Strategies in detection of the primary tumour in anti-Yo associated paraneoplastic cerebellar degeneration.
In patients with anti-Yo associated paraneoplastic cerebellar degeneration (PCD) neurological symptoms precede the diagnosis of the underlying cancer in about 60%. Ovarian carcinoma, breast cancer and other gynaecological malignancies are most frequently found as causative malignancies. Antitumour treatment should be applied in an early stage of disease. The identification of the tumour is a diagnostic challenge in many of these patients. In the first of two patients reported here a pelvic tumour was suggested after detection of a pathological lymph node and elevated tumour markers. The intraoperative findings appeared macroscopically normal during ovariectomy with adnexectomy. Not until microscopic examination of the resected tissue was performed was a tubal adenocarcinoma found. If intrapelvic gynaecological tumours are suspected a deliberate surgical exploration seems to be justified, but only after an intensive diagnostic investigation. To search for the underlying cancer in patients with paraneoplastic neurological disorders successive CT and [18F]-FDG-PET are widely recommended. Instead of this in the second reported patient whole-body dual-modality PET/CT was performed revealing enhanced uptake in three regions of the left thorax. By combining function and anatomy PET/CT was able to localise the lesions and characterise them as lymph node metastases of breast cancer. Diagnosis could be confirmed by subsequently executed needle biopsy. PET/CT seems to be highly applicable in the investigation of paraneoplastic disorders with unknown primary cancer. It may help in guidance of needle biopsy or to optimise the results of deliberate surgery and it provides whole-body tumour staging in a single session with higher diagnostic accuracy than PET alone.
Frings
Markus
M
Dept. of Neurology, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany. markus.frings@uni-essen.de
Antoch
Gerald
G
Knorn
Philipp
P
Freudenberg
Lutz
L
Bier
Ulrich
U
Timmann
Dagmar
D
Maschke
Matthias
M
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis*; D020362:Paraneoplastic Cerebellar Degeneration / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology*; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed / Q000379:methods; D014915:Whole-Body Counting / Q000379:methods
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
Clin Neurol Neurosurg. 1995 Feb;97(1):106-11
7788965
Brain. 2003 Jun;126(Pt 6):1409-18
12764061
Q J Nucl Med. 2003 Jun;47(2):85-9
12865868
Neurology. 2000 Sep 12;55(5):713-5
10980743
Lancet Neurol. 2002 Sep;1(5):294-305
12849427
J Neurol Neurosurg Psychiatry. 2000 Apr;68(4):479-82
10727484
Neurology. 1992 Oct;42(10):1931-7
1407575
Ann Neurol. 1998 May;43(5):684
9585368
J Neurol Sci. 1997 Feb 12;145(2):205-11
9094050
Ann Neurol. 1988 Oct;24(4):559-67
3239956
J Neurooncol. 2003 Jun;63(2):187-90
12825823
Radiology. 2003 Nov;229(2):526-33
14512512
Ann Neurol. 2000 Jul;48(1):105-8
10894223
J Nucl Med. 2003 Aug;44(8):1200-9
12902408
J Nucl Med. 2000 Aug;41(8):1369-79
10945530
Brain. 2001 Nov;124(Pt 11):2223-31
11673324