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Giucca A, Morrison H, Wilson T, Cossburn M. Anti-Yo paraneoplastic cerebellar degeneration in a patient with stage IV ovarian adenocarcinoma during bevacizumab maintenance therapy. BMJ Case Rep 2023; 16:e251277. [PMID: 37137547 PMCID: PMC10163414 DOI: 10.1136/bcr-2022-251277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Anti-Yo paraneoplastic cerebellar degeneration (PCD) is a rare autoimmune neurological syndrome characterised by cerebellar symptoms and frequently associated with gynaecological malignancies. While typically preceding the diagnosis of the malignancy, rarely it may present later in the disease course, heralding a recurrence prior to biochemical or radiological confirmation. Disease management is challenging and prognosis remains poor.We present the case of a woman with stage IV ovarian adenocarcinoma who developed anti-Yo PCD 16 months post malignancy diagnosis while receiving bevacizumab maintenance therapy. We review the literature and outline the difficulties in diagnosis and the frequently refractory nature of PCD to available treatments.
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Affiliation(s)
- Alice Giucca
- Department of Oncology, Bristol Haematology and Oncology Centre, Bristol, UK
| | - Hamish Morrison
- Department of Neurology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Thomas Wilson
- Department of Oncology, Bristol Haematology and Oncology Centre, Bristol, UK
| | - Mark Cossburn
- Department of Neurology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
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2
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Benabdellah N, Izzedine H, Bentata Y, Haddiya I. Ovarian tumor and glomerulopathies: case report and review of the literature. Pan Afr Med J 2019; 34:75. [PMID: 31819791 PMCID: PMC6884736 DOI: 10.11604/pamj.2019.34.75.6008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 07/15/2019] [Indexed: 11/11/2022] Open
Abstract
We describe a patient who developed nephrotic syndrome in the setting of ovarian tumor. A kidney biopsy showed minimal change nephropathy (MCN). CT scan and MR imaging followed by surgery lead to diagnostic of ovarian dermoid cyst. Surgery combined with corticosteroids resulted in a complete remission of nephrotic syndrome with disappearance of proteinuria after 3 weeks. Ten other cases of ovarian tumor associated with glomerulopathy are reviewed. This is the second case of an ovarian teratoma associated with MCN. Accurate history, physical examination, laboratory data, and kidney biopsy are highlighted in establishing the correct diagnosis in such patients.
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Affiliation(s)
- Nawal Benabdellah
- Department of Nephrology, University Hospital Mohamed VI, Oujda, Morocco
| | - Hassan Izzedine
- Department of Nephrology, Pitie-Salpetiere Hospital, 43 Boulevard de l'Hôpital, 75013 Paris, France
| | - Yassamine Bentata
- Department of Nephrology, University Hospital Mohamed VI, Oujda, Morocco
| | - Intissar Haddiya
- Department of Nephrology, University Hospital Mohamed VI, Oujda, Morocco
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3
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Paraneoplastic Cytopenia in Ovarian Germ Cell Tumor: A Novel Presentation. J Pediatr Hematol Oncol 2018; 40:e432-e434. [PMID: 29240033 DOI: 10.1097/mph.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report on the case of a 12-year-old girl, who presented with an ovarian germ cell tumor and cytopenia (anemia and thrombocytopenia) as an associated paraneoplastic syndrome, which gradually regressed after the tumor's removal. This report adds to the previously described paraneoplastic syndromes potentially associated with ovarian germ cell tumor.
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Chatterjee M, Hurley LC, Tainsky MA. Paraneoplastic antigens as biomarkers for early diagnosis of ovarian cancer. Gynecol Oncol Rep 2017; 21:37-44. [PMID: 28653032 PMCID: PMC5476453 DOI: 10.1016/j.gore.2017.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/30/2017] [Accepted: 06/05/2017] [Indexed: 12/24/2022] Open
Abstract
Paraneoplastic syndromes are a group of rare disorders that can be triggered by an abnormal immune response to proteins from tumors of the lung, ovary, lymphatics, or breast. Paraneoplastic clinical syndromes affect < 1% of patients with cancer; however, the frequency of subclinical levels of paraneoplastic autoantibodies in asymptomatic patients with cancer is unknown. Numerous studies have reported that ovarian cancer patients show signs of paraneoplastic neurological syndromes (PNSs) before or after their cancers are diagnosed. PNSs arise from a tumor-elicited immune response against onconeural antigens that are shared by tissues of nervous system, muscle, and tumor cells. Studies on the serum IgGs obtained from ovarian cancer patients have indicated the presence of onconeural antibodies in the absence of any PNS symptoms. The occurrence of PNSs is low in ovarian cancer patients and it can be accompanied by onconeural antibodies. The diagnosis of PNSs is accompanied by a suspicion of a malignant tumor such that neurologists typically refer such patients for a tumor diagnostic workup. There will be tremendous utility if subclinical levels (without paraneoplastic neurological symptoms or myositis) of these autoantibodies to paraneoplastic antigens can be exploited to screen asymptomatic high-risk patients for ovarian cancer, and used as biomarkers in immunoassays for the early detection or recurrence of ovarian cancer. Ovarian cancer overall survival is likely to be improved with early detection. Therefore, a panel of onconeural antigens that can detect paraneoplastic autoantibodies in patient sera should provide diagnostic utility for an earlier therapeutic intervention. Here we review the usefulness of PNS and other paraneoplastic syndromes and their association with paraneoplastic antigens to exploit these autoantibody biomarkers to form diagnostic multi-analyte panels for early detection of ovarian cancer.
