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Longo R, Wagner M, Savenkoff B, de Castaing MC, Desiro G, Tubail Z, Hennequin L, Mahmoud SB, Marcon N, Quetin P, Campitiello M, Plastino F. A paraneoplastic limbic encephalitis from an anorectal small cell neuroendocrine carcinoma: a case report. BMC Neurol 2019; 19:304. [PMID: 31783737 PMCID: PMC6884799 DOI: 10.1186/s12883-019-1542-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 11/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Paraneoplastic limbic encephalitis (PLE) is a rare autoimmune neurological syndrome observed in cancer patients. PLE is difficult to diagnose and presents a variable response to treatment, depending on the characteristics of the tumor and neuronal autoantibodies. CASE PRESENTATION A 64-year-old, Caucasian, non-smoker man presented with a rapidly developing cognitive impairment, personality change, spatial disorientation, and short-term memory loss associated with anorexia and cervical and inguinal lymph nodes. The 18F-FDG PET scan documented intensely hypermetabolic lymph nodes, which histologically corresponded to a metastasis from a small cell neuroendocrine carcinoma. The brain MRI revealed a high T2-weighted FLAIR signal of the hippocamps, consisted with a PLE. The presence of anti-neuronal Hu antibodies confirmed the diagnosis. The patient underwent plasmapheresis, associated to a systemic chemotherapy resulting in a partial and temporary improvement of the neurological symptoms. Four cycles of intravenous immunoglobulins were also necessary. After six cures of chemotherapy, the lymph node metastases regressed. However, a new anorectal lesion was detected and was histologically confirmed as a primary small cell neuroendocrine carcinoma, which was treated with concomitant chemoradiotherapy. At the end of this treatment, the patient showed a rapid tumor progression leading to his death. CONCLUSIONS This case highlights the rare entity, PLE, which is difficult to diagnose and manage. In addition, this is the first published case of PLE associated with an anorectal small cell neuroendocrine carcinoma, which appeared after completion of systemic chemotherapy.
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Affiliation(s)
- Raffaele Longo
- Division of Medical Oncology, "CHR Metz-Thionville", 1 Allée du Château, 57085, Ars-Laquenexy, France.
| | - Marc Wagner
- Division of Neurology, "CHR Metz-Thionville", 1 Allée du Château, 57085, Ars-Laquenexy, France
| | - Benjamin Savenkoff
- Division of Nephrology, "CHR Metz-Thionville", 1 Allée du Château, 57085, Ars-Laquenexy, France
| | | | - Guillaume Desiro
- Division of Medical Oncology, "CHR Metz-Thionville", 1 Allée du Château, 57085, Ars-Laquenexy, France
| | - Zead Tubail
- Division of Nephrology, "CHR Metz-Thionville", 1 Allée du Château, 57085, Ars-Laquenexy, France
| | - Laurent Hennequin
- Division of Radiology, "CHR Metz-Thionville", 1 Allée du Château, 57085, Ars-Laquenexy, France
| | - Sinan Ben Mahmoud
- Division of Nuclear Medecine, "CHR Metz-Thionville", 1 Allée du Château, 57085, Ars-Laquenexy, France
| | - Nathalie Marcon
- Division of Pathology, "CHR Metz-Thionville", 1 Allée du Château, 57085, Ars-Laquenexy, France
| | - Philippe Quetin
- Division of Radiotherapy, "CHR Metz-Thionville", 1 Allée du Château, 57085, Ars-Laquenexy, France
| | - Marco Campitiello
- Division of Medical Oncology, "CHR Metz-Thionville", 1 Allée du Château, 57085, Ars-Laquenexy, France
| | - Francesca Plastino
- Division of Medical Oncology, "CHR Metz-Thionville", 1 Allée du Château, 57085, Ars-Laquenexy, France
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