A case report of breast cancer and membranous nephropathy with positive anti phospholipase A2 receptor antibodies

Abstract

Background Testing for antibodies against podocyte phospholipase A2 receptor-1 (PLA2R) allows clinicians to accurately identify primary membranous nephropathy (MN). Secondary MN is associated with a spectrum of pathology including solid organ malignancy. PLA2R positivity in these patients occurs, although no case of PLA2R-positive MN has been definitively linked to cancer. Case presentation We describe a case of biopsy-proven PLA2R-positive MN, in whom invasive ductal carcinoma of the breast was discovered. The patient underwent surgery and adjuvant chemotherapy (including cyclophosphamide) and went into a sustained complete remission of her nephrotic syndrome. Discussion and conclusions Case series have reported PLA2R positivity in patients with solid organ malignancy associated MN. Our case is unusual as it is a breast malignancy, and the patients nephrotic syndrome and anti-PLA2Rab titres improved with treatment of the cancer. Here we report, to the best of our knowledge, the first case of oestrogen receptor-2 positive breast cancer associated with PLA2R positive MN in a young lady that was treated successfully by treating the malignancy.

The value of PLA2R antigen and IgG subclass staining relative to anti-PLA2R seropositivity in the differential diagnosis of membranous nephropathy

“…However, the tumor antigen frequently remains undetected during the management of the patients. Although malignancy-associated MN is usually seronegative for anti-PLA2R antibodies [ 9 , 14 ], there are occasionally cases which display a high titer of anti-PLA2R antibodies [ 37 , 38 ]. Therefore, some authors think that the subtype analysis of glomerular IgG, along with the summarized biopsy features of malignancy-associated MN is not sufficient to provide a definite diagnosis of pMN or sMN [ 11 , 39 ].…”