1
|
Akkus S, Elkhooly M, Amatya S, Shrestha K, Sharma K, Kagzi Y, Khan E, Gupta R, Piquet AL, Jaiswal S, Wen S, Tapia M, Samant R, Sista SR, Sriwastava S. Autoimmune and paraneoplastic neurological disorders: A review of relevant neuroimaging findings. J Neurol Sci 2023; 454:120830. [PMID: 37856996 DOI: 10.1016/j.jns.2023.120830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Paraneoplastic neurologic syndromes (PNS) and autoimmune encephalitis (AIE) are immune-mediated disorders. PNS is linked to cancer, while AIE may not Their clinical manifestations and imaging patterns need further elucidation. OBJECTIVE/AIMS To investigate the clinical profiles, antibody associations, neuroimaging patterns, treatments, and outcomes of PNS and AIE. METHODS A systematic review of 379 articles published between 2014 and 2023 was conducted. Of the 55 studies screened, 333 patients were diagnosed with either PNS or AIE and tested positive for novel antibodies. Data on demographics, symptoms, imaging, antibodies, cancer associations, treatment, and outcomes were extracted. RESULTS The study included 333 patients (mean age 54 years, 67% males) with PNS and AIE positive for various novel antibodies. 84% had central nervous system issues like cognitive impairment (53%), rhombencephalitis (17%), and cerebellar disorders (24%). Neuroimaging revealed distinct patterns with high-risk antibodies associated with brainstem lesions in 98%, cerebellar in 91%, hippocampal in 98%, basal ganglia in 75%, and spinal cord in 91%, while low/intermediate-risk antibodies were associated with medial temporal lobe lesions in 71% and other cortical/subcortical lesions in 55%. High-risk antibodies were associated with younger males, deep brain lesions, and increased mortality of 61%, while low/intermediate-risk antibodies were associated with females, cortical/subcortical lesions, and better outcomes with 39% mortality. Associated cancers included seminomas (23%), lung (19%), ovarian (2%), and breast (2%). Treatments included IVIG, chemotherapy, and plasmapheresis. Overall mortality was 25% in this cohort. CONCLUSION PNS and AIE have distinct clinical and radiological patterns based on antibody profiles. High-risk antibodies are associated with increased mortality while low/intermediate-risk antibodies are associated with improved outcomes. Appropriate imaging and antibody testing are critical for accurate diagnosis.
Collapse
Affiliation(s)
- Sema Akkus
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mahmoud Elkhooly
- Department of Neurology, Wayne state University, Detroit, MI, USA; Department of Neurology, Southern Illinois university, Springfield, IL, USA; Department of Neuropsychiatry, Minia University, Egypt
| | - Suban Amatya
- Department of Medicine, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Kriti Shrestha
- Department of Medicine, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Kanika Sharma
- Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX,USA
| | - Yusuf Kagzi
- Mahatma Gandhi Memorial Medical College, Indore, India
| | - Erum Khan
- Department of Neurology, University of Alabama at Birmingham, Al, USA
| | - Rajesh Gupta
- Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX,USA
| | - Amanda L Piquet
- Neuroimmunology, Neuroinfectious Disease and Neurohospitalist Sections, University of Colorado School of Medicine, CO, USA
| | - Shruti Jaiswal
- Department of Neuro-oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Sijin Wen
- West Virginia Clinical Transitional Science, Morgantown, WV, USA
| | - Michaela Tapia
- West Virginia Clinical Transitional Science, Morgantown, WV, USA
| | - Rohan Samant
- Department of Neuroradiology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sri Raghav Sista
- Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX,USA
| | - Shitiz Sriwastava
- Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX,USA.
| |
Collapse
|
2
|
Kunchok AC, Ontaneda D, Lee J, Rae-Grant A, Foldvary-Schaefer N, Cohen JA, Jones SE. Magnetic Resonance Imaging Features of Anti-Ma1/Ma2 Paraneoplastic Neurologic Syndrome. Neurology 2022; 99:900-902. [PMID: 36376085 DOI: 10.1212/wnl.0000000000201318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/12/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Amy C Kunchok
- From the Mellen Center for Multiple Sclerosis (A.C.K., D.O., J.A.C.), Neurological Institute, Section of Neuroradiology (J.L., S.E.J.), Imaging Institute, Cleveland Clinic Lerner College of Medicine (A.R.-G.), and Sleep Disorders Center (N.F.-S.), Neurological Institute, Cleveland Clinic, OH.
