Neuromyelitis optica spectrum disorder as a paraneoplastic manifestation of lung adenocarcinoma expressing aquaporin-4

Iorio, Raffaele; Rindi, Guido; Erra, Carmen; Damato, Valentina; Ferilli, Michela Ada Noris; Sabatelli, Mario

doi:10.1177/1352458515572241

Cited by 31 publications

(18 citation statements)

References 16 publications

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“…The proposed hypothetical mechanism for this behavior is that the abnormally expressed AQP4 on the tumor cells induces the anti‐AQP4 autoantibody . In fact, several reports that have investigated NMO that was accompanied by cancer reported that immunostaining showed an overexpression of AQP4 on the resected tumor cells . In the present case, however, we found no AQP4 expression after anti‐AQP4 immunostaining of the neoplastic stomach pyloric gland cells in the resected gastric tumor tissues.…”

Section: Discussioncontrasting

confidence: 58%

Case of neuromyelitis optica with recurrent stomach carcinoma

Takewaki

Kasai

Itoh

et al. 2017

Clinical & Exp Neuroim

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Background Neuromyelitis optica (NMO) is an autoimmune astrocytopathy associated with anti-aquaporin-4 (AQP4). The development of NMO in the setting of cancer suggests that AQP4 autoimmunity might in some cases be paraneoplastic. Case presentation We report an 85-year-old woman who developed a right optic neuritis and a longitudinally extensive transverse myelitis associated with AQP4 autoantibodies after the relapse of stomach cancer. Histopathological observations in several case reports have led to the hypothesis that the NMO associated with the malignancy is caused by an autoimmunity against abnormally expressed AQP4 on tumor cells. However, we found no AQP4 antigen on the cancer cells in our resected tissues. Our findings did not support the concept of a paraneoplastic process in the narrow sense. Conclusions The exact mechanisms of cancer-related NMO, which might be multifactorial, remain controversial.

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Section: Discussioncontrasting

confidence: 58%

Case of neuromyelitis optica with recurrent stomach carcinoma

Takewaki

Kasai

Itoh

et al. 2017

Clinical & Exp Neuroim

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“…Aquaporin-4 immunoreactivity has additionally been found to express on tumor cells of breast carcinoma [6], lung carcinoma [9], carcinoid [13], ovarian teratoma [15], and thymoma [23]. AQP4 autoantibodies from serum and CSF of NMO patients bound to AQP4 expressed on cell membrane of thymoma [23] and lung adenocarcinoma [9].…”

Section: E P T E Dmentioning

confidence: 96%

“…AQP4 autoantibodies from serum and CSF of NMO patients bound to AQP4 expressed on cell membrane of thymoma [23] and lung adenocarcinoma [9]. In addition, there are some other evidence to suggest an association of AQP4-IgG with tumors, such as occurrence or reoccurrence of NMOSD accompanying the recurrence or metastasis of tumors [5,8,10,13], freedom from relapse after radical cure of tumors [13][14][15], and reduction in serum AQP4-IgG after immunotherapies and anti-tumor therapies [6,12].…”

Section: E P T E Dmentioning

confidence: 97%

“…Twenty-one patients had carcinoma (11 breast (32%) (present case 3) [4][5][6][7], 3 lung (9%) [4,8,9], 2 thymic (6%) [4,10], 2 thyroid (6%) (present case 1) [4] and 2 uterine cervical (6%) [4,7] and 1 prostate (3%) [11]), 4 had lymphoma (12%) [ 4,7,12], 3 had carcinoid tumor (9%) [4,13,14], 2 had monoclonal gammopathy (6%) [4], 2 had ovarian teratoma (6%) [15,16], 1 had pituitary somatotropinoma (3%) [4], and 1 had acute myeloid leukemia (3%) (present case 2).…”

Section: Tumor Typesmentioning

confidence: 98%

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Paraneoplastic neuromyelitis optica spectrum disorders: three new cases and a review of the literature