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Affiliation(s)
- Madhumita Chatterjee
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, United States
| | - Laura C Hurley
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, United States.,Cancer Biology Graduate Program, Wayne State University School of Medicine, Detroit, MI 48201, United States
| | - Michael A Tainsky
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, United States.,Cancer Biology Graduate Program, Wayne State University School of Medicine, Detroit, MI 48201, United States.,Molecular Therapeutics Program, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, United States.,Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI 48201, United States
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Christiansen CF, Onega T, Sværke C, Körmendiné Farkas D, Jespersen B, Baron JA, Sørensen HT. Risk and prognosis of cancer in patients with nephrotic syndrome. Am J Med 2014; 127:871-7.e1. [PMID: 24838191 DOI: 10.1016/j.amjmed.2014.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/13/2013] [Accepted: 05/01/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nephrotic syndrome may be a marker of occult cancer, but population-based studies of this association are lacking. Therefore, we examined the risk and prognosis of cancer in patients with nephrotic syndrome. METHODS We conducted this population-based cohort study in Denmark, including all individuals diagnosed with nephrotic syndrome between 1980 and 2010 without a preceding cancer history. We computed the 5-year risk of cancer accounting for competing risk by death and standardized incidence ratios (SIRs) of cancer in patients with nephrotic syndrome relative to the general population. We compared the 5-year mortality for patients with cancer after nephrotic syndrome with that for a cancer cohort without a history of nephrotic syndrome using Cox regression adjusted for age, gender, and comorbidity. RESULTS Of 4293 individuals with nephrotic syndrome, 338 developed an incident cancer during a median follow-up of 5.7 years. The 5-year risk of any cancer was 4.7% in patients with nephrotic syndrome, a 73% increased risk (SIR, 1.73; 95% confidence interval [CI], 1.55-1.92). The association was most pronounced for lung cancer, kidney cancer, lymphoma, and multiple myeloma. It was highest within 1 year of nephrotic syndrome diagnosis (SIR, 4.49; 95% CI, 3.68-5.42), but remained increased beyond 1 year (SIR, 1.34; 95% CI, 1.17-1.53). The 5-year mortality after cancer was 68.5% in patients with cancer with nephrotic syndrome and 63.4% in the cancer comparison cohort (adjusted hazard ratio, 1.20; 95% CI, 1.02-1.42). CONCLUSIONS Nephrotic syndrome is a marker of occult solid tumors and hematologic malignancies and is associated with a worsened cancer prognosis.
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Affiliation(s)
| | - Tracy Onega
- Departments of Medicine and Community and Family Medicine and the Norris Cotton Cancer Center, Dartmouth Medical School, Hanover, NH
| | - Claus Sværke
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bente Jespersen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - John A Baron
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Medicine, University of North Carolina, Chapel Hill
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Paraneoplastic neurological syndromes associated with ovarian tumors. J Cancer Res Clin Oncol 2014; 141:99-108. [PMID: 24965744 PMCID: PMC4282879 DOI: 10.1007/s00432-014-1745-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/10/2014] [Indexed: 01/10/2023]
Abstract
Introduction Paraneoplastic neurological syndromes (PNS) are neurologic deficits triggered by an underlying remote tumor. PNS can antedate clinical manifestation of ovarian malignancy and enable its diagnosis at an early stage. Interestingly, neoplasms associated with PNS are less advanced and metastasize less commonly than those without PNS. This suggests that PNS may be associated with a naturally occurring antitumor response. Methods We review the literature on the diagnosis, pathogenesis and management of PNS associated with ovarian tumors: paraneoplastic cerebellar degeneration (PCD) and anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis. An approach to the diagnostic workup of underlying tumors is discussed. Results PCD can precede the manifestation of ovarian carcinoma. Anti-NMDAR encephalitis in young women appears often as a result of ovarian teratoma. Since ovarian tumors and nervous tissue share common antigens (e.g., cdr2, NMDAR), autoimmune etiology is a probable mechanism of these neurologic disorders. The concept of cross-presentation, however, seems insufficient to explain entirely the emergence of PNS. Early resection of ovarian tumors is a significant part of PNS management and improves the outcome. Conclusions The diagnosis of PNS potentially associated with ovarian tumor indicates a need for a thorough diagnostic procedure in search of the neoplasm. In some patients, explorative laparoscopy/laparotomy can be considered.
