Gynaecology meets neurology: Paraneoplastic cerebellar degeneration

Rare case of paraneoplastic cerebellar degeneration secondary to high-grade serous carcinoma of tubo-ovarian origin

This case describes a 69-year-old woman, who presented with rapidly progressive cerebellar symptoms and unintentional weight loss. Full neurological assessment excluded space-occupying lesions, vascular accidents and infection. Surprisingly, a chest, abdomen and pelvis CT showed a left hemipelvis mass, which was subsequently biopsied. A high-grade serous carcinoma of tubo-ovarian origin was found, diagnosing paraneoplastic cerebellar degeneration (PCD) secondary to this. The exact mechanism is not known, but is thought to be immune-mediated. In cases of PCD, after cancer treatment, the neurological disability stabilises to a severe level and will unfortunately be lifelong. Our patient continues to make great progress with intensive rehabilitation for her ongoing balance issues. Early recognition of PCD can lead to a prompt diagnosis of the underlying malignancy and hence subsequent management. This can at least limit the extent of the neurological disability of the disease and increase the survival rate from cancer.

Paraneoplastic cerebellar degeneration associated with ovarian cancer

Paraneoplastic cerebellar degeneration (PCD) is a rare neurological disorder characterized by a widespread loss of Purkinje cells associated with a progressive pancerebellar dysfunction. PCD often precedes the cancer diagnosis by months to years. Here, we report the case of a 64-year-old woman who developed PCD symptoms, associated with high levels of anti-Yo antibodies, one year after a previous diagnosis of ovarian cancer. Clinical features, pathogenesis and treatment of PCD associated with cancer are discussed according to previous studies.

Paraneoplastic cerebellar degeneration

One of the most dramatic and devastating examples of a remote effect of cancer is paraneoplastic cerebellar degeneration (PCD). There is convincing evidence that this disorder is caused by autoimmunity directed against cerebellar targets. Typically, the neurological presentation antedates the diagnosis of malignancy, and the cancer, when found, tends to be localized and responsive to treatment. Diagnosis depends on clinical suspicion, serology for paraneoplastic antibodies, and a focused search for cancer. Neuronal autoantibody tests facilitate the diagnosis and help direct the search for malignancy. Unfortunately, even with prompt diagnosis, current treatment strategies meet with limited success. Optimum management includes early diagnosis, treatment of cancer to remission, immunosuppression, symptomatic therapies, and compassionate support.

Paraneoplastic cerebellar degeneration in ovarian carcinoma: case report with review of immune modulation

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.

Paraneoplastic syndrome in vaginal melanoma: a case report and review of the literature

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.

Marantic endocarditis (NBTE) with systemic emboli and paraneoplastic cerebellar degeneration: uncommon presentation of ovarian cancer

We report a case in which the only presenting symptoms of the underlying ovarian malignancy were that of paraneoplastic cerebellar degeneration and nonbacterial thrombotic endocarditis. If suspecting paraneoplastic cerebellar degeneration and nonbacterial thrombotic endocarditis, complete physical examination, including pelvic exams in female patients is warranted. Investigations should include CT chest/abdominal/pelvis, MRI brain, and Transesophageal Echocardiogram. Early recognition will lead to early diagnosis of occult malignancy and initiation of appropriate therapy. Awareness of these complications as initial presentation for internists, gynecologists and neurologists may avoid diagnostic delay.