimmune syndrome associated with antibodies against NMDA receptors. In some cases, it is associated with various tumors; one of them is ovarian teratoma, which mostly affects women below the age of 30 years. Here, we report a case of ovarian teratoma associated with anti-NMDAR encephalitis treated with both laparoscopic surgery and immunotherapy. Multidisciplinary approach is the cornerstone for the management of this syndrome.
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Wu CY, Wu JD, Chen CC. The Association of Ovarian Teratoma and Anti-N-Methyl-D-Aspartate Receptor Encephalitis: An Updated Integrative Review. Int J Mol Sci 2021; 22:10911. [PMID: 34681570 DOI: 10.3390/ijms222010911] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/26/2021] [Accepted: 10/07/2021] [Indexed: 01/09/2023] Open
Abstract
Ovarian teratomas are by far the most common ovarian germ cell tumor. Most teratomas are benign unless a somatic transformation occurs. The designation of teratoma refers to a neoplasm that differentiates toward somatic-type cell populations. Recent research shows a striking association between ovarian teratomas and anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, a rare and understudied paraneoplastic neurological syndrome (PNS). Among teratomas, mature teratomas are thought to have a greater relevance with those neurological impairments. PNS is described as a neurologic deficit triggered by an underlying remote tumor, whereas anti-NMDAR encephalitis is characterized by a complex neuropsychiatric syndrome and the presence of autoantibodies in cerebral spinal fluid against the GluN1 subunit of the NMDAR. This review aims to summarize recent reports on the association between anti-NMDAR encephalitis and ovarian teratoma. In particular, the molecular pathway of pathogenesis and the updated mechanism and disease models would be discussed. We hope to provide an in-depth review of this issue and, therefore, to better understand its epidemiology, diagnostic approach, and treatment strategies.
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Sowińska-Przepiera E, Starzyński D, Syrenicz A, Dziuba I, Wiszniewska B, Rzeszotek S. Neuroendocrine Tumors: Clinical, Histological and Immunohistochemical Perspectives and Case Report-Mature Teratoma in a 16-Year-Old Girl. Pathophysiology 2021; 28:373-86. [PMID: 35366281 DOI: 10.3390/pathophysiology28030025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/22/2021] [Accepted: 08/25/2021] [Indexed: 11/22/2022] Open
Abstract
A mature teratoma is a germinal neoplasm that differentiates from embryonic multipotent cells into three germ layers. There may also be glandular tissue. The literature describes a total of 658 cases of ovarian neuroendocrine neoplasms, mainly in women over 40 years of age. The authors, together with a systemic review, present a case of a 16-year-old girl diagnosed with and treated for a neuroendocrine tumor. Case description: A 16-year-old girl visited the Paediatric Gynaecology Outpatient Clinic because of abdominal pains that intensified during menstruation. Standard painkillers and diastolic drugs were ineffective. An ultrasound examination revealed a large tumor with a heterogeneous structure in her right ovary. A sparing operation was carried out. During laparotomy, the lesion was enucleated, leaving healthy tissue. Histopathological examination revealed the typical features of teratoma, as well as the coexistence of a G1 neuroendocrine tumor. Immunohistochemical examination (IHC) showed the presence of markers characteristic for this type of tumor. The patient requires constant monitoring in the Endocrinology and Oncological Gynaecology Clinic. Conclusion: Tissue of neuroendocrine neoplasm within a teratoma is rare in this age group of patients; thus, there are currently no standards for long-term follow-up. This case adds to the body of evidence and demonstrates a possible good prognosis with non-aggressive behavior in G1 neuroendocrine tumors and teratomas in young patients.
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Kawaguchi M, Kato H, Noda Y, Suzui N, Miyazaki T, Furui T, Morishige KI, Matsuo M. CT and MRI characteristics of ovarian mature teratoma in patients with anti-N-methyl-D-aspartate receptor encephalitis. Diagn Interv Imaging 2021; 102:447-453. [PMID: 33785312 DOI: 10.1016/j.diii.2021.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of this study was to determine the computed tomography (CT) and magnetic resonance imaging (MRI) characteristics of ovarian mature teratoma in patients with anti-N-methyl-d-aspartate receptor encephalitis (NMDAR-E). MATERIALS AND METHODS A total of 125 women (mean age, 40.9±17.8 [SD] years; age range: 12-85 years) with 146 histopathologically or radiologically proven ovarian mature teratomas who underwent preoperative CT and MRI examinations were retrospectively included. Eight patients with 11 teratomas had NMDAR-E, whereas 117 patients with 135 teratomas did not have NMDAR-E. CT and MRI examinations were retrospectively reviewed and teratomas in patients with NMDAR-E were compared to those in patients without NMDAR-E. Comparisons were performed using Mann-Whitney U test or Fisher exact test. RESULTS In patients with NMDAR-E, maximum diameter of teratomas (26.1±9.3 [SD] mm), prevalence of teeth/calcification (36%) and rate of occupation by fat components (26%) were lower than those in patients without NMDAR-E (67.0±37.6 [SD] mm [P<0.01]; 75% [P<0.05]; and 65%[P<0.01], respectively). More than 75% of space was occupied by fat components in 76/135 teratomas (56%) in patients without NMDAR-E, whereas this was not observed in any teratoma in patients without NMDAR-E. CONCLUSION By comparison with teratomas in patients without NMDAR-E, teratomas in patients with NMDAR-E are smaller, have few teeth/calcification, and the amount of space occupied by fat components is smaller.
