Paraneoplastic encephalopathy: an unusual presenting feature of bladder cancer metastasis.
A 73-year-old woman with a history of localised transitional cell cancer (TCC) of the bladder, resected 22 years prior, presented with tremor, gait unsteadiness and cognitive deficits. Basic neurological workup was negative and CT of the abdomen revealed recurrent TCC with a solitary pelvic metastasis. She was treated with surgical resection of her tumour and immunosuppression. Her symptoms resolved, and it was felt her presentation was consistent with paraneoplastic encephalopathy in the setting of bladder cancer metastasis. She has remained disease and symptom free over 5 years of follow-up. This case report reviews the mechanism, clinical features and treatment of paraneoplastic neurological syndromes, and discusses briefly the management of oligometastatic recurrent bladder cancer.
Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA.
Gita
G
Thanarajasingam
Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
Margherita
M
Milone
Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA.
Manish
M
Kohli
D000368:Aged; D001927:Brain Diseases / Q000209:etiology*; D002295:Carcinoma, Transitional Cell / Q000150:complications* / Q000473:pathology; D003072:Cognition Disorders / Q000209:etiology*; D003937:Diagnosis, Differential; D004569:Electroencephalography; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology*; D006801:Humans; D008775:Methylprednisolone / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local / Q000150:complications; D018696:Neuroprotective Agents / Q000627:therapeutic use; D020361:Paraneoplastic Syndromes, Nervous System / Q000175:diagnosis*; D010388:Pelvis / Q000473:pathology; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000150:complications* / Q000473:pathology
D018696:Neuroprotective Agents; D008775:Methylprednisolone