Paraneoplastic limbic encephalitis cured with nephron-sparing surgery in a patient with clear cell renal cell carcinoma: a case report

Abstract

Paraneoplastic limbic encephalitis (PLE) in association with clear cell renal cell carcinoma has never been reported in China. We herein describe a 54-year-old man with a 1-week history of headache and a 3-day history of psychiatric symptoms. Slight nuchal rigidity was found by physical examination. Imaging studies of the head were normal. Blood and cerebrospinal fluid antibody testing were both positive for N-methyl-D-aspartic acid antibodies. Subsequent contrast-enhanced computed tomography revealed a 5.2- × 4.2-cm left kidney mass with intense enhancement. Emergent laparoscopic nephron-sparing surgery was successfully performed. Immunohistochemistry revealed clear cell renal cell carcinoma. The patient’s status improved after the surgery, and he was discharged after 1 month of hospitalization. At the 6-month follow-up, magnetic resonance imaging showed no recurrence, and the patient was living independently. This case indicates the potential effect of nephron-sparing surgery in the treatment of PLE. Tumor screening should be performed early in patients with suspected PLE. Early surgical resection of the primary tumor can improve patients’ prognosis.

Paraneoplastic NMDA encephalitis, a case report and an extensive review of available literature

“…Removing the tumor (usually an ovarian teratoma) is often an important step in the management of anti-NMDA receptor encephalitis [ 46 ]. An article describing a case of anti-NMDAr encephalitis in the setting of clear cell renal carcinoma reported that the patient markedly improved after undergoing nephron-sparing surgery for the tumor [ 47 ]. Another case of a 54-year-old patient with neuropsychiatric symptoms not responding to antiviral treatment for suspected viral encephalitis who had to be sedated due to worsening of his symptoms, was found to have a clear cell renal cell carcinoma.…”

Paraneoplastički neurološki sindrom uz karcinom bubrega

“…There are no particular clinical patterns, imaging and laboratory abnormalities specific for PNS. In addition, PNS usually occur in patients with lung carcinoma, neuroblastoma or thymoma, but other tumors and malignant lymphomas should be considered as well, as shown in this case [1,[5][6][7][8][9] .…”

“…Most neurologic PNS present as peripheral nervous system syndromes and myopathies, as shown in Table 1. Reports on central nervous system presentation are limited to anti-NMDAR and other limbic encephalitis, thus we present the first case of PNS associated with RCC which presented as severe form of Bickerstafflike brainstem encephalitis [2,[9][10][11][12][13][14][15] . Both conditions are antibody-mediated diseases treated with pulse dose methylprednisolone and TPE, which lead to temporal clinical response, as seen in our case.…”

Paraneoplastic encephalitis associated with renal cell carcinoma

“…Renal cell carcinoma (RCC) is cancer developed from renal cells of several different types according to the cellular origin [ 8 ]. Clear cell is the most common type of RCC, though few case reports of paraneoplastic encephalitis associated with clear cell RCC have been published [ 9 - 11 ]. All aforementioned cases presented with limbic encephalitis, showing memory impairment and cognitive decline without clear lesion on brain magnetic resonance imaging (MRI).…”

“…RCC have been published [9][10][11]. All aforementioned cases presented with limbic encephalitis, showing memory impairment and cognitive decline without clear lesion on brain magnetic resonance imaging (MRI).…”