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They are mediated by immunologic mechanisms derived from the tumour's neuronal protein expression.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Paraneoplastic cerebellar degeneration (PCD) is one of these syndromes. Its clinical presentation is that of a symmetrical pancerebellar syndrome, with vertigo, ataxia and dysarthria, which develops acutely, in days or weeks.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report a patient with PCD secondary to pulmonary adenocarcinoma with positivity for anti-MA2 onconeural antibodies.</p><p id="par0015" class="elsevierStylePara elsevierViewall">75-year old male who went to hospital due to a 1-week history of progressive gait instability and a general syndrome with 12<span class="elsevierStyleHsp" style=""></span>kg weight loss in the previous year. Smoking 20<span class="elsevierStyleHsp" style=""></span>cigarettes/day, hypertension and dyslipidaemia were found in his personal medical history. He also had widespread atheromatous disease and valvulopathy with double aortic lesion. Physical examination revealed a significant decrease in muscle mass and a grade <span class="elsevierStyleSmallCaps">iii</span>/<span class="elsevierStyleSmallCaps">vi</span> systolic murmur. The neurological examination revealed an unsteady gait; positive to Romberg sign with lateropulsion. Dysmetria or nystagmus were not present. A blood count, a complete biochemistry profile and tumour markers (alpha-fetoprotein, CEA, CA 19.9, PSA and beta-2-microglobulin) were among the complementary tests performed, all being normal. A chest X-ray showed a right hilar density increase, and a brain MRI revealed a lacunar infarct in the left corona radiata and white matter small hyperintensities. The thoraco-abdomino-pelvic CT scan showed right hilar and peribronchial necrotic lymphadenopathies. The results of a bronchoscopy were normal. An onconeural antibody panel was requested, being positive for anti-Ma2. The said panel also included the following antibodies: anti-Hu, anti-Yo, anti-Ri, anti-CV2, anti-anfifisin, anti-recoverin, anti-SOX-4, anti-titin, anti-Zic4, anti-GAD65 and anti-Tr. An endobronchial ultrasound allowed a biopsy of the hilar lymphadenopathy, showing infiltration by adenocarcinoma. The patient was treated with chemotherapy with carboplatin-pemetrexed and prednisone at a dose of 1<span class="elsevierStyleHsp" style=""></span>mg/kg/day. 6 months after starting treatment, tumour progression was observed, therefore, a second-line of chemotherapy was initiated with docetaxel, which was suspended two months later due to the patient's clinical deterioration. As for the neurological symptoms, these remained stable the first 6 months with subsequent progression, reaching the inability to ambulate. The patient died 11 months after diagnosis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Diagnosis of PCD can be difficult, because, in most patients (60%), the neurological symptoms appear before the primary tumour is identified. Therefore, a first step in diagnosis is to suspect this possibility, and a second step, to search for onconeural antibodies so as to identify the syndrome as paraneoplastic, something that would prompt a search for the underlying neoplasm.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">There are a variety of onconeural antibodies associated with PCD, however only 2 are relatively specific. These antibodies are the anti-Yo, which are associated with breast and gynaecological cancer, and anti-Tr, often associated with lymphoma. The absence of onconeural antibodies does not exclude a PNS; thus, 50% of patients with PCD do not have these antibodies and diagnosis in these is especially difficult.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients with anti-MA2 antibodies, as in our case, usually have signs and symptoms compatible with encephalitis with limbic, diencephalic or brainstem involvement, either alone or in combination. Presenting itself as an isolated cerebellar syndrome with ataxia, as in the case of our patient, is less common. In patients under 50 years of age, the presence of these antibodies is associated with testicular tumours, and in elderly patients, mainly with lung neoplasms, especially non-small-cell lung cancer.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> In younger patients, the strong association with testicular neoplasms and good response to treatment have led to propose performing a uni- or bilateral orchiectomy, although a testicular neoplasm has not been confirmed, in those where other neoplasms have not been documented and/or there are risk factors for testicular neoplasms, such as a history of cryptorchidism or presence of microcalcifications on testicular ultrasound.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> In these patients, treatment of the underlying neoplasm, associated with the immunosuppressant, involves neurological improvement or stabilization in up to 54% of cases.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ameneiros-Lago E, Fernández-Fernández FJ, Lijó-Carballeda C. Degeneración cerebelosa paraneoplásica asociada a anticuerpos anti-Ma2. Med Clin (Barc). 2016;147:e55–e56.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Paraneoplastic syndromes involving the nervous system" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.B. Darnell" 1 => "J.B. Posner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra023009" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2003" "volumen" => "349" "paginaInicial" => "1543" "paginaFinal" => "1554" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14561798" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on paraneoplastic neurologic disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.R. Rosenfeld" 1 => "J. Dalmau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1634/theoncologist.2010-0001" "Revista" => array:6 [ "tituloSerie" => "Oncologist" "fecha" => "2010" "volumen" => "15" "paginaInicial" => "603" "paginaFinal" => "617" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20479279" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Paraneoplastic cerebellar degeneration" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. Vernino" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/B978-0-444-51892-7.00013-9" "Revista" => array:6 [ "tituloSerie" => "Handb Clin Neurol" "fecha" => "2012" "volumen" => "103" "paginaInicial" => "215" "paginaFinal" => "223" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21827891" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical analysis of anti-Ma2-associated encephalitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Dalmau" 1 => "F. Graus" 2 => "A. Villarejo" 3 => "J. Posner" 4 => "D. Blumenthal" 5 => "B. Thiessen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/brain/awh203" "Revista" => array:6 [ "tituloSerie" => "Brain" "fecha" => "2004" "volumen" => "127" "paginaInicial" => "1831" "paginaFinal" => "1844" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15215214" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Orchiectomy for suspected microscopic tumor in patients with anti-Ma2-associated encephalitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.M. Mathew" 1 => "R. Vandenberghe" 2 => "A. García-Merino" 3 => "T. Yamamoto" 4 => "J.C. Landolfi" 5 => "M.R. Rosenfeld" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1212/01.wnl.0000252379.81933.80" "Revista" => array:6 [ "tituloSerie" => "Neurology" "fecha" => "2007" "volumen" => "68" "paginaInicial" => "900" "paginaFinal" => "905" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17151337" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014700000010/v1_201701210037/S2387020616307173/v1_201701210037/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014700000010/v1_201701210037/S2387020616307173/v1_201701210037/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616307173?idApp=UINPBA00004N" ]
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Vol. 147. Issue 10.
Pages e55-e56 (November 2016)
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Vol. 147. Issue 10.
Pages e55-e56 (November 2016)
Letter to the Editor
Paraneoplastic cerebellar degeneration associated with anti-Ma2 antibodies
Degeneración cerebelosa paraneoplásica asociada a anticuerpos anti-Ma2
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Eugenia Ameneiros-Lago
, Francisco José Fernández-Fernández, Cristina Lijó-Carballeda
Corresponding author
Servicio de Medicina Interna, Complejo Hospitalario Universitario de Ferrol, Ferrol, La Coruña, Spain
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