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|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 4 | Page : 1099-1100
Paraneoplastic Cerebellar Degeneration with Demyelinating Polyradiculoneuropathy in a Case of Anti-Yo Antibody-Positive Breast Cancer
Sankalp S Mohan, Khushboo S Hatekar, Smita P Patil, Juber D Shaikh
Department of Medicine, DY Patil University School of Medicine, Nerul, Navi Mumbai, Maharashtra, India
|Date of Submission||23-Oct-2020|
|Date of Decision||17-Jan-2021|
|Date of Acceptance||15-Feb-2021|
|Date of Web Publication||2-Sep-2021|
Sankalp S Mohan
Department of Medicine, DY Patil University, Sector 7, Nerul, Navi Mumbai, Maharashtra - 400 706
Source of Support: None, Conflict of Interest: None
|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 Oct 22];69:1099-100. Available from: https://www.neurologyindia.com/text.asp?2021/69/4/1099/325324
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|
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|Figure 2: Nerve conduction studies showing absent tibial and peroneal F-wave responses|
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|Figure 3: MRI lumbosacral spine with contrast showing enhancement of cauda equina nerve roots|
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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|
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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. Extracerebellar involvement such as limbic encephalitis and peripheral neuropathy is generally less common in anti-Yo PCD.
Guillain-Barre Syndrome (GBS) has been described with small cell lung cancer, commonly associated with anti-ganglioside antibodies. 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.
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.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]