Paraneoplastic Neurological Syndromes and the Role of PET Imaging

Sioka, Chrissa; Fotopoulos, Andreas; Kyritsis, Athanassios P.

doi:10.1159/000312657

Cited by 21 publications

(11 citation statements)

References 111 publications

(57 reference statements)

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“…Several studies [10][11][12] showed evidence of higher specificity and sensitivity of 18 FDG PET imaging than other conventional diagnostic tests and imaging in the diagnosis of cancer associated with PNS, but in our patient the presence of a breast carcinoma was suspected on the basis of mammography, US, CT scan and MRI while PET findings were non specific.…”

Section: Dear Sirscontrasting

confidence: 58%

Brainstem and spinal cord involvement in a paraneoplastic syndrome associated with anti-Yo antibody and breast cancer

Plantone¹,

Caliandro

Iorio³

et al. 2010

J Neurol

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Paraneoplastic neurological syndromes (PNS) are associated with breast cancer in\1% of cases [1]. Anti-Yo/PCA-1 antibody is usually detected in female patients with breast or gynaecologic cancer and is most commonly associated with progressive cerebellar degeneration (PCD) [2][3][4][5].Here we describe a case of a 60-year-old woman who, in May 2008, complained of progressive weakness of lower limbs followed, after 2 months, by dysesthesias in the four limbs, dysphagia, diplopia and sensory ataxia. Total body computed tomography (CT) scan, brain and spinal cord magnetic resonance imaging (MRI) were normal, electromyography (EMG) showed evidence of acute and chronic denervation in the four limb muscles, oligoclonal bands were present in the cerebrospinal fluid and serum anti-onconeural antibodies were negative. She was treated with steroids for several months with partial benefit but soon after drug discontinuation her symptoms worsened. At our first neurological examination in January 2010, the patient was unable to walk for severe sensory ataxia and showed lower limb weakness and spasticity, mild dysarthria, dysphagia, diplopia and dysesthesias in the four limbs. Sensory and motor evoked potentials were altered both at upper and lower limbs and EMG showed evidence of acute and chronic denervation in the muscles of upper and lower extremities. At that time, serum anti-Yo/PCA-1 antibody was positive. Total body CT scan and mammography showed evidence of a nodular opacity associated with two clusters of retroareolar microcalcifications in the left breast. A total body 2-deoxy-2-18 F-fluoro-D-glucose positron emission tomography ( 18 FDG PET)/CT imaging showed high metabolic activity in the right axillary lymph nodes but ultrasound scan (US) and MRI confirmed the left breast calcifications with no evidence of axillary lymph node pathological alterations bilaterally. The left mammary lesion was surgically removed in March 2010. Histopathological examination revealed the presence of foci of ductal carcinoma in situ of G2 grade. Radiotherapy and hormonal therapy were started in April 2010. Soon after the surgery, the neurological symptoms progressively improved. At the last neurological examination in July 2010, the ataxia was reduced and the patient was ambulatory without aid or rest for about 10 m, with only a mild proximal weakness of the legs and diplopia persisting. The EMG evaluation showed improvement mainly at the lower limbs with reduction of acute denervation signs.Despite the fact that, in our patient, the clinical picture was not evocative of a classical PNS, we suspected a paraneoplastic encephalomyelitis; we repeated tests for anti-onconeural antibodies and diagnostic investigations for cancer, and we found serum positivity for anti-Yo/ PCA-1 antibody associated with a ductal breast carcinoma in situ.Very few cases of anti-Yo/PCA-1 antibody associated PNS, different from PCD, have already been described including several cases of peripheral neuropathy [6, 7] and a case of motor neuron disease involving bot...

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Section: Dear Sirscontrasting

confidence: 58%

Brainstem and spinal cord involvement in a paraneoplastic syndrome associated with anti-Yo antibody and breast cancer

Plantone¹,

Caliandro

Iorio³

et al. 2010

J Neurol

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“…Gultekin et al reported that 28 (64%) of 44 PLE patients had abnormal MRI findings, such as unilateral or bilateral temporal lobe abnormalities on T2-weighted images, and 5 (20%) of 25 patients had enhanced lesions (12). In addition, in most cases of PLE, 18 F-FDG PET usually shows hypermetabolism in the temporal lobes with negative findings on MRI or the presence of T2-hyperintense mesiotemporal lesions, and the 18 F-FDG PET may be correlated with disease activity (13).…”

Section: Discussionmentioning

confidence: 99%

Paraneoplastic Neurological Syndrome in a Patient with Squamous Cell Lung Cancer

Mori¹,

Yamada²,

Ohno

et al. 2013

Intern. Med.

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A 78-year-old man presented with urinary retention and difficulty walking. Both legs showed muscle weakness, and he was experiencing lower body hypoesthesia. T2-weighted magnetic resonance imaging revealed lesions with high signal intensity and enhancement in the spinal cord and cerebrum. A cerebrospinal fluid specimen showed inflammatory changes, but negative cytology findings. Chest computed tomography revealed a tumor measuring 40 mm in diameter, and a lung biopsy revealed the presence of squamous cell carcinoma. We diagnosed the patient with paraneoplastic neurological syndrome related to lung cancer. The patient was treated with steroid pulse therapy and chemotherapy, which relieved the symptoms and enabled the patient to achieve an independent gait.

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“…The PNS are rare complications of cancer (\1 %), but they are associated with a high morbi-mortality, very often responding only to the treatment of the underlying tumor [16]. Up to 60 % of patients with PNS have highly specific onconeural antibodies and certain presentations are most frequently linked to malignancy (the so-called classical syndromes) [14].…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, previous studies have reported on the usefulness of 18 F-FDG-PET in PNS, but its accuracy seems to be related to the pre-test probability [9][10][11][12][13][14][15][16][17][18][19][20]. Nevertheless, only Vaidyanathan et al [21] evaluated PET/CT in terms of pre-test clinical probability and its relation to the final detection of malignancy.…”

Section: Introductionmentioning

confidence: 99%

Utility of 18F-FDG-PET/CT in patients suspected of paraneoplastic neurological syndrome: importance of risk classification

et al. 2016

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Paraneoplastic Neurological Syndromes and the Role of PET Imaging

Cited by 21 publications

References 111 publications

Brainstem and spinal cord involvement in a paraneoplastic syndrome associated with anti-Yo antibody and breast cancer

Brainstem and spinal cord involvement in a paraneoplastic syndrome associated with anti-Yo antibody and breast cancer

Paraneoplastic Neurological Syndrome in a Patient with Squamous Cell Lung Cancer

Utility of 18F-FDG-PET/CT in patients suspected of paraneoplastic neurological syndrome: importance of risk classification

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