Paraneoplastic cerebellar degeneration: Initial presentation of occult breast cancer

2021 ◽  
Author(s):  
Nuh Filizoglu ◽  
Tunc Ones ◽  
Selin Kesim ◽  
Salih Ozguven ◽  
Tanju Yusuf Erdil
Keyword(s):  
Breast Cancer ◽  
Cerebellar Degeneration ◽  
Initial Presentation ◽  
Paraneoplastic Cerebellar Degeneration ◽  
Occult Breast Cancer

Paraneoplastic cerebellar degeneration diagnosed by anti-Yo determination in a young woman with early breast cancer

2020 ◽  
Vol 13 (8) ◽  
pp. e233863 ◽  
Author(s):  
Oriol Mirallas ◽  
María Alejandra Rezqallah Arón ◽  
Nadia Saoudi Gonzalez ◽  
Santiago Escrivá-de-Romaní
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Brain Mri ◽  
Neoadjuvant Treatment ◽  
Cerebellar Degeneration ◽  
Paraneoplastic Cerebellar Degeneration ◽  
Her2 Positive ◽  
Limb Weakness ◽  
Fluid Analysis ◽  
Positron Emission

A 44-year-old woman diagnosed with a HER2 positive early breast cancer, receiving neoadjuvant treatment with paclitaxel and targeted agents, trastuzumab together with pertuzumab, presented to the emergency room with gait instability and upper right limb weakness. The neurological examination was compatible with cerebellar alteration showing right dissymmetry of the finger-nose and heel-knee manoeuvre. A head CT and a brain MRI were performed and negative. The electromyography showed alterations of the pyramidal pathway and somatosensory pathway. In order to determine the cause of the cerebellar affection, a lumbar puncture was performed. The cerebrospinal fluid analysis was non-specific, but the antineuronal anti-Yo antibody was positive, being diagnosed of a paraneoplastic cerebellar degeneration (PCD). A positron emission tomography CT ruled out metastatic disease. The patient completed four cycles of antiHER2 blockade and weekly paclitaxel, achieving a complete pathological response. One year later, she maintains a complete remission but the PCD still prevails.

scholarly journals Anti-Yo Mediated Paraneoplastic Cerebellar Degeneration Associated with Pseudobulbar Affect in a Patient with Breast Cancer

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Allison N. Martin ◽  
Patrick M. Dillon ◽  
David E. Jones ◽  
David R. Brenin ◽  
David A. Lapides
Keyword(s):  
Breast Cancer ◽  
Paraneoplastic Syndrome ◽  
Radical Mastectomy ◽  
Cerebellar Degeneration ◽  
Paraneoplastic Syndromes ◽  
Paraneoplastic Cerebellar Degeneration ◽  
Modified Radical Mastectomy ◽  
Stage Iiia ◽  
Pseudobulbar Affect ◽  
New Onset

Paraneoplastic cerebellar degeneration (PCD) is a rare anti-Yo mediated paraneoplastic syndromes rarely that is infrequently associated with breast cancer. We present a case of a 52-year-old female presenting with diplopia, gait instability, dysarthria, dysphagia, nystagmus, and, most notably, new onset paroxysmal episodes of uncontrollable crying concerning for pseudobulbar affect (PBA). Serologic testing showed anti-Yo antibodies. The patient was found to have stage IIIA breast cancer as the inciting cause of the paraneoplastic syndrome. The patient was treated with neoadjuvant chemotherapy, modified radical mastectomy, adjuvant Herceptin, and pertuzumab. She was given IVIG for paraneoplastic syndrome, antidepressants, and dextromethorphan-quinidine (Nuedexta), the first FDA-approved therapy for PBA. With multimodality therapy, she demonstrated significant improvement in neurologic and mood symptoms associated with PCD and PBA.

scholarly journals Diffuse Bone Marrow Metastasis as the Initial Presentation of an Occult Breast Cancer

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Frank S. Fan ◽  
Chung-Fan Yang ◽  
Yi-Fen Wang
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Interleukin 1 ◽  
Growth Factor Receptor ◽  
Metastatic Potential ◽  
Initial Presentation ◽  
Unknown Primary ◽  
Bone Marrow Metastasis ◽  
Mucin 1 ◽  
Occult Breast Cancer

Introduction. Breast cancer is one of the malignancies which tend to involve the bone marrow, but initial presentation with diffuse bone marrow metastasis from an occult breast cancer is very rare. Prognosis is generally very poor for marrow metastasis from solid tumors except that breast cancer is a treatable disease even in such a dismal condition. Case. A 64-year-old woman’s headache was found to result from diffuse adenocarcinoma metastasis in the bone marrow from an unknown primary site. Intensive immunohistochemistry study of bone marrow biopsy specimen confirmed the disease nature to be an estrogen receptor-positive/human epidermal growth factor receptor 2-negative breast cancer. Mammography and magnetic resonance imaging of breasts revealed a suspicious primary lesion in the right breast. Treatment with tamoxifen alone achieved a sustained response. Discussion. Mucin 1 (MUC1), also known as cancer antigen 15-3 (CA 15-3), facilitates motility and metastatic potential of breast cancer cells. Interleukin-1β (IL-1β) drives breast cancer cell growth and colonization in bone marrow adipose tissue niche. Receptor activator of nuclear factor kappa-B (RANK) and its ligand (RANKL) activate osteoclasts to make a favorable bone marrow microenvironment for tumor cells. Agents against MUC1, IL-1β, and RANKL might be of therapeutic effect for patients like ours.

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