| | - Daniel Ontaneda
- From the Mellen Center for Multiple Sclerosis (A.C.K., D.O., J.A.C.), Neurological Institute, Section of Neuroradiology (J.L., S.E.J.), Imaging Institute, Cleveland Clinic Lerner College of Medicine (A.R.-G.), and Sleep Disorders Center (N.F.-S.), Neurological Institute, Cleveland Clinic, OH
| | - Jonathan Lee
- From the Mellen Center for Multiple Sclerosis (A.C.K., D.O., J.A.C.), Neurological Institute, Section of Neuroradiology (J.L., S.E.J.), Imaging Institute, Cleveland Clinic Lerner College of Medicine (A.R.-G.), and Sleep Disorders Center (N.F.-S.), Neurological Institute, Cleveland Clinic, OH
| | - Alexander Rae-Grant
- From the Mellen Center for Multiple Sclerosis (A.C.K., D.O., J.A.C.), Neurological Institute, Section of Neuroradiology (J.L., S.E.J.), Imaging Institute, Cleveland Clinic Lerner College of Medicine (A.R.-G.), and Sleep Disorders Center (N.F.-S.), Neurological Institute, Cleveland Clinic, OH
| | - Nancy Foldvary-Schaefer
- From the Mellen Center for Multiple Sclerosis (A.C.K., D.O., J.A.C.), Neurological Institute, Section of Neuroradiology (J.L., S.E.J.), Imaging Institute, Cleveland Clinic Lerner College of Medicine (A.R.-G.), and Sleep Disorders Center (N.F.-S.), Neurological Institute, Cleveland Clinic, OH
| | - Jeffrey A Cohen
- From the Mellen Center for Multiple Sclerosis (A.C.K., D.O., J.A.C.), Neurological Institute, Section of Neuroradiology (J.L., S.E.J.), Imaging Institute, Cleveland Clinic Lerner College of Medicine (A.R.-G.), and Sleep Disorders Center (N.F.-S.), Neurological Institute, Cleveland Clinic, OH
| | - Stephen E Jones
- From the Mellen Center for Multiple Sclerosis (A.C.K., D.O., J.A.C.), Neurological Institute, Section of Neuroradiology (J.L., S.E.J.), Imaging Institute, Cleveland Clinic Lerner College of Medicine (A.R.-G.), and Sleep Disorders Center (N.F.-S.), Neurological Institute, Cleveland Clinic, OH
| |
Collapse
|
3
|
Alsaeed M, Lim CAR, Plecash A, Chen T. Paraneoplastic sensorimotor neuropathy and ventral cauda equina nerve root enhancement as initial presentation of small cell lung carcinoma: a case study. BMC Neurol 2021; 21:374. [PMID: 34579672 PMCID: PMC8474708 DOI: 10.1186/s12883-021-02404-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Paraneoplastic neurologic syndromes (PNS) are rare, however, are important to recognize as oftentimes they precede the detection of an occult malignancy. Our case highlights a rare circumstance of paraneoplastic radiculoneuropathy and the importance of recognizing PNS in antibody negative disease, as is the case in up to 16% of sensory neuronopathies, and the process of excluding other etiologies. CASE PRESENTATION We discuss a 51-year-old man who presented with asymmetric subacute sensorimotor deficits in the lower limbs. Initial clinical examination showed weakness throughout the right lower limb and normal strength on the left with objective numbness in a mixed dermatomal and stocking-glove distribution. Electrophysiology was consistent with axonal sensorimotor neuropathy. Cerebrospinal fluid showed pleocytosis and elevated protein. Intravenous immunoglobulin treatment was given with some improvement in pain symptoms but no measurable motor improvement. Following clinical and electrophysiologic deterioration the patient was transferred to a tertiary centre. Magnetic resonance imaging of the spine showed smooth enhancement of the ventral caudal nerve roots. Chest computed tomography revealed left lower vascular scarring. Further positron emission tomography scan imaging identified fluorodeoxyglucose avid right lung lymphadenopathy. Bronchoscopy-guided biopsy revealed small cell lung carcinoma. Onconeural and antiganglioside antibodies were negative. The patient was then transferred to a medical oncology ward where he underwent chemoradiotherapy and subsequently experienced improvement in his motor function, supporting that his neurological condition was indeed secondary to a paraneoplastic process. CONCLUSIONS Onconeural negative paraneoplastic radiculoneuropathy can precede diagnosis of small cell lung carcinoma. If considered early and adequately investigated, it can allow earlier diagnosis and treatment of underlying malignancy, improving overall and neurological prognosis.