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Ata A, Gürses I, Kıykım A, Arıcan A. Nephrotic syndrome associated with gemcitabine use in a patient with ovarian cancer. AMERICAN JOURNAL OF CASE REPORTS 2012; 13:268-70. [PMID: 23569546 PMCID: PMC3614261 DOI: 10.12659/ajcr.883583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 07/20/2012] [Indexed: 11/28/2022]
Abstract
Background: Here we present a patient who developed nephrotic syndrome associated with gemcitabine use. Case Report: Gemcitabine therapy was initiated following tumor recurrence in a patient with ovarian cancer, who was previously treated twice with carboplatin and paclitaxel. Radiological findings waned and tumor marker concentrations decreased after gemcitabine treatment. However, edema and ascites development was observed on the fifth treatment cycle. Laboratory results revealed increased blood urea nitrogen and creatinine levels, decreased serum albumin concentrations, and increased 24-hour urinary protein excretion. Renal biopsy findings were compatible with membranous glomerulonephritis. Gemcitabine administration was stopped and the cyclophosphamide and steroid therapy were initiated. The symptoms and findings disappeared after the cessation of gemcitabine and immunosuppressive treatment. Conclusions: Gemcitabine treatment may be associated with proteinuria to the extent of nephrotic syndrome.
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Affiliation(s)
- Alper Ata
- Mersin State Hospital Clinic Of Medical Oncology, Mersin, Turkey
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González-Fontal GR, Restrepo JG, Henao-Martínez AF. Minimal-change disease as a paraneoplastic syndrome in a patient with ovarian carcinoma. Clin Kidney J 2011; 4:427-9. [PMID: 25984215 PMCID: PMC4421649 DOI: 10.1093/ndtplus/sfr106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 07/28/2011] [Indexed: 11/14/2022] Open
Abstract
Minimal-change disease (MCD) is an exceptional paraneoplastic presentation. We are describing the case of an ovarian paraneoplastic nephrotic syndrome. The kidney biopsy was consistent with MCD. Steroids and immunosuppressive therapy were given with no change in the nephrotic-range proteinuria. A complete resolution of the nephrotic syndrome was soon observed with improvement of her clinical condition after five cycles of chemotherapy with paclitaxel and carboplatin and tumor-debulking surgery. Ovarian carcinoma paraneoplastic nephrotic syndrome secondary to MCD is an extremely rare event, which is important to recognize since it is responsive to the standard chemotherapy.
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Affiliation(s)
| | - Juan G Restrepo
- Division of Hematology/oncology, Department of Medicine, CES University-Fundacion Valle del Lili, Cali, Colombia
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Bradley WH, Dottino PR, Rahaman J. Paraneoplastic cerebellar degeneration in ovarian carcinoma: case report with review of immune modulation. Int J Gynecol Cancer 2008; 18:1364-7. [PMID: 18217973 DOI: 10.1111/j.1525-1438.2007.01173.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Paraneoplastic cerebellar degeneration (PCD) is a rare nonmetastatic complication of a carcinoma. It is typically mediated by antibodies generated against tumor antigens. These antigens are the same proteins as expressed on Purkinje cells within the cerebellum; immune activation in the central nervous system (CNS) results in the syndrome. A 56-year-old woman with stage IIIC serous ovarian carcinoma diagnosed 3 years prior developed progressive limb ataxia. Serum anti-Yo antibodies were positive, confirming the diagnosis of PCD. Treatment with plasmaphoresis, intravenous immune globulin, and immune modulation with corticosteroids and tacrolimus was unsuccessful. Although the syndrome can be debilitating and treatment options are limited, it may also be an example of a successful host immune response in certain cases.
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Affiliation(s)
- W H Bradley
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Mount Sinai Medical Center, New York, New York, USA
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Hauspy J, Nevin A, Harley I, Mason W, Quirt I, Ghazarian D, Laframboise S. Paraneoplastic syndrome in vaginal melanoma: a case report and review of the literature. Int J Gynecol Cancer 2007; 17:1159-63. [PMID: 17309666 DOI: 10.1111/j.1525-1438.2006.00857.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The authors of this article present a case of a woman diagnosed with a vaginal melanoma who developed paraneoplastic syndrome (PNS) soon after diagnosis. A review of the literature regarding PNSs in gynecological malignancies is also described in this article. To our knowledge, this is the first reported case of paraneoplastic cerebellar degeneration with opsoclonus myoclonus secondary to a vaginal melanoma. In addition, our patient had an unusually acute progression to pancerebellar symptoms over the course of 3 weeks. Her paraneoplastic symptoms improved significantly after partial resection of the melanoma.
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Affiliation(s)
- J Hauspy
- Department of Gynecologic Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Tjalma WA. Tjalma syndrome. Gynecol Oncol 2006. [DOI: 10.1016/j.ygyno.2005.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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