Cai

Chu

et al. 2015

International Journal of Neuroscience

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Neuromyelitis optica spectrum disorders (NMOSD) occasionally develop in patients with tumor in relation to aquaporin-4 IgG (AQP4-IgG), representing a new paraneoplastic phenomenon. We reported three patients with paraneoplastic NMOSD and provided a comprehensive review of the literature. A total of 34 cases with paraneoplastic NMOSD were identified from our own case database (n = 3) and the previous literature (n = 31). The median age at NMOSD-related symptom onset was 50.5 years, and 91% of the cases were female. 11 (32%) cases had breast carcinoma. In 15 (44%) cases, NMOSD-related symptoms preceded tumor detection [median, 4 (range 1-180) months], and in 19 (56%) cases, symptoms followed tumor detection [median, 12 (range 3-180) months]. 5/14 (36%) cases had hiccups and vomiting as the initial symptoms, with the involvement of medulla oblongata. In 10/14 (71%) cases, cervical spinal cord was involved. In contrast to idiopathic NMO, NMOSD is more likely to be paraneoplastic than in patients aged over 50 years at the onset of symptoms, especially for female patients. Breast carcinoma is the most common tumor associated with paraneoplastic NMOSD, accounting for nearly a third of all types of tumors. Paraneoplastic NMOSD usually involves medulla oblongata and cervical spinal cord. We recommend adding AQP4-IgG as an onconeural antibody, but its clinical utility warrants further investigations.

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“…Paraneoplastic syndromes are remote effects of cancer caused by an autoimmune response triggered by tumor cells. However, although most commonly an idiopathic autoimmune condition [1], there were only a few cases of NMOD presenting paraneoplastic syndromes, such as mature B-cell neoplasm [2], hepatic metastasis from a small-bowel neuroendocrine tumor [3], stomach carcinoid tumor [4], lung carcinoma [5,6], esophageal cancer [7], adenocarcinoma of the lung and breast [8], squamous cell lung, ovarian carcinoma and adrenocortical carcinoma [9], esophageal Adenocarcinoma [1]. As a result, NMOSD in elderly patients should raise the suspicion of paraneoplastic etiology.…”

Section: Introductionmentioning

confidence: 99%

Paraneoplastic neuromyelitis optica spectrum disorder associated with breast cancer: a case report and literature review

Jia

Qin

Yuan

2019

Preprint

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Background: Neuromyelitis optica spectrum disorder (NMOSD) is an astrocytopathy with demyelinating lesions caused by aquaporin 4 (AQP4) antibodies. Although most commonly an idiopathic autoimmune condition, NMOSD may also occur as a paraneoplastic syndrome in rare instances. Case presentation: Herein, we report a rare case of a 60-year-old woman with paraneoplastic NMOSD associated with breast cancer. Conclusions: Our findings increase the recognition that NMOSD may present as a paraneoplastic neurological syndrome associated with breast cancer. Our case also raises awareness of an important complication of neurological complications of breast cancer. Early diagnosis of paraneoplastic NMOSD may be imperative for a better prognosis. Keywords: Neuromyelitis optica spectrum disorder, paraneoplastic syndrome, breast cancer.

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Neuromyelitis optica spectrum disorder as a paraneoplastic manifestation of lung adenocarcinoma expressing aquaporin-4

Abstract: This case expands the spectrum of paraneoplastic AQP4 autoimmunity highlighting the importance of considering an oncological screening in patients with late-onset NMOSD.

Cited by 31 publications

References 16 publications

Case of neuromyelitis optica with recurrent stomach carcinoma

Case of neuromyelitis optica with recurrent stomach carcinoma

Paraneoplastic neuromyelitis optica spectrum disorders: three new cases and a review of the literature

Paraneoplastic neuromyelitis optica spectrum disorder associated with breast cancer: a case report and literature review

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