Collapse
Affiliation(s)
- Meshari Alsaeed
- Division of Neurology, Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Chloe A R Lim
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alyson Plecash
- Division of Neurology, Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Tychicus Chen
- Division of Neurology, Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| |
Collapse
|
4
|
Huang J, Li H, Zhou R, Huang W, Lin W, Chen T, Long Y. Clinical Heterogeneity in Patients with Glutamate Decarboxylase Antibody. Neuroimmunomodulation 2019; 26:234-238. [PMID: 31661704 DOI: 10.1159/000502695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/08/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To explore the diversity and clinical features of anti-glutamate decarboxylase (GAD) antibody-associated neurological diseases. METHODS Clinical data of a series of 5 patients positive for anti-GAD antibodies were retrospectively analyzed. RESULTS All 5 patients were female, with a median age of 41.5 years (range 19-60 years). Their neurological symptoms included stiff-person syndrome (SPS), encephalitis, myelitis, cramp, visual loss, and paresthesia. Three patients (60%) were diagnosed with tumors, 2 cases of thymic tumor and 1 of breast cancer. On immunohistochemistry for tumor pathology, expression of GAD65 was found only in 1 patient. Four patients (80%) had abnormal brain MRI findings. All patients received immunotherapy and improved significantly after treatment, but 4 (80%) then experienced a relapse. CONCLUSIONS Neurological manifestations in anti-GAD-positive patients are diverse and include SPS, encephalitis, myelitis, cramp, visual loss, and paresthesia.
Collapse
Affiliation(s)
- Jiehong Huang
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Guangzhou, China
- Second Clinical College, Guangzhou Medical University, Xinzao, Panyu District, Guangzhou, China
| | - Huilu Li
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Guangzhou, China
- Second Clinical College, Guangzhou Medical University, Xinzao, Panyu District, Guangzhou, China
| | - Ruisi Zhou
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Guangzhou, China
- Second Clinical College, Guangzhou Medical University, Xinzao, Panyu District, Guangzhou, China
| | - Wenyao Huang
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Guangzhou, China
- Second Clinical College, Guangzhou Medical University, Xinzao, Panyu District, Guangzhou, China
| | - Wenhui Lin
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Guangzhou, China
- Second Clinical College, Guangzhou Medical University, Xinzao, Panyu District, Guangzhou, China
| | - Ting Chen
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Guangzhou, China
- Second Clinical College, Guangzhou Medical University, Xinzao, Panyu District, Guangzhou, China
| | - Youming Long
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China,
- Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, Guangzhou, China,
- Second Clinical College, Guangzhou Medical University, Xinzao, Panyu District, Guangzhou, China,
| |
Collapse
|
5
|
Sundermann B, Schröder JB, Warnecke T, Heindel W, Schäfers M, Weckesser M, Buerke B. Imaging Workup of Suspected Classical Paraneoplastic Neurological Syndromes: A Systematic Review and Retrospective Analysis of 18F-FDG-PET-CT. Acad Radiol 2017; 24:1195-1202. [PMID: 28551401 DOI: 10.1016/j.acra.2017.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 11/17/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to assess the clinical efficacy of positron emission tomography (PET) or combined PET-computed tomography (CT) with 18F-fluorodeoxyglucose (FDG) for whole-body cancer screening in patients with suspected paraneoplastic neurological syndromes (PNS). The following main research questions were addressed: What is the percentage of positive findings to be expected in whole-body FDG-PET-CT in adult patients with PNS? How many false positives can be expected as assessed by clinical and histopathological workup? Are there patients who present with a tumor despite initially negative findings? MATERIALS AND METHODS This is a systematic review of the literature and retrospective analysis of FDG-PET-CT and clinical follow-up data from 45 consecutive patients (age: 56.6 ± standard deviation 15.8 years, 14 female, 31 male). Suspicious lesions were identified and correlated with immediate workup and clinical follow-up. RESULTS Fourteen studies were included in the review. Eleven malignancies (24.4% of patients) were identified by FDG-PET-CT in this sample. This is a higher percentage of positive findings compared to most previous reports. There was one initially negative finding. CONCLUSIONS Whole-body FDG-PET-CT is suitable to identify additional malignancies in patients with suspected classical PNS referred to a tertiary medical center. The utility by means of true-positive findings is higher in classical PNS than suggested by studies in less select patient populations.
