Normalization of the tumor marker CA-125 after oophorectomy in a patient with paraneoplastic cerebellar degeneration without detectable cancer.
A 61-year-old woman developed severe subacute cerebellar degeneration in association with a neuronal antinuclear autoantibody. Neurologic investigations were remarkable only for mild CSF leukocytosis. Despite no radiographic evidence of cancer, a salpingo-oophorectomy was performed on the basis of an increased gynecologic cancer marker (CA-125) and the neurologic symptoms that were strongly suggestive of paraneoplastic cerebellar degeneration. Although no tumor was detected in the surgical specimen, CA-125 levels normalized after surgery. The patient remains stable 12 months after surgery with a severe cerebellar syndrome, no evidence of cancer, and persistent circulating antineuronal autoantibodies. An elevated tumor marker in a patient with a presumed paraneoplastic neurologic disorder should suffice as evidence of an occult neoplasm, and guide definitive treatment.
Mason
W P
WP
Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Dalmau
J
J
Curtin
J P
JP
Posner
J B
JB
D001323:Autoantibodies / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood*; D002526:Cerebellar Diseases / Q000097:blood*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010052:Ovariectomy; D010053:Ovary / Q000473:pathology / Q000601:surgery; D010257:Paraneoplastic Syndromes / Q000097:blood*
D001323:Autoantibodies; D014408:Biomarkers, Tumor; D018394:CA-125 Antigen