Paraneoplastic neurological syndrome in a patient with gastric cancer

Abstract

myasthenic syndrome, which affects approximately 3% of patients with small-cell lung cancer, and myasthenia gravis, which affects 15% of patients with thymoma. For other solid tumors, the incidence of PNS is much less than 1% [2]. Here, we report a rare case of a patient with gastric cancer presenting with primary clinical fi ndings of PNS. Case reportThe patient was a 63-year-old woman with wellcontrolled diabetes and hypertension who presented with sensory disturbance and a feeling of "pins and needles" in her lower distal extremities in May 2007. She was treated with oral medicine and a nerve block injection at a neighborhood clinic, but her condition did not improve. Her neurological disorder became more severe, such that she was unable to walk, and the symptoms spread to the upper extremities. Therefore, she was admitted to our hospital for examination and treatment in September 2007.A neurological examination showed asymmetrical apallesthesia in the lower legs. Severe pain, warmth, and tactile sensations were present below the knees, and her Rankin score was 4 on admission. Sensory nerve conduction study (SCS) showed absent sensory potentials in the bilateral sural nerves and right ulnar nerve when a motor nerve conduction study (MCS) was within normal limits in the bilateral median, ulnar, and tibial nerves (Fig. 1).Laboratory tests showed normal levels of vitamins B1, B2, B6, B12, and E, and folic acid, and no disturbance of electrolyte balance. An elevated titer of antinuclear antibody, of 640 units, was present, but elevated titers of antibodies specifi c for connective tissue disease were not detected. Lumbar puncture showed negative cytology and no infl ammatory changes (such as pleocytosis, intrathecal synthesis of IgG, and oligocloAbstract Paraneoplastic neurological syndromes (PNSs) are a heterogeneous group of neurological disorders caused by immunemediated mechanisms. The incidence of PNS is much less than 1% for solid tumors, except for small-cell lung cancer and thymoma. We report a rare case of gastric cancer that presented with primary clinical fi ndings of PNS. The patient was a 63-year-old woman who was admitted for worsening neuropathy. Laboratory and neurological tests excluded a nutritional defi cit, diabetes mellitus, and connective tissue disease as causes of her neuropathy. Computed tomography (CT) of the abdomen, positron emission tomography (PET)-CT, and endoscopy of the stomach revealed gastric cancer with lymph node swelling. Distal gastrectomy was performed and pathological and immunohistochemical examinations indicated endocrine cell carcinoma. The gastrectomy stopped the exacerbation of her symptoms and recurrence was not observed, but the neurological disorders were irreversible. This case suggests that early diagnosis of the primary tumor is required to improve the outcome in patients with PNS.

Paraneoplastic Limbic Encephalitis in a Human Epidermal Growth Factor Receptor-2-positive Gastric Cancer Patient Treated with Trastuzumab-combined Chemotherapy: A Case Report and Literature Review

“…The management of PNS symptoms has been challenging, as various immunosuppressive treatments have proved to be ineffective for syndromes with onconeural antibodies. Previous studies suggest that surgical tumor removal could stabilize and even improve the clinical picture of these patients (7,8). In the present case, the response to trastuzumab-combined chemotherapy was clinically stable disease, including stable neurological symptoms, and the SUVmax of the mesial temporal regions was 5.8 by PET/ CT; however, chemotherapy eventually failed, and the patient's symptoms deteriorated, with the SUVmax of the mesial temporal regions rising to 10.8.…”

CV2/CRMP5-antibody-related Paraneoplastic Neurologic Syndrome Associated with Gastrointestinal Stromal Tumor

“…As in this patient, early detection is important for satisfactory neurological and oncological outcomes. Should the diagnosis come late, after the symptomatology has been established, the neuropathy may be unresponsive to treatment, and irreversible neurological damage can occur ( 1 , 11 - 14 ).…”

“…PNS of unknown cause is often observed in association with a malignant tumor. There have been reports of PNS in association with gastric cancer ( 1 , 2 ), but its association with a gastrointestinal stromal tumor (GIST) is extremely rare.…”

Gastric Cancer Case with Skin Metastases and Scleroderma-like Paraneoplastic Rheumatic Syndrome

“…It is estimated that paraneoplastic syndromes affect up to 8% of patients with cancer [9], [10]. The incidence of paraneoplastic syndrome is much less than 1% for solid tumors, except for small-cell lung cancer and thymoma [11]. The paraneoplastic syndromes are classified into endocrine, neurologic, dermatologic, rheumatologic, and hematologic syndromes [12].…”