Collapse
Affiliation(s)
- Benedikt Sundermann
- University Hospital Münster, Department of Clinical Radiology, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Münster, Germany.
| | | | - Tobias Warnecke
- University Hospital Münster, Department of Neurology, 48149 Münster, Germany
| | - Walter Heindel
- University Hospital Münster, Department of Clinical Radiology, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Münster, Germany
| | - Michael Schäfers
- University Hospital Münster, Department of Nuclear Medicine, 48149 Münster, Germany; University of Münster, DFG EXC 1003 "Cells in Motion" Cluster of Excellence, 48149 Münster, Germany; University of Münster, European Institute of Molecular Imaging, 48149 Münster, Germany
| | - Matthias Weckesser
- University Hospital Münster, Department of Nuclear Medicine, 48149 Münster, Germany
| | - Boris Buerke
- University Hospital Münster, Department of Clinical Radiology, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Münster, Germany
| |
Collapse
|
6
|
Hadjivassiliou M, Alder SJ, Van Beek EJR, Hanney MB, Lorenz E, Rao DG, Sharrack B, Tindale WB. PET scan in clinically suspected paraneoplastic neurological syndromes: a 6-year prospective study in a regional neuroscience unit. Acta Neurol Scand 2009; 119:186-93. [PMID: 18855873 DOI: 10.1111/j.1600-0404.2008.01089.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The role of PET in the diagnosis of paraneoplastic neurological syndromes (PNS) has previously been reported in retrospective studies, from specialized neuro-oncology units, often selecting patients with positive paraneoplastic antibodies. OBJECTIVES To prospectively assess the usefulness of PET in detecting malignancy in patients clinically suspected of having PNS. METHODS PET was performed in patients suspected of PNS within 4 weeks of the normal CT body scan. All patients were followed up. RESULTS Eighty patients suspected of having PNS underwent PET. 18/80 (23%) were abnormal and suspicious of malignancy. The total number of definite and probable PNS with abnormal PET was 11/18 (61%). The total number of definite and probable PNS with a normal PET was 3/62 (5%). Only 50% of patients with biopsy-proven malignancy were positive for paraneoplastic antibodies. The prevalence of abnormal PET in patients presenting with classical PNS was 41% as opposed to 21% in patients with non-classical PNS. The sensitivity and specificity of PET in diagnosing PNS was 75% and 87% respectively. CONCLUSIONS PET is a valuable tool in clinically suspected PNS. Its use should not be restricted to specialized neuro-oncology units or in patients with positive paraneoplastic antibodies. Positive yield is the highest amongst patients with classical PNS.
Collapse
Affiliation(s)
- M Hadjivassiliou
- Department of Neurology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, NHS Trust, Sheffield, UK.
