Cases reported "Paraneoplastic Syndromes"

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11/17. Paraneoplastic hypercalcemia associated with adenosquamous carcinoma of the endometrium.

    Paraneoplastic hypercalcemia associated with adenosquamous carcinoma of the endometrium is described. This is the first reported case of a gynecologic cancer in which the paraneoplastic syndrome has been conclusively shown by immunohistochemical analysis to be due to ectopic parathormone.
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keywords = gynecologic
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12/17. Autoimmune paraneoplastic cerebellar degeneration: ultrastructural localization of antibody-binding sites in purkinje cells.

    Sera from three of four patients with paraneoplastic cerebellar degeneration (PCD) associated with gynecologic cancer had antibodies that stained the cytoplasm of purkinje cells in a characteristic discrete and coarsely granular pattern. No such antibodies were found in PCD patients with small cell cancer of the lung, in patients with cerebellar degeneration without cancer, in nonneurologic patients with small cell carcinoma or gynecologic cancer, or in normal subjects. Immunoelectron microscopy revealed that the antibodies of PCD bound to clusters of ribosomes, granular endoplasmic reticulum, and the trans-face of the vesicles of the Golgi complex in purkinje cells. Immunostaining was localized in orderly arrays of stacked parallel cisternae of the endoplasmic reticulum in the perikaryon and dendritic processes. This pattern suggested that at least one autoantigen of PCD may be a glycoprotein specific cerebellar tissue that is associated with the endoplasmic reticulum. Some patches of Purkinje plasma membrane also were immunostained.
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ranking = 2
keywords = gynecologic
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13/17. A variant of the anti-Purkinje cell antibody in a patient with paraneoplastic cerebellar degeneration.

    An anti-Purkinje cell antibody was found in the serum and CSF of a man with adenocarcinoma of the lung and paraneoplastic cerebellar degeneration (PCD). This antibody differed from the autoantibodies found in patients with gynecologic cancer and PCD in that it produced a different pattern of Purkinje cell cytoplasmic staining, did not react with PCD antigens in Purkinje cell Western blots, and the antigen had a different species distribution. Unlike the antinuclear antibody found in patients with PCD and small-cell lung carcinoma, the antigen was restricted to the cytoplasm of purkinje cells. If autoantibodies are important in the pathogenesis of PCD, this case illustrates that they can recognize different antigenic epitopes in the nervous system, but cause similar clinicopathologic syndromes.
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keywords = gynecologic
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14/17. Paraneoplastic retinopathy associated with uterine sarcoma.

    We present the first reported case of cancer-associated retinopathy with uterine sarcoma. A 65-year-old woman presented in August 1990 with loss of vision, photophobia, and visual field restriction. Antiretinal antibodies were elevated. A diagnosis of cancer-associated retinopathy was made, the patient was started on prednisone, and a workup for malignancy was initiated. The patient was found to have uterine sarcoma. She underwent an extrafascial hysterectomy with bilateral salpingo-oophorectomy followed by eight courses of chemotherapy (carboplatin and cyclophosphamide). After that, the patient's vision improved, her visual field stabilized. She was doing well when last seen, in July 1994. The literature regarding cancer-associated retinopathy and paraneoplastic syndromes associated with gynecologic malignancies is reviewed.
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ranking = 1
keywords = gynecologic
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15/17. 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.
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ranking = 1
keywords = gynecologic
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16/17. paraneoplastic cerebellar degeneration with anti-Purkinje cell antibody associated with primary tubal cancer.

    In patients with paraneoplastic cerebellar degeneration (PCD) due to gynecologic malignancies, a high titer of anti-Purkinje cell antibody (anti-Yo) has been found. Most patients, however, have limited oncologic disease at the time of onset of neurologic symptoms. We describe 2 cases of PCD due to tubal cancer with anti-Yo antibody. The onset of PCD occurred 4 and 14 months before the detection of cancer, respectively, and the presence of anti-Yo antibody facilitated early laparotomy in both cases. These patients, whose neurologic symptoms have not progressed, have survived without evidence of disease for 81 and 30 months since surgery, respectively. The presence of the anti-Yo antibody in patients with PCD warrants an aggressive approach to diagnosis and treatment of the underlying gynecologic cancer.
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ranking = 2
keywords = gynecologic
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17/17. A reversible neuronal antibody (anti-Tr) associated paraneoplastic cerebellar degeneration in Hodgkin's disease.

    paraneoplastic cerebellar degeneration (PCD) has been associated with a variety of neoplasms, most commonly with gynecologic tumors, breast cancer, small cell lung cancer, and Hodgkin's disease (HD). In some patients PCD is associated with circulating antineuronal antibodies like anti-Hu, anti-Yo or anti-Ri. Previously, only 5 patients with a new antineuronal antibody called anti-Tr, proposed to be specific for HD, have been reported. We describe 1 further patient with HD and reversible PCD with a decline in anti-Tr antibody titers in cerebrospinal fluid and serum corresponding to the improvement of clinical symptoms. At the present time the immunoreactive pattern observed in rat cerebellum is the only way to identify anti-Tr antibodies and differentiate them from other antibodies that immunoreact with the purkinje cells.
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ranking = 1
keywords = gynecologic
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