Anti-N-methyl-D-aspartate Receptor Encephalitis as a Paraneoplastic Presentation of Mature Ovarian Teratoma

Koenig, Zachary A; Yednock, Joel

doi:10.12659/ajcr.933240

Cited by 2 publications

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“…In women, anti-NMDAR encephalitis is more prevalent. Several studies have demonstrated that anti-NMDAR encephalitis is associated with tumours, mainly teratomas and viruses 9. The absence of common viral infections in the patient’s diagnostic workup and the notable elevation of tumour-associated AFP levels prior to surgical intervention provide strong support for the teratoma as the etiological basis for the anti-NMDAR encephalitis in this case.…”

Section: Discussionmentioning

confidence: 52%

“…Animal experiments have demonstrated that ovarian teratoma may trigger the production of anti-NMDAR antibodies in the body 13. These antibodies are capable of crossing the blood–brain barrier and causing neurological symptoms in humans 9. Therefore, it is crucial to consider the possibility of AE in cases where the patient in this study is diagnosed with IT of the ovary and presents with personality changes.…”

Section: Discussionmentioning

confidence: 97%

“…However, in the case presented here, the patient had IT, which carries a higher risk of metastasis (lymph nodes, liver and other organs) and recurrence, particularly in grade 3 tumours. Thus, surgical resection followed by chemotherapy was recommended to minimise these risks 9 14. AE that causes SE has a poor prognosis, and it can cause irreversible brain damage in children.…”

Section: Discussionmentioning

confidence: 99%

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Patient with concurrent anti-NMDAR autoimmune encephalitis and immature teratoma of the ovary

Kai-Jing,

Xiao-juan,

Xiao-Hui

2023

BMJ Case Rep

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In young women with anti-N-methyl-D-aspartate receptor (anti-NMDAR) autoimmune encephalitis (AE), co-occurrence with ovarian teratoma is common. While the management of mature teratoma with AE is well documented, literature on managing immature teratoma (IT) in tandem with AE is relatively scarce. Here, we report a case of a female patient in her early adolescence who presented with abdominal pain and was diagnosed with grade 3 IT combined with anti-NMDAR AE after an ovarian tumour was discovered and resected. Postsurgery, the patient received immunotherapy, chemotherapy and antiepileptic therapy, and two follow-up evaluations showed no signs of recurrence or sequelae. This case highlights the importance of a high index of suspicion for concurrent AE in the presence of ovarian teratoma, particularly IT, and the crucial role of concurrent administration of immunotherapy and chemotherapy following tumour resection in impacting prognosis.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Patient with concurrent anti-NMDAR autoimmune encephalitis and immature teratoma of the ovary

Kai-Jing,

Xiao-juan,

Xiao-Hui

2023

BMJ Case Rep

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Patterns of Neuropsychiatric Manifestations of Ovarian Teratomas: A Systematic Review of Case Reports

Umutoni Mihigo,

Uljic,

Kaushal

et al. 2024

Cureus

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Ovarian teratomas are germ cell tumors composed of multiple cell types. Ovarian teratomas may express antigens found in the nervous system or neuroendocrine proteins. These neural antigens and neuroendocrine proteins may lead to an autoimmune response with associated encephalitis. There are a growing number of case reports of autoimmune encephalitis in patients with ovarian teratomas. However, the patterns of neuropsychiatric manifestations of ovarian teratomas associated with encephalitis have not been established. The aim of this article is to conduct a systematic review to determine the patterns of neuropsychiatric manifestations of ovarian teratoma-associated encephalitis, focusing on their frequency and clinical course. Thirty-three case reports were collected and analyzed for a systematic review. The studies were full-text, peer-reviewed journal publications from April 2014 to April 2024. Fifty-eight patients were included in our study. The age group of 22-35 years old was the most reported, with 25 (43.1%) patients. The most commonly reported symptoms were memory impairment in 29 (50%) patients, hallucinations in 25 (43.1%) patients, and aggressive behavior in 23 (39.7%) patients. Neuropsychiatric symptoms had a prodromal phase of flu-like symptoms in 31 (53.4%) patients. The neuropsychiatric symptoms preceded the diagnosis of ovarian teratoma in 57 (98.3%) patients. In 53 (91.4%) patients, patients did not respond to psychiatric medications. Autoimmune antibodies to neural antigens were found in 45 (77.6%) patients, with 25 (43.1%) patients having neural tissue present in the teratoma. Treatment of the underlying teratoma and encephalitis led to full recovery in 37 (63.8%) patients. However, long-term outcomes such as relapse and mortality were discussed in only 11 (19.0%) patients. Findings suggest that neuropsychiatric symptoms correlate with teratoma-associated encephalitis and often precede tumor detection. The treatment of the teratoma led to full recovery of the neuropsychiatric manifestations; however, the long-term outcomes of the patients need to be further studied. Future research is needed on the prognosis of patients with neuropsychiatric manifestations of ovarian teratoma.

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Anti-N-methyl-D-aspartate Receptor Encephalitis as a Paraneoplastic Presentation of Mature Ovarian Teratoma

Cited by 2 publications

References 0 publications

Patient with concurrent anti-NMDAR autoimmune encephalitis and immature teratoma of the ovary

Patient with concurrent anti-NMDAR autoimmune encephalitis and immature teratoma of the ovary

Patterns of Neuropsychiatric Manifestations of Ovarian Teratomas: A Systematic Review of Case Reports

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