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Patel RR, Subramaniam RM, Mandrekar JN, Hammack JE, Lowe VJ, Jett JR. Occult malignancy in patients with suspected paraneoplastic neurologic syndromes: value of positron emission tomography in diagnosis. Mayo Clin Proc 2008; 83:917-22. [PMID: 18674476 DOI: 10.4065/83.8.917] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the value of positron emission tomography (PET) in diagnosing occult malignancies in patients with paraneoplastic neurologic syndromes (PNSs) at Mayo Clinic's site in Rochester, MN. PATIENTS AND METHODS We retrospectively reviewed the medical charts of all 107 patients who underwent PET from January 1, 2000, to July 31, 2006, for the indication of suspected PNS. Three patients did not meet inclusion criteria. PET results were considered positive if increased fludeoxyglucose F 18 uptake indicated malignancy (24 patients). Results from computed tomography were interpreted as positive if any suspect lesion was consistent with malignancy (26 patients). RESULTS One hundred four patients with PNS were identified from the PET central database; 73 patients had at least 1 positive result for paraneoplastic antibody, and 31 had antibody-negative PNS. Malignancy was confirmed pathologically in 10 patients, of whom 8 had positive PET results. There were 2 cases of confirmed malignancy (fallopian tube adenocarcinoma and spindle cell uterine carcinoma) for which PET results were negative. Two patients with positive PET results declined biopsy. Computed tomography was able to identify 3 of the 10 malignancies detected. Five cases of malignancy were detected only by PET. All patients with confirmed malignancy had positive results for at least 1 paraneoplastic antibody. One patient with positive results for PNS antibody and negative PET results was diagnosed as having small cell carcinoma on a follow-up PET scan after 27 months. PET had sensitivity, specificity, positive predictive value, and negative predictive value of 80%, 67%, 53%, and 88%, respectively. CONCLUSION PET scan was shown to be more sensitive than computed tomography for detecting occult malignancy (confirmed by positive test results for autoantibody) among patients with suspected PNS. The greatest clinical utility of PET could be in its high negative predictive value.
Collapse
Affiliation(s)
- Rajesh R Patel
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | | | | | | | | | | |
Collapse
|
8
|
Suzuki H, Hasegawa T, Higuchi M, Kanno R, Endoh K, Teranishi Y, Gotoh M. Usefulness of [18F] Fluoro-2-deoxyglucose–Positron Emission Tomography–Computed Tomography (FDG–PET–CT) in the Detection of Lung Cancer Recurrence with Paraneoplastic Neurological Syndrome. Clin Oncol (R Coll Radiol) 2006; 18:636-7. [PMID: 17054327 DOI: 10.1016/j.clon.2006.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
9
|
Talbot JN, Kerrou K, Gutman F, Périé S, Grahek D, Roulet E, Saint Guily JL, Montravers F. Place de la TEP au FDG dans la localisation des cancers de primitif inconnu. Presse Med 2006; 35:1371-6. [PMID: 16969333 DOI: 10.1016/s0755-4982(06)74820-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
FDG-PET can be successful in localizing the primary cancer when a metastasis is discovered but no primary tumor can be identified (cancer of unknown primary, or CUP) by physical examination, laboratory testing (for tumor markers, for example) or conventional imaging. The greatest number of PET studies in CUP concern secondary lesions in cervical lymph nodes, and PET is an established clinical use (highest ranking, 1A) according to the 3rd German Consensus Conference and an "option" in the French Standards, Options, and Recommendations. Success rates range from 30% to 50% in most studies using PET; a higher rate was reported recently with PET/CT. FDG-PET should be performed sufficiently early in cases of neurological paraneoplastic syndrome, because established lesions become irreversible. Identification of the antibody present helps to specify the organ and FDG-PET can then localize the lesion; together these techniques make it possible to perform curative surgery even when the primary tumor is not visible. The success rate is somewhat lower than in cases of metastasis, around 35%. The clinical utility of PET in other paraneoplastic syndromes has not yet been sufficiently studied, but these conditions are rare. It is precisely in cases with a kind of 'orphan' indication that FDG PET should be considered, as an effective "problem solver".
