Atormac
briv
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 5501  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (1,426 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures

 Article Access Statistics
    Viewed146    
    Printed0    
    Emailed0    
    PDF Downloaded6    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
LETTER TO EDITOR
Year : 2021  |  Volume : 69  |  Issue : 4  |  Page : 1099-1100

Paraneoplastic Cerebellar Degeneration with Demyelinating Polyradiculoneuropathy in a Case of Anti-Yo Antibody-Positive Breast Cancer


Department of Medicine, DY Patil University School of Medicine, Nerul, Navi Mumbai, Maharashtra, India

Date of Submission23-Oct-2020
Date of Decision17-Jan-2021
Date of Acceptance15-Feb-2021
Date of Web Publication2-Sep-2021

Correspondence Address:
Sankalp S Mohan
Department of Medicine, DY Patil University, Sector 7, Nerul, Navi Mumbai, Maharashtra - 400 706
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.325324

Rights and Permissions



How to cite this article:
Mohan SS, Hatekar KS, Patil SP, Shaikh JD. Paraneoplastic Cerebellar Degeneration with Demyelinating Polyradiculoneuropathy in a Case of Anti-Yo Antibody-Positive Breast Cancer. Neurol India 2021;69:1099-100

How to cite this URL:
Mohan SS, Hatekar KS, Patil SP, Shaikh JD. Paraneoplastic Cerebellar Degeneration with Demyelinating Polyradiculoneuropathy in a Case of Anti-Yo Antibody-Positive Breast Cancer. Neurol India [serial online] 2021 [cited 2021 Sep 25];69:1099-100. Available from: https://www.neurologyindia.com/text.asp?2021/69/4/1099/325324




Sir,

Paraneoplastic cerebellar degeneration (PCD) is an uncommon disorder associated with lung cancer, gynecologic and breast cancer, and lymphoma.

We present a case of anti-Yo antibody-positive PCD with subacute inflammatory demyelinating polyneuropathy (SIDP) simultaneously, before the clinical evidence of cancer. To our knowledge, this is the first such reported case in the literature.

A presented with a 6-week history of imbalance while walking, progressive weakness of lower limbs, dysphagia, and dysarthria. She had a history of a small axillary lump on the right side. Examination revealed horizontal nystagmus with features of limb ataxia, quadriparesis, and areflexia. The patient developed respiratory muscle weakness and required ventilatory support.

On investigation, her magnetic resonance imaging (MRI) brain and cerebrospinal fluid examinations were normal. MRI whole spine showed prominent enhancement of anterior nerve roots of cauda equina [Figure 1]. Nerve conduction studies were suggestive of predominantly motor demyelinating polyneuropathy with absent late responses [Figure 2]. Her positron emission tomography (PET) scan was suggestive of right axillary hypermetabolic necrotic nodal mass. Paraneoplastic serum neuronal antibody profile revealed anti-Yo/Purkinje cell cytoplasmic antibody type 1 (PCA-1) positive antibodies [Figure 3].
Figure 1: Histopathology: Hematoxylin and eosin (H&E) stain showing high-grade poorly differentiated carcinoma

Click here to view
Figure 2: Nerve conduction studies showing absent tibial and peroneal F-wave responses

Click here to view
Figure 3: MRI lumbosacral spine with contrast showing enhancement of cauda equina nerve roots

Click here to view


A lymph node biopsy was done and an immunohistochemistry report suggested GATA 3 positive, human epidermal growth factor receptor 2 (HER-2)/Neu positive poorly differentiated grade 3 invasive breast carcinoma in the axillary lump [Figure 4].
Figure 4: Serum paraneoplastic neuronal antibody panel showing positive anti-Yo antibody

Click here to view


She was started on intravenous immunoglobulin (IVIG) therapy without significant improvement. Right modified radical mastectomy was performed.

Chemotherapy with trastuzumab and repeat IVIG was planned; however, could not be given because of financial constraints. The patient required prolonged ventilatory support and did not survive.

Anti-Yo-positive patients generally have restrictive cerebellar dysfunction, whereas the patients carrying anti-Hu antibodies often present with paraneoplastic encephalomyelopathy and sensory neuronopathy.[1] Extracerebellar involvement such as limbic encephalitis and peripheral neuropathy is generally less common in anti-Yo PCD.[2]

Guillain-Barre Syndrome (GBS) has been described with small cell lung cancer, commonly associated with anti-ganglioside antibodies.[3] However, GBS or SIDP is not associated with anti-Yo antibodies.

In most patients, symptoms of PCD present months to years before a diagnosis of cancer is made and can develop at any stage of cancer with no relationship to nodal status. The overall prognosis is poor.[4]

In conclusion, we suggest looking for a paraneoplastic cause if demyelinating neuropathy is associated with subacute cerebellar ataxia, since early diagnosis may lead to better functional outcomes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Graus F, Elkon KB, Lloberes P, Ribalta T, Torres A, Ussetti P, et al. Neuronal antinuclear antibody (anti-Hu) in paraneoplastic encephalomyelitis simulating acute polyneuritis. Acta Neurol Scand 1987;75:249-52.  Back to cited text no. 1
    
2.
Peterson K, Rosenblum MK, Kotanides H, Posner JB. Paraneoplastic cerebellar degeneration. I. A clinical analysis of 55 anti-Yo antibody-positive patients. Neurology 1992;42:1931-7.  Back to cited text no. 2
    
3.
Kim MH, Hwang MS, Park YK, Park Y, Ahn YC, Oh HS, et al. Paraneoplastic Guillain-Barré syndrome in small cell lung cancer. Case Rep Oncol 2015;8:295-300.  Back to cited text no. 3
    
4.
Shams'ili S, Grefkens J, de Leeuw B, van den Bent M, Hooijkaas H, van der Holt B, et al. Paraneoplastic cerebellar degeneration associated with antineuronal antibodies: Analysis of 50 patients. Brain 2003;126(Pt 6):1409-18.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow