title: Second primary tumor in anti-Ma1/2-positive paraneoplastic limbic encephalitis.
abstract: Memory loss can be a symptom of paraneoplastic limbic encephalitis (PLE) a neuropsychiatric disorder associated mostly with small-cell lung cancer and anti-Hu antibodies or with testicular tumors and anti-Ma2 antibodies. We present the case of a patient with temporal coincidence of beginning cognitive decline and diagnosis of a carcinoma of the prostate in whom we diagnosed anti-Ma1/Ma2-positive PLE. The tumor had been completely resected but memory impairment further deteriorated. As the effective treatment of the cancer is considered as the most efficient treatment of a paraneoplastic neurological syndrome (PNS) a second neoplasia was suspected in the patient. By the aid of whole body positron emission tomography with 18-fluorine fluoro-2-deoxy-glucose (FDG-PET) an adenocarcinoma of the cecum could be detected. Two months after surgery anti-Ma antibodies were negative. We conclude that a second neoplasia should be considered, if effective cancer treatment does not lead to improvement or stabilisation of a PNS. Tumor search should be exhaustive and include PET when conventional imaging fails to show a malignancy.
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany. thomas.leyhe@med.uni-tuebingen.de
authors.forename: T
authors.initials: T
authors.lastname: Leyhe
authors.forename: R
authors.initials: R
authors.lastname: Schüle
authors.forename: F
authors.initials: F
authors.lastname: Schwärzler
authors.forename: T
authors.initials: T
authors.lastname: Gasser
authors.forename: T
authors.initials: T
authors.lastname: Haarmeier
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D000941:Antigens / Q000276:immunology; D000951:Antigens, Neoplasm / Q000276:immunology; D002430:Cecal Neoplasms / Q000473:pathology*; D003072:Cognition Disorders / Q000209:etiology; D004569:Electroencephalography; D006801:Humans; D020363:Limbic Encephalitis / Q000209:etiology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D016609:Neoplasms, Second Primary / Q000150:complications* / Q000473:pathology; D009419:Nerve Tissue Proteins / Q000276:immunology; D049268:Positron-Emission Tomography; D011471:Prostatic Neoplasms / Q000473:pathology*
chemical_list: D000941:Antigens; D000951:Antigens, Neoplasm; C117985:Ma1 antigen; C119249:Ma2 antigen; D009419:Nerve Tissue Proteins