Hodgkin’s lymphoma associated with paraneoplastic cerebellar degeneration in children: a case report and review of the literature

Abstract

Paraneoplastic cerebellar degeneration (PCD) can occur severely and appear as subacute cerebellar syndrome. PCD may be associated with small cell lung cancer, adenocarcinoma, breast cancer, ovarian carcinoma, and Hodgkin's lymphoma. An 11-year-old male was admitted with acute cerebellar ataxia, dysarthria, and diplopia. Mediastinal conglomerated lymph nodes were depicted in a chest computed tomography (CT) examination, and diagnosis of stage IV Hodgkin's lymphoma was obtained after a lymph node biopsy. The antibodies against Purkinje cells (anti-Tr antibody) were positive immunohistochemically. Thus, paraneoplastic cerebellar degeneration depending on Hodgkin's disease was diagnosed. Despite the completion of chemotherapy, neurological recovery was not observed in the patient and plasmapheresis with immunoadsorption, and intravenous immunoglobulin (IVIG) was performed. Truncal ataxia, gait disturbance, and tremors decreased. Consequently, we thought that plasmapheresis with the immunoadsorption method and IVIG therapy might be a treatment option for cerebellar ataxia caused by a mechanism of immune ancestry.

Cerebellar cortical degeneration associated with feline leukemia virus infection and cerebellar lymphoma in a young cat

“…Intrauterine or perinatal infection of feline panleukopenia virus reportedly causes cerebellar hypoplasia, with the presence of a decreased granular cell layer (Shamir et al, 1999). In humans, CCD is a rare paraneoplastic neurological syndrome associated with Hodgkin lymphoma as well as other tumor types (Avramova et al, 2016;Gungor et al, 2017). Polyclonal B-cell activation in human patients with Hodgkin lymphoma may be responsible for an autoimmune reaction in the cerebellum (Avramova et al, 2016).…”

“…This neurological alteration is characterized by a substantial loss of Purkinje cells and the granular layer, and astrocytosis (Barone et al, 2002;Negrin et al, 2006;Biolatti et al, 2010). Cerebellar cortical degeneration has been described in humans as part of paraneoplastic neurological syndromes and also associated with viral infections (i.e, HIV) (Gungor et al, 2017;Pedroso et al, 2018). Lymphoma is the second-most common intracranial tumor in cats (Mandara et al, 2016).…”

Clinical Profile and Differential Diagnosis of Classical Paraneoplastic Neurologic Syndromes in Lymphomas

“…Лимфома Ходжкина является четвертой по частоте опухолью, при которой встре-чается ПМД и обнаруживаются антинейрональные антитела анти-Tr и анти-mGluR1 [11,[13][14][15][16][17]. По данным исследования С. Briani и соавт., в кото-ром участвовали 53 пациента с лимфомами (24 с ЛХ и 29 с НХЛ в возрасте от 16 до 84 лет), у 10 из 16 больных с ПМД и ЛХ и у 2 из 5 с НХЛ обнаружи-вались в плазме крови анти-Tr антитела; у 1 паци-ента были выявлены aнти-GAD антитела [11].…”

“…Aнти-Tr антитела представляют собой иммуно-глобулины класса G и являются антителами к клет-кам Пуркинье. Aнти-Tr антитела могут выявляться в спинномозговой жидкости или в плазме крови [13,14]. Исследование F. Bernal и соавт.…”

“…приво-дят описание успешного применения плазмафе-реза при ПМД у 11-летнего пациента с ЛХ и ПМД. После шестикратного проведения плазмафере-за с иммуносорбцией и внутривенного введения иммуноглобулина (4 раза по 400 мг/кг в сутки в течение 5 дней каждые 3 нед) симптомы ПМД уменьшились [14].…”