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Affiliation(s)
- Masaya Kawaguchi
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Hiroki Kato
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yoshifumi Noda
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Natsuko Suzui
- Department of Pathology, Gifu University, Gifu, 501-1194, Japan
| | | | - Tatsuro Furui
- Department of Obstetrics and Gynecology, Gifu University, Gifu, 501-1194, Japan
| | | | - Masayuki Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
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Wölk T, Schargus M, Seidel G. [Isolated metamorphopsia and visual pseudohallucinations in a patient with anti-NMDA receptor encephalitis]. Ophthalmologe 2021; 118:276-9. [PMID: 32430609 DOI: 10.1007/s00347-020-01120-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article reports the case of a 40-year-old male patient with isolated metamorphopsia and visual pseudohallucinations lasting for 2 weeks. As the ophthalmological findings were not pathological, a further neurological examination was performed. After diagnosis of anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, which can be manifested in various psychiatric, neurological and ophthalmological ways, the oligosymptomatic patient received high-dose corticosteroid treatment with intravenous immunoglobulins, which stopped the symptoms.
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Zhao X, Li J, Zhu Q, Liang G, Xia W, He X, Zhu C, Qi H, Deng B, Chen X, Zhang J. HLA-A and HLA-DRB1 may play a unique role in ovarian teratoma-associated anti-N-methyl-D-aspartate receptor encephalitis. Reprod Biol Endocrinol 2020; 18:107. [PMID: 33160385 PMCID: PMC7648266 DOI: 10.1186/s12958-020-00661-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ovarian teratoma-associated anti-N-methyl-D-aspartate receptor encephalitis (NMDAR-E) is a severe autoimmune neurological disorder, and the influence of teratoma-induced autoantibodies on the pathogenesis remains unclear. METHODS Ovarian teratoma tissues were collected from teratoma patients with and without NMDAR-E. Proteins were extracted and then analyzed using iTRAQ-coupled LC-MS/MS, which was followed by bioinformatics analysis. Candidate proteins were verified by Western blotting and immunohistochemistry. RESULTS In total, 36 differentially expressed proteins (DEPs) were identified between the control group and NMDAR-E group, and the bioinformatics analysis revealed that the DEPs were mainly involved in immune-related pathways, especially HLA-A and HLA-DRB1. The western blotting results for HLA-A and HLA-DRB1 were consistent with the results of the iTRAQ analysis. Additionally, the immunohistochemical data revealed that the aggregation of HLA-A (+) and HLA-DRB1 (+) cells was more apparent in the teratoma tissues of NMDAR-E patients compared with that in the tissues of controls. CONCLUSION Our investigation indicated that HLA-A and HLA-DRB1 might be involved in mediating ovarian teratoma-associated NMDAR-E. These findings provide new insights into the pathophysiological mechanisms and provide information for the functional exploration of proteins in the future.
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Affiliation(s)
- Xiaoya Zhao
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, No. 910, Hengshan Rd, Shanghai, 200030, China
| | - Juan Li
- Department of Pathology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200030, China
| | - Qian Zhu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, No. 910, Hengshan Rd, Shanghai, 200030, China
| | - Guiling Liang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, No. 910, Hengshan Rd, Shanghai, 200030, China
| | - Wei Xia
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, No. 910, Hengshan Rd, Shanghai, 200030, China
| | - Xiaoqing He
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, No. 910, Hengshan Rd, Shanghai, 200030, China
| | - Chenfeng Zhu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, No. 910, Hengshan Rd, Shanghai, 200030, China
| | - Hang Qi
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, No. 910, Hengshan Rd, Shanghai, 200030, China
| | - Bo Deng
- Department of Neurology, Huashan Hospital and Institute of Neurology, Fudan University, No. 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Xiangjun Chen
- Department of Neurology, Huashan Hospital and Institute of Neurology, Fudan University, No. 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
| | - Jian Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, No. 910, Hengshan Rd, Shanghai, 200030, China.
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Pekar-Zlotin M, Rabinovich I, Goldrat I, Vaknin Z, Gidoni Y, Zur-Naaman H, Maymon R, Smorgick N. Ovarian Dermoid Cysts Associated with Paraneoplastic Syndrome N-methyl-D-aspartic Acid Receptor Antibodies Encephalitis. J Minim Invasive Gynecol 2020; 28:1190-1193. [PMID: 32979534 DOI: 10.1016/j.jmig.2020.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/05/2020] [Accepted: 09/19/2020] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To describe the incidence of ovarian dermoid cysts associated with paraneoplastic encephalitis syndrome due to N-methyl-D-aspartic acid (NMDA) receptor antibodies among women undergoing surgical resection of dermoid cysts. DESIGN Retrospective cohort study. SETTING University-affiliated department of obstetrics and gynecology. PATIENTS All patients with pathology-proven ovarian dermoid cysts who underwent surgical resection in our department between January 2008 and December 2019. Their demographic, clinical, and surgical characteristics are described, with emphasis on cases diagnosed with anti-NMDA receptor encephalitis. INTERVENTIONS Ovarian dermoid cyst resection by cystectomy or salpingo-oophorectomy. MEASUREMENTS AND MAIN RESULTS A total of 233 patients were operated on for ovarian dermoid cysts, comprising 2 cases diagnosed with anti-NMDA receptor encephalitis (0.85%). Among the women without NMDA receptor encephalitis, the mean age was 33.3 ± 14.9 years, 84.0% were of reproductive age, 5.2% were premenarchal, and 10.8% were menopausal. The mean diameter of the dermoid cyst in this group was 77.3 ± 33.3-mm. The 2 patients diagnosed with anti-NMDA receptor encephalitis were 21 years old and 42 years old. The diameters of their dermoid cysts were 15-mm and 80-mm, respectively. The patients with anti-NMDA receptor encephalitis were managed with laparoscopic resection, plasmapheresis, intravenous immunoglobulins, and corticosteroids; 1 patient also received immunosuppressive treatment. Both recovered without significant neurologic sequela. CONCLUSION Paraneoplastic syndrome due to NMDA receptor antibodies is a rare complication of dermoid cysts. This complication may occur in younger or older women, as well as in small- or large-diameter cysts. Thus, a high index of suspicion is required to correctly diagnose and treat women presenting with neurologic symptoms in the presence of dermoid cysts.
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Affiliation(s)
- Marina Pekar-Zlotin
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofe Medical Center), Zerifin, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors)
| | - Irina Rabinovich
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofe Medical Center), Zerifin, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors)
| | - Itai Goldrat
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofe Medical Center), Zerifin, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors)
| | - Zvi Vaknin
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofe Medical Center), Zerifin, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors)
| | - Yariv Gidoni
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofe Medical Center), Zerifin, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors)
| | - Hilli Zur-Naaman
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofe Medical Center), Zerifin, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors)
| | - Ron Maymon
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofe Medical Center), Zerifin, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors)
| | - Noam Smorgick
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofe Medical Center), Zerifin, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (all authors)..
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Abstract
Anti-N-methyl-d-aspartate (Anti-NMDA) receptor encephalitis is an acute autoimmune disorder. The symptoms range from psychiatric symptoms, movement disorders, cognitive impairment, and autonomic dysfunction. Previous studies revealed that vaccination might induce this disease. A few cases were reported to be related to H1N1 vaccine, tetanus/diphtheria/pertussis and polio vaccine, and Japanese encephalitis vaccine. Although vaccination is a useful strategy to prevent infectious diseases, in a low risk, it may trigger serious neurological symptoms. In addition to anti-NMDA receptor encephalitis, other neurological diseases were reported to be associated with a number of vaccines. In this paper, the anti-NMDA receptor encephalitis cases related to a number of vaccines and other neurological symptoms that might be induced by these vaccines were reviewed. In addition, anti-NMDA receptor encephalitis cases that were induced by virus infection were also reviewed.
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Affiliation(s)
- Hsiuying Wang
- Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan
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Chernyshkova I, Estefan B, Hoque MR, Lee A. Neurologic Presentation of Probable Seronegative Paraneoplastic Encephalitis in a Woman With an Ovarian Teratoma. Cureus 2020; 12:e8485. [PMID: 32656003 PMCID: PMC7341459 DOI: 10.7759/cureus.8485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/06/2020] [Indexed: 12/24/2022] Open
Abstract
We describe a case of probable autoimmune encephalitis developed as a result of paraneoplastic syndrome in a woman with an ovarian teratoma. Patients may present with psychiatric and neurological symptoms, which are caused by anti-N-methyl-D-aspartate (anti-NMDA) receptor antibodies produced in response to a teratoma that crosses the blood-brain barrier and damages brain tissue in the limbic area, causing encephalitis. Our patient presented with seizures, myoclonus, and memory problems. This is a relatively newly discovered and rare problem; however, it can be quite debilitating if left untreated. This diagnosis may be often missed due to the absence of highly sensitive tests. Autoimmune encephalitis has to be on the list of differential diagnoses for patients with new-onset psychiatric or neurological symptoms.
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Affiliation(s)
| | - Bebsy Estefan
- Psychiatry, St. Barnabas Medical Center, Bronx, USA
- Psychiatry, NewYork-Presbyterian/Weill Cornell Medical Center, Manhattan, USA
| | - Md Rezaul Hoque
- Internal Medicine, St. Barnabas Hospital Health System / Albert Einstein College of Medicine, Bronx, USA
| | - Alice Lee
- Internal Medicine, City University of New York School of Medicine, Bronx, USA
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15
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Tay MJ, Chua KG. A combined behavioral and pharmacological approach in nonparaneoplastic-related anti-N-methyl-D-aspartate receptor encephalitis: A case report with positive outcome in a male patient. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2020. [DOI: 10.4103/jisprm.jisprm_3_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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