Republished: Which antibody and which cancer in which paraneoplastic syndromes?

Gozzard, Paul; Maddison, Paul

doi:10.1136/jnnp.2010.224105rep

Cited by 11 publications

(7 citation statements)

References 31 publications

(14 reference statements)

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“…Autoantibodies against retinal proteins have been detected by using immunohistochemistry and immunoblotting (Western blot) in sera of many patients affected by CAR or other paraneoplastic neurologic diseases. 37,[54][55][56][57] Autoantibodies found in breast-CAR often target important intracellular molecules involved in signal phototransduction, metabolic functions, and other key cellular processes. 30,58 In some cases, AAbs can be detected before clinical diagnosis of breast malignancy and before visual symptoms of CAR.…”

Section: Antiretinal Autoantibodies In Breast-carmentioning

confidence: 99%

Latest Updates on Antiretinal Autoantibodies Associated With Vision Loss and Breast Cancer

Adamus¹

2015

Investigative Ophthalmology & Visual Science

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Cancer-associated retinopathy (CAR) is an uncommon paraneoplastic disorder of the retina that is frequently associated with breast cancer in pre- and postmenopausal women older than 50 years. In this review, we will give an update on the current knowledge regarding the association of antiretinal autoantibodies with the breast-CAR syndrome. Women with breast cancer and visual indications of CAR have a significantly increased incidence of autoantibodies (AAbs) against retinal proteins when compared to healthy women. The onset of visual loss in association with antiretinal AAbs peaks 2 to 3 years after the clinical diagnosis of breast cancer. Differences in severity of symptoms between women with or without antiretinal AAbs are evident, revealing more unfavorable presentation in seropositive women. The incidence of CAR in breast cancer is likely to rise as the survival time of patients with breast cancer increases; consequently, a prediction of breast-CAR based on autoimmunity to individual retinal antigens, or to panels of antigens (signatures), is clinically important.

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Section: Antiretinal Autoantibodies In Breast-carmentioning

confidence: 99%

Latest Updates on Antiretinal Autoantibodies Associated With Vision Loss and Breast Cancer

Adamus¹

2015

Investigative Ophthalmology & Visual Science

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“…The symptoms of PNS vary based on the part of the nervous system affected. Symptoms can present acutely or sub-acutely and include tremors, visual complaints, ataxia, seizures, autonomic dysfunction, peripheral neuropathy and others (Table 3) [5]. Based on the symptoms, affected region of nervous system on imaging studies and types of autoantibodies elicited, the subtypes of PNS include PEM, PCD, limbic encephalitis (found in our patient), opsoclonus myoclonus, subacute sensory neuronopathy and LEMS [5].…”

Section: Discussionmentioning

confidence: 81%

“…Positive autoantibodies associated with PNS also make this diagnosis more likely. Therefore, a combination of clinical features, laboratory and imaging findings can help with the diagnosis of PNS (Tables 3 and 4) [5][6][7].…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Paraneoplastic Encephalitis in Association With Breast Cancer

Agrawal¹,

Agrawal²

2018

J Med Cases

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We present a case of a 47-year-old female who presented with diffuse dysesthetic pain in both legs for past 3 months. She described the sensation as of pins and needles. She also had balance difficulty and developed progressively worsening back pain and spasms. Relatives reported that the patient had memory difficulties. The patient would repeat questions even after the questions had already been answered. Magnetic resonance imaging (MRI) of cervical, thoracic and lumbosacral spine with and without contrast showed mild multilevel degenerative changes in cervical spine and minimal disc bulges from L1 to S1 levels with no areas of significant spinal canal or neural foraminal stenosis. MRI of brain was performed which showed abnormal T2/FLAIR hyperintensity along the left medial temporal lobe and additional small foci in the right centrum semiovale/corona radiate and bilateral periventricular white matter. Based on the MRI findings, a diagnosis of limbic encephalitis was made. A lumbar puncture was also done. Cerebrospinal fluid (CSF) showed 14 oligoclonal bands with elevated IgG synthesis. Paraneoplastic antibody panel showed high titers of amphiphysin antibody (1:15,360). Since this is a paraneoplastic antibody, computed tomography of chest, abdomen and pelvis was performed. It showed several enlarged right axillary lymph nodes. Ultrasound of right breast showed 4 mm hypoechoic nodule at 2 o'clock axis (upper inner quadrant). The biopsy of this lesion and axillary lymph node showed invasive ductal carcinoma of the breast. For further evaluation, MRI of bilateral breast was performed. It revealed additional areas of enhancements in upper outer and lower outer quadrants of right breast. Biopsy of the upper outer area of enhancement revealed invasive ductal carcinoma and ductal carcinoma in situ (DCIS). Biopsy of the lower outer aspect showed infiltrating lobular carcinoma and lobular carcinoma in situ (LCIS). Our report highlights a rare patient presenting with paraneoplastic limbic encephalitis with underlying breast cancer. When encountering a patient with unexplained neurologic symptoms, paraneoplastic neurological syndromes (PNSs) should be considered as part of the differential. And a thorough search of autoantibodies associated with PNS should be considered. If such autoantibodies are present, search for an underlying malignancy should be undertaken.

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“…[5] Table 1 gives the common classical paraneoplastic syndromes with clinical features and investigations. [8] Based on the evidence accumulated over the last two decades, recognition of a classical neurologic syndrome associated with single antibody is an exception rather than a rule. [2] Usually, the onset is subacute.…”

Section: Introductionmentioning

confidence: 99%

Paraneoplastic neurologic syndrome: A practical approach

Kannoth

2012

Ann Indian Acad Neurol

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Paraneoplastic neurological syndromes (PNS) are rare disorders associated with cancer, not caused by direct invasion, metastasis or consequences of treatment. They are usually autoimmune in nature. Often, PNS precedes the manifestations of cancer. Onconeural antibodies are important in the diagnosis and management of these disorders. These antibodies are specific for the malignancy rather than for a particular neurological syndrome. Often, there are different antibodies associated with the same syndrome. Multiple antibodies are also known to coexist in a given patient with malignancy. While investigating a patient for suspected PNS, the entire gamut of onconeural antibodies should be investigated so as not to miss the diagnosis. In 30–40% of the cases, PNS can occur without antibodies. Investigations for identifying the underlying cancer can be directed by the antibody panel. If conventional screening for cancer is negative, a positron emission scanning/computed tomography scan can be useful. Patients need follow-up surveillance for cancer if not detected in the first instance. Cancer detection and treatment, immunotherapy and supportive care are important components of treatment of PNS. Immunotherapy is very effective in PNS associated with cell membrane-associated antibodies like voltage-gated potassium channel complex, NMDA receptor antibodies and voltage-gated calcium channel antibodies. Immunotherapy includes steroids, IVIgG, plasmaphereis, cytotoxic medications and rituximab. Supportive therapy includes symptomatic treatment with antiepileptic and analgesic medications, physiotherapy, speech therapy and occupational therapy. PNS can mimic any neurologic syndrome. A high index of clinical suspicion is important for early diagnosis and prompt management and better outcome.

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Republished: Which antibody and which cancer in which paraneoplastic syndromes?

Cited by 11 publications

References 31 publications

Latest Updates on Antiretinal Autoantibodies Associated With Vision Loss and Breast Cancer

Latest Updates on Antiretinal Autoantibodies Associated With Vision Loss and Breast Cancer

A Rare Case of Paraneoplastic Encephalitis in Association With Breast Cancer

Paraneoplastic neurologic syndrome: A practical approach

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