Collapse
Affiliation(s)
- Jean-Noël Talbot
- Service de Médecine Nucléaire, AP-HP Hôpital Tenon, Université Pierre et Marie Curie, Paris.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Asher I, Elbirt D, Kushnir M, Sthoeger ZM. [Opsoclonus myoclonus with ataxia]. Harefuah 2005; 144:163-7, 232. [PMID: 15844453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Opsoclonus myoclonus with ataxia (OMA) is a rare neurological disorder. The syndrome is characterized by involuntary, conjugate, multidirectional eye movements accompanied by involuntary movements of limb or face, and sometimes ataxia, dysarthria, irritability, dementia, altered level of consciousness and even death. OMA is associated with various etiologies including infectious, toxic, drug-related, vascular and paraneoplastic conditions. Paraneoplastic opsoclonus myoclonus with ataxia (POMA) is more common in patients over 40 years of age and is usually associated with lung (especially small cell), breast and ovarian cancer but has also been reported with many other cancers. The syndrome is thought to be mediated by autoantibodies directed against onconeural antigens that are expressed by the tumor as well as by neurons. Studies from several laboratories were able to demonstrate a role for the cellular response in the pathogenesis of POMA. The results for treatment of this syndrome have been disappointing, although aggressive multimodality immunosuppressive treatments have been used. This is a case study of a patient with POMA who clearly demonstrates the difficulties in the diagnosis and treatment of this syndrome.
Collapse
Affiliation(s)
- Ilan Asher
- Department of Internal Medicine B, Kaplan Medical Center Rehovot affiliated to the Hadassah Hebrew University Medical School, Jerusalem, Israel
| | | | | | | |
Collapse
|
11
|
Abstract
Paraneoplastic symptoms caused by abnormal gastrointestinal motility may be the initial manifestation of small cell lung cancer (SCLC). We report a case of a 63-year-old woman who presented with progressive constipation culminating in obstipation, and associated symptoms of more widespread dysmotility. A paraneoplastic syndrome was suspected. The only abnormality on chest computed tomography was a minimally enlarged paratracheal lymph node. Positron emission tomography demonstrated increased activity in the lymph node. The antinuclear neuronal antibody titer was elevated. Bronchoscopy with transtracheal biopsy confirmed the diagnosis of SCLC. One year after diagnosis, the patient had progressive symptoms of intestinal obstruction, and ultimately feculent vomiting. On abdominal radiography, colonic sitz markers ingested a year earlier were in virtually the same positions as after ingestion. Palliative colectomy with ileostomy was performed. The myenteric plexus in the terminal ileum and colon showed infiltration by a mixture of B-cell and T-cell lymphocytes and plasma cells, and no gross neuronal abnormalities. We review the clinical and pathologic features, clinical course, and management of paraneoplastic pseudoobstruction.
Collapse
Affiliation(s)
- S Jun
- Division of Gastroenterology, University of California, San Francisco, CA 94143, USA
| | | | | | | |
Collapse
|
12
|
Younes-Mhenni S, Janier MF, Cinotti L, Antoine JC, Tronc F, Cottin V, Ternamian PJ, Trouillas P, Honnorat J. FDG-PET improves tumour detection in patients with paraneoplastic neurological syndromes. ACTA ACUST UNITED AC 2004; 127:2331-8. [PMID: 15361417 DOI: 10.1093/brain/awh247] [Citation(s) in RCA: 188] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
To determine the usefulness of [18F]fluorodeoxyglucose (FDG) whole body FDG-PET in the diagnosis of tumours in patients with paraneoplastic neurological syndromes (PNS), we prospectively studied 20 patients with paraneoplastic antibodies in whom conventional imaging gave negative or inconclusive results for the presence of tumour. All 20 patients had neurological manifestations compatible with PNS and well-characterized paraneoplastic antibodies (12 anti-Hu, one anti-Hu and anti-CV2, one anti-CV2, four anti-Yo, one anti-Ri and one anti-amphiphysin). The mean delay between the onset of neurological symptoms and FDG-PET was 10 months (range 1-54). In these 20 patients, abnormal uptake was demonstrated in 18 patients, with some patients having abnormal signal in several areas. We observed abnormal uptake in the mediastinum (13 cases), lung (two cases), breast (two cases), parotid gland (one case), or the cervical, supraclavicular or axillary lymph nodes (seven cases). Following FDG-PET, the histological diagnosis of the tumour was made in 14 patients (small cell lung carcinoma in eight cases, breast adenocarcinoma in two, lung adenocarcinoma in two, axillary metastasis of ovary carcinoma in one, and malignant thymoma in one). Two other patients with abnormal FDG uptake showed radiological evidence of lung cancer, but a histological diagnosis could not be obtained. In two other patients, initial FDG-PET showed abnormal FDG uptake that was not confirmed a few months later by repeat FDG-PET. In the two patients with negative FDG-PET, peritoneal carcinomatosis was diagnosed in one and no tumour was found in the other. In our series, the sensitivity of FDG-PET for tumour detection was >83% demonstrating a clear role of this technique in the management of patients with PNS. However, in our series, the specificity of FDG uptake was only 25% due to unexplained abnormal FDG uptake in three patients and in abnormal FDG uptake due to a benign tumour in one patient. Over the study period, we saw 73 other patients with PNS and paraneoplastic antibodies. A tumour was demonstrated in 71 out of 73 by conventional techniques. Since false-positive and false-negative results are possible with FDG-PET and in most patients with PNS, the tumour is demonstrated by conventional techniques, we believe that FDG-PET should be reserved, at the moment, for patients with well-defined PNS antibodies when conventional imaging fails to identify a tumour or when lesions are difficult to biopsy.
Collapse
Affiliation(s)
- S Younes-Mhenni
- Neurology B, Hôpital Pierre Wertheimer, Université Claude Bernard, Lyon, France
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Dadparvar S, Anderson GS, Bhargava P, Guan L, Reich P, Alavi A, Zhuang H. Paraneoplastic encephalitis associated with cystic teratoma is detected by fluorodeoxyglucose positron emission tomography with negative magnetic resonance image findings. Clin Nucl Med 2004; 28:893-6. [PMID: 14578703 DOI: 10.1097/01.rlu.0000093284.54060.aa] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The role of fluorodeoxyglucose (FDG) positron emission tomography (PET) as a functional imaging technique used in the evaluation of a variety of malignancies has been well known. Paraneoplastic encephalitis is a rare central nervous complication, which has been reported in some tumors. Traditionally, magnetic resonance imaging of the brain is performed to aid in its diagnosis. The authors report a case of paraneoplastic encephalitis, associated with cystic teratoma, which had positive FDG-PET findings but appeared normal on magnetic resonance imaging.
Collapse
Affiliation(s)
- Simin Dadparvar
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
| | | | | | | | | | | | | |
Collapse
|
14
|
|
15
|
Rees JH, Hain SF, Johnson MR, Hughes RA, Costa DC, Ell PJ, Keir G, Rudge P. The role of [18F]fluoro-2-deoxyglucose-PET scanning in the diagnosis of paraneoplastic neurological disorders. Brain 2001; 124:2223-31. [PMID: 11673324 DOI: 10.1093/brain/124.11.2223] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The detection of an occult tumour in a patient with a suspected paraneoplastic neurological disorder (PND) may be difficult because of the limitations of conventional imaging techniques. [(18)F]fluoro-2-deoxyglucose-PET (FDG-PET) can visualize a small tumour anywhere within the body. We retrospectively reviewed the case notes of 43 unselected patients with suspected PND referred for FDG-PET scanning to determine how useful this technique was when conventional imaging was negative. All patients had undergone standard radiological investigations and bronchoscopy (where appropriate) prior to PET scanning. There were discrete areas of hypermetabolism suggestive of malignancy (positive) in 16 patients (37%). A tissue diagnosis of cancer was subsequently made in seven patients (two at post-mortem), further radiological studies were suggestive of cancer in one patient, one patient subsequently presented with a metastatic deposit which was biopsied, and four patients died shortly afterwards without a post-mortem. In three patients, subsequent investigations were negative for cancer. Serum anti-neuronal antibodies were present in 43% and CSF oligoclonal bands were present in 46% of patients with positive PET scans compared with 16 and 26%, respectively, in PET-negative patients, but this was not significant. Only one patient with a negative scan has been diagnosed subsequently as having malignancy on prolonged follow-up. These findings confirm that FDG-PET scanning is a useful technique in the detection of small tumours in patients with suspected PND. False positives and false negatives do occur, but at a sufficiently low frequency to justify the clinical usefulness of this technique.
Collapse
Affiliation(s)
- J H Rees
- National Hospital for Neurology and Neurosurgery, London, UK.
| | | | | | | | | | | | | | | |
Collapse
|